What Is the Status of the Prudent Layperson Standard in State Legislation?

Abstract

Study Objectives: The American College of Emergency Physicians (ACEP) in 2002 urged a national prudent layperson standard (PLS) for access to emergency care, which “addresses issues such as prior authorization and denials of emergency care,” by managed care entities, and “defends the rights of patients to have emergency department care when they believe their symptoms warrant it.” In that issue paper ACEP reported that 32 states and the District of Columbia had adopted the PLS. A separate study in the same year reported that 47 states had adopted the PLS, a discrepancy which may result from the range of legislative provisions. The aim of this study was to describe the managed care legislation pertaining to emergency medical care in all 50 states and the District of Columbia (henceforth, “jurisdictions”). We hypothesize that there is significant variability among legislative definitions of, and requirements regarding the coverage of care for emergency conditions.