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205.8459 Emergency service.

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Page 1 of 1 205.8459 Emergency service. (1) Any provider presented with a request for an emergency service, for a nonlife-threatening condition or a condition that would not result in irreparable harm, by a <br>Medicaid recipient participating in a managed care program but not in a restricted <br>Medicaid status, shall not provide the service on an emergency basis unless the <br>provider first makes a reasonable effort to contact the recipient's designated <br>managed care primary physician for prior approval. Any provider presented with a <br>request for an emergency service, due to a life-threatening condition or a condition <br>that would result in irreparable harm, by a Medicaid recipient participating in a <br>managed care program but not in a restricted Medicaid status, may provide the <br>service without prior approval from the recipient's designated managed care primary <br>physician. (2) For the purposes of implementing KRS 205.8455, 205.8457, and this section, the Department for Medicaid Services, in consultation with the Recipient Utilization <br>Review Committee, shall in conformity with the federal Emergency Medical <br>Treatment and Active Labor Act (42 U.S.C. sec. 1395dd, as amended) and any other <br>applicable federal law, and in administrative regulation promulgated pursuant to <br>KRS Chapter 13A, define an emergency service, irreparable harm, immediate grave <br>bodily harm, life-threatening condition, and nonlife-threatening condition. Effective: July 15, 1994 <br>History: Created 1994 Ky. Acts ch. 96, sec. 5, effective July 15, 1994; and ch. 316, sec. 5, effective July 15, 1994. Legislative Research Commission Note (7/15/94). This statute was enacted by identical sections in two bills (1994 Ky. Acts chs. 96 &amp; 316) which have been codified <br>together.