Sec. 10.09.44.22. Payment for Emergency Services

A. The PACE provider shall be responsible for prompt payment for all emergency services received by participants.

B. If a claim is submitted to the PACE provider within 9 months of the date of service, the PACE provider shall reimburse a hospital emergency facility and provider, without requiring prior authorization or approval for payment from the PACE provider, for:

(1) Emergency services;

(2) Medical screening services rendered at an emergency facility to meet the requirements of the federal Emergency Medical Treatment and Active Labor Act; and

(3) Medically necessary and appropriate services if:

(a) The PACE provider authorized, referred, or otherwise allowed the participant to use the emergency facility; and

(b) The services are related to the condition for which the participant was allowed to use the emergency facility.