Page:United States Statutes at Large Volume 111 Part 1.djvu/520

 Ill STAT. 496 PUBLIC LAW 105-33—AUG. 5, 1997 Applicability. authorization or the emergency care provider's contractual relationship with the organization or manager, and "(ii) to comply with guidelines established under section 1852(d)(2) (respecting coordination of post-stabilization care) in the same manner as such guidelines apply to Medicare+Choice plans offered under part C of title XVin. The requirement under clause (ii) shall first apply 30 days after the date of promulgation of the guidelines referred to in such clause. "(B) EMERGENCY SERVICES DEFINED. —In subparagraph (A)(i), 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 (C)). "(C) EMERGENCY MEDICAL CONDITION DEFINED.—In subparagraph (B)(ii), 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. " (3) PROTECTION OF ENROLLEE-PROVIDER COMMUNICA- TIONS.— "(A) IN GENERAL.— Subject to subparagraphs (B) and (C), under a contract under section 1903(m) a medicaid managed care organization (in relation to an individual enrolled under the contract) shall not prohibit or otherwise restrict a covered health care professional (as defined in subparagraph (D)) from advising such an individual who is a patient of the professional about the health status of the individual or medical care or treatment for the individual's condition or disease, regardless of whether benefits for such care or treatment are provided under the contract, if the professional is acting within the lawful scope of practice. "(B) CONSTRUCTION. —Subparagraph (A) shall not be construed as requiring a medicaid managed care organization to provide, reimburse for, or provide coverage of, a counseling or referral service if the organization— "(i) objects to the provision of such service on moral or religious grounds; and "(ii) in the manner and through the written instrumentalities such organization deems appropriate, makes available information on its policies regarding such service to prospective enrollees before or during

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