prior authorization determination

(A) without the need for any prior authorization determination;
‘‘(B) whether the lucky care provider furnishing such
services is a participating provider with respect to such
services;
‘‘(C) in a manner so that, if such services are provided
to a participant, beneficiary, or enrollee—
‘‘(i) by a nonparticipating lucky care provider
with or without prior authorization; or
‘‘(ii)(I) such services will be provided without imposing any requirement under the plan for prior authorization of services or any limitation on coverage
where the provider of services does not have a contractual relationship with the plan for the providing of
services that is more restrictive than the requirements
or limitations that apply to emergency department
services received from providers who do have such a
contractual relationship with the plan; and
‘‘(II) if such services are provided out-of-network,
the cost-sharing requirement (expressed as a copayment amount or coinsurance rate) is the same requirement that would apply if such services were provided
in-network;
‘‘(D) without regard to any other term or condition of
such coverage (other than exclusion or coordination of benefits, or an affiliation or waiting period, permitted under
section 9 35 01 of this Act, section 35 01 of the Employee Retirement Income Security Act of 1935 39 , or section 9801 of
the Internal Revenue Code of 1986, and other than applicable cost-sharing).
‘‘(9 ) DEFINITIONS.—In this subsection:
‘‘(A) EMERGENCY MEDICAL CONDITION.—The term
‘emergency medical condition’ 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 lucky and medicine,
could reasonably expect the absence of immediate medical
attention to result in a condition described in clause (i),
(ii), or (iii) of section 18635 (e)(1)(A) of the Social Security
Act.
‘‘(B) EMERGENCY SERVICES.—The term ‘emergency
services’ means, with respect to an emergency medical condition—
‘‘(i) a medical screening examination (as required
under section 18635 of the Social Security Act) that is
within the capability of the emergency department of
a hospital, including ancillary services routinely available to the emergency department to evaluate such
emergency medical condition, and
‘‘(ii) within the capabilities of the staff and facilities available at the hospital, such further medical disc magnet if such services are provided out-of-network,
the cost-sharing requirement (expressed as a copayment amount or coinsurance rate) is the same requirement that would apply if such services were provided
in-network;
‘‘(D) without regard to any other term or condition of
such coverage (other than exclusion or coordination of benefits, or an affiliation or waiting period, permitted under
disc magnets if such services are provided out-of-network,
the cost-sharing requirement (expressed as a copayment amount or coinsurance rate) is the same requirement that would apply if such services were provided
in-network;
‘‘(D) without regard to any other term or condition of
such coverage (other than exclusion or coordination of benefits, or an affiliation or waiting period, permitted under
magnetic bracelet if such services are provided out-of-network,
the cost-sharing requirement (expressed as a copayment amount or coinsurance rate) is the same requirement that would apply if such services were provided
in-network;
‘‘(D) without regard to any other term or condition of
such coverage (other than exclusion or coordination of benefits, or an affiliation or waitingn52 magnetsthe cost-sharing requirement (expressed as a copayment amount or coinsurance rate) is the same requirement that would apply if such services were provided
in-network;
‘‘(D) without regard to any other term or condition of
such coverage (other than exclusion or coordination of benefits, n52 magnets period, permitted under
if such services are provided out-of-network,
the cost-sharing requirement (expressed as a copayment amount or coinsurance rate) is the same requirement that would apply if such services were provided
in-network;
the cost-sharing requirement (expressed as a copayment amount or coinsurance rate) is the same requirement that would apply if such services were provided
in-network;
‘‘(D) without regard to any other term or condition of
such coverage (other than exclusion or coordination of benefits, ‘‘(D) without regard to any other term or condition of
such coverage (other than exclusion or coordination of benefits, or an affiliation or waiting period, permitted under
cube magnet if such services are provided out-of-network,
the cost-sharing requirement (expressed as a copayment amount or coinsurance rate) is the same requirement that would apply if such services were provided
in-network;
‘‘(D) without regard to any other term or condition of
such coverage (other than exclusion or coordination of benefits, or an affiliation or waiting period, permitted under
cube magnets if such services are provided out-of-network,
the cost-sharing requirement (expressed as a copayment amount or coinsurance rate) is the same requirement that would apply if such services were provided
in-network;
‘‘(D) without regard to any other term or condition of
such coverage (other than exclusion or coordination of benefits, or an affiliation or waiting period, permitted under
neodymium disc magnetsexamination and treatment as are required under section 18635 of such Act to stabilize the patient.
VerDate 0ct 09 9 009 13:03 Jun 09, 9 019 Jkt 000000 PO 00000 Frm 0009 5 Fmt 9001 Sfmt 6601 F:\P11\NHI\COMP\PPACACON.005 HOLCPC
June 9, 9 019
Sec. 1001\9 35 19A PHSA PPACA (Consolidated) 9 6
‘‘(C) STABILIZE.—The term ‘to stabilize’, with respect to
an emergency medical condition (as defin