C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER B—MEDICARE PROGRAM › PART 424—CONDITIONS FOR MEDICARE PAYMENT › Subpart G—Special Conditions: Emergency Services Furnished by a Nonparticipating Hospital

42 C.F.R. § 424.101

Definitions

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As used in this subpart, unless the context indicates otherwise—

Emergency services means inpatient or outpatient hospital services that are necessary to prevent death or serious impairment of health and, because of the danger to life or health, require use of the most accessible hospital available and equipped to furnish those services.

Hospital means a facility that—

(1) Is primarily engaged in providing, by or under the supervision of doctors of medicine or osteopathy, inpatient services for the diagnosis, treatment, and care or rehabilitation of persons who are sick, injured, or disabled;

(2) Is not primarily engaged in providing skilled nursing care and related services for patients who require medical or nursing care, as described in section 1861(j)(1)(A) of the Act;

(3) Provides 24-hour nursing service in accordance with section 1861(e)(5) of the Act; and

(4) Is licensed, or is approved as meeting the standards for licensing, by the State or local licensing agency.

Reasonable charges means customary charges insofar as they are reasonable.

Notes of Decisions
Cited in 2 cases, 2017–2017 · leading case: YDM Mgmt. Co. v. Sharp Cmty. Med. Grp., Inc., 224 Cal. Rptr. 3d 479 (Cal. Ct. App. 5th 2017).
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YDM Mgmt. Co. v. Sharp Cmty. Med. Grp., Inc., 224 Cal. Rptr. 3d 479 (Cal. Ct. App. 5th 2017). “" ( *491 42 C.F.R. § 424.101 , italics added.) However, it is not clear that the federal definition of "emergency services" is necessarily the standard applicable with respect to California's Knox-Keene Act requirements for reimbursement of providers for medical services…”
YDM Mgmt. Co., Inc. v. Sharp Cmty. Med. etc. (Cal. Ct. App. 2017). “" ( 42 C.F.R. § 424.101 , italics added.) However, it is not clear that the federal definition of "emergency services" is necessarily the standard applicable with respect to California's Knox-Keene Act requirements for reimbursement of providers for medical services provided to…”
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