§ 14132.025
390 words·~2 min read·
/ca/welfare-and-institutions-code/14132-025A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
(a)Notwithstanding any other law, emergency services and care necessary for the treatment of an emergency medical condition, as defined in subdivision
(b)of Section 1317.1 of the Health and Safety Code, are a covered benefit. For purposes of this section, “emergency services and care” has the same meaning as defined in Section 438.114 of Title 42 of the Code of Federal Regulations and paragraph
(1)of, and subparagraph
(A)of paragraph
(2)of, subdivision
(a)of Section 1317.1 of the Health and Safety Code.
(b)For a beneficiary with a psychiatric emergency medical condition, as defined in subdivision
(k)of Section 1317.1 of the Health and Safety Code, emergency services and care necessary to relieve or eliminate that condition are covered, regardless of whether the beneficiary is voluntary, or involuntarily detained for assessment, evaluation, and crisis intervention, or placement for evaluation and treatment pursuant to the Lanterman-Petris-Short Act (Part 1 (commencing with Section 5000) of Division 5 of the Welfare and Institutions Code).
(1)A Medi-Cal managed care plan, as defined in subdivision
(j)of Section 14184.101, shall be responsible for covering, and reimbursing providers furnishing, the emergency services and care described in subdivisions
(a)and (b), and any poststabilization care services required under Section 438.114 of Title 42 of the Code of Federal Regulations, for its enrolled Medi-Cal beneficiaries, excluding any Medi-Cal specialty mental health services provided once an enrolled beneficiary is admitted for inpatient psychiatric care.
(2)This subdivision does not limit or reduce the scope of covered emergency services and care described in subdivisions
(a)and
(b)for Medi-Cal fee-for-service beneficiaries.
(d)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this section by means of all-plan letters, information notices, plan or provider bulletins, or similar instructions until the department can promulgate any necessary regulations.
(e)For purposes of this section, emergency services and care includes emergency room professional services and facility charges for emergency room visits.
(f)This section shall be implemented in a manner consistent with federal law and only to the extent federal financial participation is available and not otherwise jeopardized.
(g)The Legislature finds and declares that this section is intended to clarify, and not expand, the scope of Medi-Cal covered benefits.