205.8459 Emergency service.
203 words·~1 min read·
/ky/chapter-205/205-8459A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
(1)Any provider presented with a request for an emergency service, for a nonlife-
threatening condition or a condition that would not result in irreparable harm, by a
Medicaid recipient participating in a managed care program but not in a restricted
Medicaid status, shall not provide the service on an emergency basis unless the
provider first makes a reasonable effort to contact the recipient's designated
managed care primary physician for prior approval. Any provider presented with a
request for an emergency service, due to a life-threatening condition or a condition
that would result in irreparable harm, by a Medicaid recipient participating in a
managed care program but not in a restricted Medicaid status, may provide the
service without prior approval from the recipient's designated managed care primary
physician.
(2)For the purposes of implementing KRS 205.8455, 205.8457, and this section, the
Department for Medicaid Services, in consultation with the Recipient Utilization
Review Committee, shall in conformity with the federal Emergency Medical
Treatment and Active Labor Act (42 U.S.C. sec. 1395dd, as amended) and any other
applicable federal law, and in administrative regulation promulgated pursuant to
KRS Chapter 13A, define an emergency service, irreparable harm, immediate grave
bodily harm, life-threatening condition, and nonlife-threatening condition.