Emergency Services and Care (Behavioral Health)
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- Screenings, examinations, and evaluations for the purpose of determining whether a psychiatric emergency medical condition exists; and
- Treatment necessary to relieve or eliminate the psychiatric emergency medical condition. The intent is to assure that enrollees who have non-medical, mental health emergencies receive proper access to and continuity of care.
Emergency Services and Care also means additional screening, examination and evaluation by a physician, or other personnel to the extent permitted by applicable law and within the scope of their licensure and clinical privileges, to determine if a Psychiatric Emergency Medical Condition exists, and the care and treatment necessary to relieve or eliminate the Psychiatric Emergency Medical Condition.
Emergency Services and Care also means additional screening, examination, and evaluation by a physician, or other personnel to the extent permitted by applicable law and within the scope of their licensure and clinical privileges, to determine if a Psychiatric Emergency Medical Condition exists, and the care and treatment necessary to relieve or eliminate the Psychiatric Emergency Medical Condition.
Psychiatric Emergency Medical Condition means a psychiatric medical condition for which the onset is sudden and manifests itself by symptoms of sufficient severity (including severe pain) such that a prudent layperson possessing an average knowledge of medicine and health could reasonably expect the absence of immediate medical attention to result in any of the following:
- Placing the health of the afflicted person, or others, in serious jeopardy.
- Serious impairment to bodily functions; or
- Serious dysfunction of any bodily organ or part. In cases of the provision of Emergency Services and Care, the provider agrees to notify Health Net as soon as possible, but no later than 24 hours after it could be reasonably determined that the patient is an enrollee.