Introduced Version






HOUSE BILL No. 1171

_____


DIGEST OF INTRODUCED BILL



Citations Affected: IC 12-15-13.

Synopsis: Diagnostic codes and forms for Medicaid claims. Updates claims processing forms under the Medicaid program. Requires the office of Medicaid policy and planning to use the most current forms for claims that the office processes within 90 days after the effective date of the new form.

Effective: July 1, 2011.





Brown T




    January 10, 2011, read first time and referred to Committee on Public Health.







Introduced

First Regular Session 117th General Assembly (2011)


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. 1171



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

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

SOURCE: IC 12-15-13-7; (11)IN1171.1.1. -->     SECTION 1. IC 12-15-13-7 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2011]: Sec. 7. (a) The office and an entity with which the office contracts for the payment of claims shall accept claims submitted on any of the following forms by an individual or organization that is a contractor or subcontractor of the office:
        (1) HCFA-1500.
         (1) CMS-1500 or its subsequent form.
        (2) HCFA-1450 (UB92).
        (2) CMS-1450 (UB04) or its subsequent form.

        (3) American Dental Association (ADA) claim form.
        (4) Pharmacy and compound drug form.
    (b) The office and an entity with which the office contracts for the payment of claims:
        (1) may designate as acceptable claim forms other than a form listed in subsection (a); and
        (2) may not mandate the use of a crossover claim form.
SOURCE: IC 12-15-13-7.2; (11)IN1171.1.2. -->     SECTION 2. IC 12-15-13-7.2 IS AMENDED TO READ AS

FOLLOWS [EFFECTIVE JULY 1, 2011]: Sec. 7.2. (a) As used in this section, "provider" has the meaning set forth in IC 27-8-11-1.
    (b) Not more than ninety (90) days after the effective date of a diagnostic or procedure code described in this subsection:
        (1) the office shall for all purposes begin using the most current version of the:
            (A) current procedural terminology (CPT);
            (B) international classification of diseases (ICD);
            (C) American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM);
            (D) current dental terminology (CDT);
            (E) Healthcare common procedure coding system (HCPCS); and
            (F) third party administrator (TPA);
        codes under which the office pays processes claims for services provided under the Medicaid program; and
        (2) a provider shall begin using the most current version of the:
            (A) current procedural terminology (CPT);
            (B) international classification of diseases (ICD);
            (C) American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM);
            (D) current dental terminology (CDT);
            (E) Healthcare common procedure coding system (HCPCS); and
            (F) third party administrator (TPA);
        codes under which the provider submits claims for payment for services provided under the Medicaid program.
    (c) If a provider provides services that are covered under the Medicaid program:
        (1) after the effective date of the most current version of a diagnostic or procedure code described in subsection (b); and
        (2) before the office begins using the most current version of the diagnostic or procedure code;
the office shall reimburse the provider under the version of the diagnostic or procedure code that was in effect on the date that the services were provided.