Introduced Version
HOUSE BILL No. 1810
_____
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.
January 23, 2003, read first time and referred to Committee on Public Health.
Introduced
First Regular Session 113th General Assembly (2003)
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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.