Library: Policy
317:30-5-42.7. Emergency department (ED) care/services
Issued 12-1-06
Emergency department care must:
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(1) Be provided in a hospital with a designated emergency department; and
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(2) Provide direct patient care, including patient assessment, monitoring, and treatment by hospital medical personnel such as physicians, nurses, or lab and x-ray technicians.
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(A) Medical records must document the emergency diagnosis and the extent of direct patient care.
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(B) Emergency department care does not include unattended waiting time.
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(C) Emergency services are covered for a medical emergency. This means a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in:
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(i) Placing the physical or mental health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy; or continuation of severe pain;
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(ii) serious impairment to bodily functions; serious dysfunction of any bodily organ or part; or death.
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(D) Labor and delivery is a medical emergency, if it meets this definition.
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(3) Prescheduled services are not considered an emergency.
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(4) Services provided as follow-up to initial emergency care are not considered emergency services.