As part of the Balanced Budget Act of 1997, Congress enacted this standard for Medicare and Medicaid managed care plans.
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ACEP News: Vol 29 – No 05 – May 2010The prudent layperson standard was also extended to all federal employees in 1999. The standard required health plans to cover emergency services if a prudent layperson believed he or she was experiencing a medical emergency.
In such cases, prior authorization from the plan is not required.
“Achieving adoption of the prudent layperson standard has been a priority of ACEP since 1993. It was the intense focus of our advocacy and media activities for so many ACEP leaders at the state and national level—and was vehemently opposed by health plans state by state for many years,” Dr. Gardner said.
“To see this patient-centered ACEP initiative become the law of the land is a tremendous achievement for emergency medicine,” Dr. Gardner concluded.
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