Access to Emergency Medical Services Act of 1995

Summary

Access to Emergency Medical Services Act of 1995 - Requires a health plan that provides any emergency services coverage to cover emergency services furnished to a plan enrollee without regard to: (1) whether the provider has an arrangement with the plan; and (2) prior authorization. Mandates prompt payment in a reasonable and appropriate amount and prohibits cost-sharing greater for hospital emergency services than for other settings. Requires specified measures relating to the timeliness of prior authorization determinations regarding needed care identified in initial evaluations. Prohibits plans from discouraging appropriate use of the 911 emergency telephone number or from denying coverage or payment for an item or service solely on the basis that an enrollee uses the number. Amends titles XVIII (Medicare) and XIX (Medicaid) of the Social Security Act to require health maintenance organizations, competitive medical plans, and managed care plans to meet the requirements of this paragraph. Allows State laws that provide protections exceeding those of this Act. Provides for civil money penalties for violations.

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Documents

3 official files

• Introduced in Senate (text)

  Introduced in Senate · EN · 12 September 1995

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• Introduced in Senate (PDF)

  Introduced in Senate · EN · 12 September 1995

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• Introduced in Senate

  summary · EN · 12 September 1995

  Open at official source

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