304.1 7A-641 Treatment of a stabilized covered person with an emergency medical condition in a nonparticipating hospital's emergency room. (1) Where a covered person with an emergency medical condition has been stabilized, as required by the Consolidated Omnib us Budget Reconciliation Act of 1985 (COBRA), 42 U.S.C. sec. 300bb, in the emergency department of a nonparticipating hospital, and an insurer under its health benefit plan requires prior authorization for poststabilization treatment, approval or denial un der the preauthorization requirement shall be provided in a timely manner appropriate to conditions of the patient and delivery of the services, but in no case to exceed two (2) hours from the time the request is made and all relevant information is provid ed. The insurer's failure to make a determination within the two (2) hour time frame, shall constitute an authorization for the hospital to provide the medical service for which prior authorization was sought. (2) The nonparticipating hospital providing em ergency room services, poststabilization treatment, or both, shall be paid at a rate negotiated between the nonparticipating hospital and the insurer. . (2) The nonparticipating hospital providing em ergency room services, poststabilization treatment, or both, shall be paid at a rate negotiated between the nonparticipating hospital and the insurer. Nothing in this section is to be construed as requiring the payment of one hundred percent (100%) of the billed charges. Effective: July 14, 2000 History: Created 2000 Ky. Acts ch. 262, sec. 20, effective July 14, 2000.
Kentucky Legal Code