(a) To be a covered benefit under medical assistance for the needy as provided in section 365-1(5)(a) of the Social Services Law, any emergency or urgent surgery shall be for alleviation of severe pain or for the immediate diagnosis and/or treatment of conditions which threaten disability or death if not promptly diagnosed or treated. No such emergency or urgent surgery requires prior determination of coverability. In each case, a person designated by the Commissioner of Health shall determine coverability of this benefit based upon the documented existence of one or more conditions such as the following:

1. (1) obstetrical crises and/or labor;
2. (2) acute trauma;
3. (3) reparative or reconstructive surgical procedures performed within 60 days of acute trauma;
4. (4) malignancy, confirmed or suspected;
5. (5) hemorrhage or threat of hemorrhage;
6. (6) serious infection;
7. (7) severe pain;
8. (8) shock or impending shock;
9. (9) decompensated vital functions or threat to vital functions such as sensorium, respiration, circulation, excretion and sensory organs;
10. (10) congenital defects or abnormalities in a newborn infant best managed by prompt intervention;
11. (11) any condition the management of which requires prompt diagnostic procedures necessarily performed on an inpatient basis such as biopsy and endoscopy; or
12. (12) any other condition which causes severe pain or threatens disability or death if not promptly diagnosed or treated.