As part of the Patient Protection and Affordable Care Act signed into law on March 23, 2010, insurance companies will now be barred from imposing pre-authorization requirements on EMTALA care. The Act also requires insurers to pay hospitals not under contract with them for EMTALA services on the same basis as they pay their own in-network hospitals.
Under the new law, insurance plans cannot (1) require a prior authorization for screening and stabilization services as defined under EMTALA; (2) impose any requirement or condition on a non-contracted hospital that is more restrictive than those it imposes on hospitals with contracts; (3) impose different coinsurance or copayment requirements on non-network hospitals than they impose on in-network hospitals; or (4) apply any other coverage restriction (other than otherwise permissible cost-sharing and pre-existing condition exclusions).
The new provision does not apply to services provided in an emergency department if those services are not required to determine whether an “emergency medical condition” exists and to stabilize such a condition.
The new requirements for insurance payment for EMTALA services become effective on or after September 23, 2010.