Cal. Code Regs. Tit. 22, § 53622 - Definitions
(a) The following
definitions shall govern the construction of this article unless the context or
subject matter otherwise requires:
(1) "Day"
means a calendar day.
(2) "Dispute"
means a dispute concerning payment for care under emergency circumstances
provided to plan members by nonplan providers.
(3) "Emergency services" or "care under
emergency circumstances" means those health care services required for
alleviation of severe pain or immediate diagnosis and treatment of unforeseen
medical conditions which if not immediately diagnosed and treated would lead to
disability or death. Such emergency is deemed to continue until:
(A) In reasonable medical judgment, the
patient's condition has stabilized sufficiently so as to permit either:
(1) Discharge, or
(2) Referral and transfer of the patient, in
accordance with instructions from the patient's plan, to such level of
treatment or care as may be appropriate, and
(B) A reasonable time within which to
complete such discharge, or referral and transfer.
(4) "Party" means the provider, the plan or
any person, other than an officer or employee of the Department acting in an
official capacity, who has been allowed to appear in the proceeding.
(5) "Provider" means a nonplan provider who
files a claim against a plan for emergency services in accordance with this
article.
Notes
Note: Authority cited: Sections 14312 and 14454, Welfare and Institutions Code. Reference: Section 14454, Welfare and Institutions Code.
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