SB1769112th GA (Historical)Introduced

Amends TCA Title 8; Title 53; Title 56; Title 63; Title 68 and Title 71.

This bill prohibits a health benefit plan from denying coverage for emergency services obtained in certain medical facilities. Present law prohibits a health benefit plan from denying coverage for emergency services if the symptoms presented by an enrollee of the plan and recorded by the attending provider indicate that an emergency medical condition could exist, regardless of whether or not prior authorization was obtained to provide those services and regardless of whether or not the provider furnishing the services has a contractual agreement with the health benefit plan for the provision of the services to the enrollee. Present law defines "emergency services" as health care items and service furnished in a hospital that are required to determine, evaluate and/or treat an emergency medical condition, until the condition is stabilized, as directed or ordered by a physician or directed by physician or hospital protocol. This bill adds satellite emergency department facilities, freestanding emergency rooms, urgent care centers, and physicians' offices to the list of medical facilities where health care items and service may be furnished in order to qualify as "emergency services," thereby requiring coverages for services in those facilities in accordance with the above-described present law provision.

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Overview

This bill prohibits a health benefit plan from denying coverage for emergency services obtained in certain medical facilities. Present law prohibits a health benefit plan from denying coverage for emergency services if the symptoms presented by an enrollee of the plan and recorded by the attending provider indicate that an emergency medical condition could exist, regardless of whether or not prior authorization was obtained to provide those services and regardless of whether or not the provider furnishing the services has a contractual agreement with the health benefit plan for the provision of the services to the enrollee. Present law defines "emergency services" as health care items and service furnished in a hospital that are required to determine, evaluate and/or treat an emergency medical condition, until the condition is stabilized, as directed or ordered by a physician or directed by physician or hospital protocol. This bill adds satellite emergency department facilities, freestanding emergency rooms, urgent care centers, and physicians' offices to the list of medical facilities where health care items and service may be furnished in order to qualify as "emergency services," thereby requiring coverages for services in those facilities in accordance with the above-described present law provision.

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Sponsor

Unknown

Details
Session

112th General Assembly

Introduced

January 18, 2022

Subjects
2430241522902170

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SB1769: Amends TCA Title 8; Title 53; Title 56; Title 63; Title 68 and Title 71. | LegisGo