Page:United States Statutes at Large Volume 124.djvu/915

 124 STAT. 889 PUBLIC LAW 111–148—MAR. 23, 2010 shall cover emergency services (as defined in paragraph (2)(B))— ‘‘(A) without the need for any prior authorization deter- mination; ‘‘(B) whether the health care provider furnishing such services is a participating provider with respect to such services; ‘‘(C) in a manner so that, if such services are provided to a participant, beneficiary, or enrollee— ‘‘(i) by a nonparticipating health care provider with or without prior authorization; or ‘‘(ii)(I) such services will be provided without imposing any requirement under the plan for prior authorization of services or any limitation on coverage where the provider of services does not have a contrac- tual relationship with the plan for the providing of services that is more restrictive than the requirements or limitations that apply to emergency department services received from providers who do have such a contractual relationship with the plan; and ‘‘(II) if such services are provided out-of-network, the cost-sharing requirement (expressed as a copayment amount or coinsurance rate) is the same requirement that would apply if such services were provided in-network; ‘‘(D) without regard to any other term or condition of such coverage (other than exclusion or coordination of benefits, or an affiliation or waiting period, permitted under section 2701 of this Act, section 701 of the Employee Retire- ment Income Security Act of 1974, or section 9801 of the Internal Revenue Code of 1986, and other than applicable cost-sharing). ‘‘(2) DEFINITIONS.—In this subsection: ‘‘(A) EMERGENCY MEDICAL CONDITION.—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 a condition described in clause (i), (ii), or (iii) of section 1867(e)(1)(A) of the Social Security Act. ‘‘(B) EMERGENCY SERVICES.—The term ‘emergency serv- ices’ means, with respect to an emergency medical condi- tion— ‘‘(i) a medical screening examination (as required under section 1867 of the Social Security Act) that is within the capability of the emergency department of a hospital, including ancillary services routinely available to the emergency department to evaluate such emergency medical condition, and ‘‘(ii) within the capabilities of the staff and facili- ties available at the hospital, such further medical examination and treatment as are required under sec- tion 1867 of such Act to stabilize the patient.