1. (1) "Non-emergent medical condition" means a medical condition that does not meet the criteria of an emergency medical condition under 42 U.S.C. 1395dd (e) of the Emergency Medical Treatment and Active Labor Act.
2. (2) "Non-emergent medical care" means medical care provided in an emergency room for the treatment of a non-emergent medical condition.

3. (3) "Non-emergent medical care" does not mean:

   1. (a) medically necessary services to conduct a medical screening examination to determine whether the Medicaid member has an emergent or non-emergent medical condition; and
   2. (b) medical care provided to a Medicaid member who, using a prudent layperson standard, reasonably believes they are experiencing an emergency medical condition as defined by 42 U.S.C. 1395dd(e) of the Emergency Medical Treatment and Active Labor Act.
4. (4) "Medicaid member" means a person who enrolls in an ACO in accordance with the department's Choice of Health Care Delivery Program freedom-of-choice waiver under Subsection 1915(b) of the Social Security Act.

KEY: Medicaid

Date of Last Change: February 12, 2024

Notice of Continuation: September 13, 2023

Authorizing, and Implemented or Interpreted Law: 26B-1-213; 26B-3-108; 26B-3-204