Bill Text: IN HB1264 | 2010 | Regular Session | Introduced

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Bill Title: Emergency room Medicaid reimbursement.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced - Dead) 2010-01-12 - First reading: referred to Committee on Public Health [HB1264 Detail]

Download: Indiana-2010-HB1264-Introduced.html

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Introduced Version

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HOUSE BILL No. 1264

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DIGEST OF INTRODUCED BILL

Citations Affected: IC 12-15-12-18.

Synopsis: Emergency room Medicaid reimbursement. Specifies emergency department screening services requiring reimbursement under the Medicaid program.

Effective: July 1, 2010.

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Brown T

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    January 12, 2010, read first time and referred to Committee on Public Health.

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Introduced

Second Regular Session 116th General Assembly (2010)

PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana Constitution) is being amended, the text of the existing provision will appear in this style type, additions will appear in this style type, and deletions will appear in this style type.
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HOUSE BILL No. 1264

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    A BILL FOR AN ACT to amend the Indiana Code concerning human services.

Be it enacted by the General Assembly of the State of Indiana:

SOURCE: IC 12-15-12-18; (10)IN1264.1.1. -->     SECTION 1. IC 12-15-12-18 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2010]: Sec. 18. (a) As used in this section, "screening services" includes professional emergency physician screening services provided under current procedural terminology (CPT) codes 99281 through 99283.
    (a) (b) Except as provided in subsection (b), (c), this section applies to:
        (1) emergency services provided to an individual enrolled in the Medicaid risk-based managed care program; and
        (2) medically necessary screening services provided to an individual enrolled in the Medicaid risk-based managed care program;
who presents to an emergency department with an emergency medical condition.
    (b) (c) This section does not apply to emergency services or screening services provided to an individual enrolled in the Medicaid risk-based managed care program by a provider who has contracted

with a the individual's Medicaid risk-based managed care organization to provide emergency services to the individual.
    (c) (d) Payment for emergency services and medically necessary screening services in the emergency department of a hospital licensed under IC 16-21 must be in an amount equal to one hundred percent (100%) of the current Medicaid fee for service reimbursement rates for such services.
    (d) (e) Payment under subsection (c) (d) is the responsibility of the enrollee's risk-based managed care organization. This subsection does not prohibit the risk-based managed care organization from entering into a subcontract with another Medicaid risk-based managed care organization providing for the latter organization to assume financial responsibility for making the payments required under this section.
    (e) (f) This section does not limit the ability of the managed care organization to:
        (1) review; and
        (2) make a determination of;
the medical necessity of the services provided in a hospital's emergency department for purposes of determining coverage for such services.