SENATE BILL No. 64
By Committee on Financial Institutions and Insurance
AN ACT concerning insurance; emergency room payments.
Be it enacted by the Legislature of the State of Kansas:
Section 1. This act shall be known as the emergency room services
Sec. 2. As used in this act:
(a) ``Emergency medical condition'' means the sudden and, at the
time, unexpected onset of a health condition that requires immediate
medical attention, where failure to provide medical attention would result
in serious impairment to bodily functions or serious dysfunction of a bod-
ily organ or part, or would place the person's health in serious jeopardy.
(b) ``Emergency services'' means health care items and services fur-
nished or required to evaluate and treat an emergency medical condition.
(c) ``Health benefit plan'' means any hospital or medical expense pol-
icy, health, hospital or medical service corporation contract, and a plan
provided by a municipal group-funded pool, or a health maintenance
organization contract offered by an employer or any certificate issued
under any such policies, contracts or plans. ``Health benefit plan'' does
not include policies or certificates covering only accident, credit, dental,
disability income, long-term care, hospital indemnity, medicare supple-
ment, specified disease, vision care, coverage issued as a supplement to
liability insurance, insurance arising out of a workers compensation or
similar law, automobile medical payment insurance, or insurance under
which benefits are payable with or without regard to fault and which is
statutorily required to be contained in any liability insurance policy or
(d) ``Health carrier'' means any insurance company, nonprofit medi-
cal and hospital service corporation, municipal group-funded pool, fra-
ternal benefit society or health maintenance organization, as these terms
are defined by the Kansas Statutes Annotated.
(e) ``Participating provider'' means a provider who, under a contract
with the health carrier or with its contractor or subcontractor, has agreed
to provide health care services to covered persons with an expectation of
services receiving payment, other than coinsurance, copayments or de-
ductibles, directly or indirectly from the health carrier.
(f) ``Provider'' means a physician or other health care practitioner
licensed, accredited or certified to perform specified health care services
consistent with state law.
Sec. 3. (a) A health benefit plan shall cover emergency services nec-
essary to screen and stabilize a covered person and shall not require prior
authorization of such services if a prudent lay person acting reasonably
would have believed that an emergency medical condition existed. With
respect to care obtained from a noncontracting provider within the service
area of a managed care plan, a health carrier shall cover emergency serv-
ices necessary to screen and stabilize a covered person and shall not re-
quire prior authorization of such if a prudent lay person would have rea-
sonably believed that use of a contracting provider would result in a delay
that would worsen the emergency, or if a provision of federal, state or
local law requires the use of a specific provider.
(b) A health benefit plan shall cover emergency services if the health
carrier, acting through a participating provider or other authorized rep-
resentative, has authorized the provision of emergency services.
(c) If a participating provider or other authorized representative of a
health carrier authorizes emergency services, the health carrier shall not
subsequently retract its authorization after the emergency services have
been provided, or reduce payment for an item or service furnished in
reliance on approval, unless the approval was based on a material mis-
representation about the covered person's health condition made by the
provider of emergency services.
(d) Coverage of emergency services shall be subject to applicable
copayments, coinsurance and deductibles.
(e) For immediately required post-evaluation or post-stabilization
services, a health carrier shall provide access to an authorized represen-
tative 24 hours a day, seven days a week, to facilitate review.
Sec. 4. This act shall take effect and be in force from and after its
publication in the statute book.