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State Legislative Dashboard
June 12, 2024

Prudent Layperson

State Legislative Issues

State legislation and regulations for the Prudent Layperson Standard (PLP) requiring coverage of emergency medical treatment of a condition(s) where a patient believed they were having a medical emergency.

Alabama

Reg. Health Chap. 420-5-6 Applies to HMOs only.

Alaska

Statute Ins. Title 21.07.020

Arizona

Statute Ins. 20-2803

Arkansas

Statute Ins. 20-9-309

California

Statute Health 1317.1 Applies to Medicaid Fee for Service state programs and private insurance only. Enacted effective laws similar to prudent layperson focusing on a patient’s presenting symptoms rather than final diagnosis when determining whether to pay emergency care claims.

Colorado

Title 10. Ins § 10-16-704

Connecticut

Statute 700c 38a-478r

Delaware

Statute § 3349 Chap 33 Title 18

Florida

Statute Chapter 641.513 Requirements for providing emergency services and care. 

Applies to HMOs only. Enacted effective laws similar to prudent layperson focusing on a patient’s presenting symptoms rather than final diagnosis when determining whether to pay emergency care claims.

Georgia

Subject 511-9-2. Emergency Medical Services

Illinois

Statute Chap. 215-134-10

Applies to Medicaid Fee for Service state programs and private insurance only

Indiana

Statute Title 27-13-1-11.7

Applies to HMOs only

Iowa

Statute Title 13 514C.16

Kansas

Statute Ins. 40-4602

Kentucky

Statute Title 25 304.17A

Louisiana

Statute Title 22 657

Maine

Reg. Chap. 2-31-850

Maryland

Statute Title 19-701§ 15-126

Applies to HMOs only

Massachusetts

Statute 22-175-47U

Michigan

Statute Ins. 500.3406k

Minnesota

Statute Chap. 62A.049

Mississippi

Miss. Code § 41-145-NEW-004

Applies to HMOs only

Missouri

Statute Health 354.400

Montana

Statute Ins. 33-36-205

Nebraska

Statute 44-6827

Nevada

Statute NRS 695G.170

New Hampshire

Section 420-J:3

New Jersey

Admin. Code 8:38-1.2

Applies to HMOs only. Applies to Medicaid Managed Care Plans and private insurance only.

New Mexico

Statute 59A-57-4

New York

Statute 32-3216

North Carolina

Statute Ins. 58-3-190

North Dakota

Statute 26.1-26.4-02

Ohio

Statute Ins. 3923.65

Applies to Medicaid Fee for Service state programs and private insurance only

Oklahoma

Statute Ins. Chap. 2 6055

Oregon

Statute Ins. Chap. 743A.012

Pennsylvania

Statute Ins. Chap. 991.2102

Rhode Island

Reg. Health R23-17.12-UR

Enacted effective laws similar to prudent layperson focusing on a patient’s presenting symptoms rather than final diagnosis when determining whether to pay emergency care claims.

South Carolina

Statute Ins. 38-71-1520

South Dakota

Statute Ins. 58-17C-27

Tennessee

Statute Ins. Title 56-7-2355

Enacted effective laws similar to prudent layperson focusing on a patient’s presenting symptoms rather than final diagnosis when determining whether to pay emergency care claims.

Texas

Statute Ins. Title 6-843

Utah

Statute Ins. 31A-22-627

Vermont

8 V.S.A. § 4089b

Virginia

Statute Ins. 38.2-4300

Applies to HMOs only

Washington

Statute Ins. 48.43.005

Washington, D.C.

Statute 31–2802. Covered services.

West Virginia

Statute Ins. 33-1-21

Wisconsin

Statute Ins. 632.85

Wyoming

No current information available.

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