Introduced Version






HOUSE BILL No. 1810

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DIGEST OF INTRODUCED BILL



Citations Affected: IC 12-15-15-2.6.

Synopsis: Emergency room physician services. Requires that certain physician services provided in a hospital emergency department to a patient enrolled in the Medicaid risk-based managed care program by a physician who does not have a contract with the patient's managed care organization must be paid at 100% of the rates payable under the Medicaid fee structure.

Effective: July 1, 2003.





Brown C




    January 23, 2003, read first time and referred to Committee on Public Health.







Introduced

First Regular Session 113th General Assembly (2003)


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. 1810



    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 12-15-15-2.6; (03)IN1810.1.1. -->     SECTION 1. IC 12-15-15-2.6 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2003]: Sec. 2.6. (a) This section applies to physician services provided in the emergency department of a hospital licensed under IC 16-21 to an individual enrolled in the Medicaid risk-based managed care program by a physician who does not have a contract with the enrollee's Medicaid risk-based managed care organization.
    (b) Payment for physician services described in subsection (a) must be at a rate of one hundred percent (100%) of rates payable under the Medicaid fee structure.
    (c) The payment under subsection (b) must be calculated using the same methodology used for all other physicians participating in the Medicaid program.
    (d) For services rendered and documented in an individual's medical record, physicians must be reimbursed for federally required medical screening examinations that are necessary to

determine the presence of an emergency (using the appropriate Current Procedural Terminology (CPT) codes 99281, 99282, 99283, 99284, or 99285, described in the Current Procedural Terminology Manual published annually by the American Medical Association) without authorization by the enrollee's primary medical provider or managed care organization.
    (e) Payment for all other physician services described in subsection (a) provided to enrollees in the Medicaid risk-based managed care program must be at a rate of one hundred percent (100%) of the Medicaid fee structure rates if the service is authorized, prospectively or retrospectively, by the enrollee's primary medical provider or managed care organization based on information documented in the enrollee's medical record.
    (f) A primary medical provider is not responsible for a payment required under this section.