Regulation .22 Payment for Emergency Services.
Regulation .22 Payment for Emergency Services.LinkCopy Citation
A.
The PACE provider shall be responsible for prompt payment for all emergency services received by PACE participants.
B.
If a claim is submitted to the PACE provider within 9 months of the date of service, the PACE provider shall reimburse a hospital emergency facility and provider or free-standing urgent care center, without requiring prior authorization or approval for payment from the PACE provider, for:
(1)
Emergency services;
(2)
Medical screening services rendered at an emergency facility to meet the requirements of the federal Emergency Medical Treatment and Active Labor Act; and
(3)
Medically necessary and appropriate services if:
(a)
The PACE provider authorized, referred, or otherwise allowed the PACE participant to use the emergency facility; and
(b)
The services are related to the condition for which the PACE participant was allowed to use the emergency facility.