SB 66-2_ Filed 03/31/2005, 11:07 Brown T
Adopted 3/31/2005
Text Box
PREVAILED Roll Call No. _______
FAILED Ayes _______
WITHDRAWN Noes _______
RULED OUT OF ORDER
[
HOUSE MOTION ____
]
MR. SPEAKER:
I move that Engrossed Senate Bill 66 be amended to read as follows:
SOURCE: Page 3, line 10; (05)MO006604.3. -->
Page 3, between lines 10 and 11, begin a new paragraph and insert:
SOURCE: IC 12-15-12-6; (05)MO006604.3. -->
"SECTION 3. IC 12-15-12-6 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2005]: Sec. 6. (a) A Medicaid
recipient may be admitted to a hospital by a physician other than the
recipient's managed care provider if the recipient requires immediate
medical treatment.
(b) The admitting physician shall notify the recipient's managed care
provider of the recipient's admission not more than forty-eight (48)
hours after the recipient's admission.
(c) Payment for services provided a recipient admitted to a hospital
under this section shall be made only for services that the office or the
contractor under IC 12-15-30 determines were medically reasonable
and necessary.
(d) A physician who provides physician services in the
emergency department of a hospital licensed under IC 16-21 to a
recipient of services from a managed care organization shall notify
the managed care organization not later than five (5) business days
after the physician provided a service to the recipient. The
managed care organization may specify the procedure by which the
physician must notify the managed care organization, including
that the notice may be in written or electronic format.
SOURCE: IC 12-15-12-18.5; (05)MO006604.4. -->
SECTION 4. IC 12-15-12-18.5 IS ADDED TO THE INDIANA
CODE AS A
NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2005]:
Sec. 18.5. (a) Subject to federal law,
a managed care organization may establish policies to control the
inappropriate utilization of emergency room services by a
recipient.
(b) Before a managed care organization may implement a policy
under subsection (a), the managed care organization shall notify
each Medicaid recipient at least thirty (30) days before
implementing the policy.
(c) A recipient may appeal under IC 4-21.5 the implementation
of a policy under subsection (a).".
SOURCE: Page 3, line 33; (05)MO006604.3. -->
Page 3, line 33, reset in roman "(e) This section does not apply to".
Page 3, line 33, reset in roman "the Medicaid".
Page 3, reset in roman line 34.
Page 3, between lines 34 and 35, begin a new paragraph and insert:
SOURCE: IC 12-15-15-2.7; (05)MO006604.4. -->
"SECTION 4. IC 12-15-15-2.7 IS ADDED TO THE INDIANA
CODE AS A
NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2005]:
Sec. 2.7. (a) This section applies to a
physician who:
(1) provides services in an emergency department of a hospital
licensed under IC 16-21; and
(2) does not have a contract with a managed care
organization.
(b) For services rendered and documented in an individual's
medical record, physicians must be reimbursed for federally
required medical screening exams that are necessary to determine
the presence of an emergency using the appropriate Current
Procedural Terminology (CPT) codes 99281, 99282, or 99283
described in the Current Procedural Terminology Manual
published annually by the American Medical Association, without
authorization by the enrollee's primary medical provider.
(c) A physician may agree to provide the services described in
subsection (b) for:
(1) a negotiated rate other than one hundred percent (100%)
of the rate payable under the Medicaid fee structure; or
(2) one hundred percent (100%) of the rate payable under the
Medicaid fee structure.".
Renumber all SECTIONS consecutively.
(Reference is to ESB 66 as printed March 25, 2005.)
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MO006604/DI 104 2005