Page:United States Statutes at Large Volume 111 Part 1.djvu/314

 Ill STAT. 290 PUBLIC LAW 105-33 —AUG. 5, 1997 of an unforeseen illness, injury, or condition, and (II) it was not reasonable given the circumstances to obtain the services through the orgsmization, "(ii) the services were renal dialysis services and were provided other than through the organization because the individual was temporarily out of the plan's service area, or "(iii) the services are maintenance care or poststabilization care covered under the guidelines established under paragraph (2); "(D) the organization provides access to appropriate providers, including credentialed specialists, for medically necessary treatment and services; and "(E) coverage is provided for emergency services (as defined in paragraph (3)) without regard to prior authorization or the emergency care provider's contractual relationship with the organization. "(2) GUIDELINES RESPECTING COORDINATION OF POST-STA- BILIZATION CARE. —^A Medicare+Choice plan shall comply with such guidelines as the Secretary may prescribe relating to promoting efficient and timely coordination of appropriate maintenance and post-stabilization care of an enrollee after the enrollee has been determined to be stable under section 1867. "(3) DEFINITION OF EMERGENCY SERVICES. — In this subsection— "(A) IN GENERAL.—The term 'emergency services' means, with respect to an individual enrolled with an organization, covered inpatient and outpatient services that— "(i) are furnished by a provider that is qualified to furnish such services under this title, and "(ii) are needed to evaluate or stabilize an emergency medical condition (as defined in subparagraph (B)). "(B) EMERGENCY MEDICAL CONDITION BASED ON PRU- DENT LAYPERSON.— 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 health and medicine, could reasonably expect the absence of immediate medical attention to result in— "(i) placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy, "(ii) serious impairment to bodily functions, or "(iii) serious dysfunction of any bodily organ or part. "(4) ASSURING ACCESS TO SERVICES IN MEDICARE+CHOICE PRIVATE FEE-FOR-SERVICE PLANS. —In addition to any other requirements under this part, in the case of a Medicare+Choice private fee-for-service plan, the organization offering the plan must demonstrate to the Secretary that the organization has sufficient number and range of health care professionals and providers willing

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