Citations Affected: IC 12-15;
IC 34-6-2-117.
Synopsis: Health. Requires the Medicaid primary care case management program and the
risk-based managed care program to cover and pay for certain emergency and post-stabilization
care services. Specifies reimbursement levels for certain emergency and post-stabilization care
services. Amends the definition of "emergency" for purposes of the children's health insurance
program. Amends the definition of "professional health care provider" concerning a nonprofit
health care organization. Removes expiration provision from the statute requiring that, under
the Medicaid primary care case management program, certain physician services provided to
a program enrollee in a hospital emergency department must be at a rate equal to 100% of rates
payable under the Medicaid fee structure. (The introduced version of this bill was prepared by
the interim study committee on Medicaid oversight.) (This conference committee report: (1)
removes the expiration date on the statute regarding payment rates for Medicaid emergency
room services; and (2) amends the definition of "professional health care provider" concerning
a nonprofit health care organization.
Effective: Upon passage; July 1, 2001; January 1, 2002.
MR. PRESIDENT:
Your Conference Committee appointed to confer with a like committee from the House
upon Engrossed Senate Amendments to Engrossed House Bill No. 1872 respectfully reports
that said two committees have conferred and agreed as follows to wit:
that the House recede from its dissent from all Senate amendments and
that the House now concur in all Senate amendments to the bill and that
the bill be further amended as follows:
Delete the title and insert the following:
A BILL FOR AN ACT to amend the Indiana Code concerning
health.
SECTION 1, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2001]: Sec. 2.5. (a) Payment for physician services provided
in the emergency department of a hospital licensed under IC 16-21
must be at a rate of one hundred percent (100%) of rates payable under
the Medicaid fee structure.
(b) The payment under subsection (a) must be calculated using the
same methodology used for all other physicians participating in the
Medicaid program.
(c) 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.
(d) Payment for all other physician services provided in an
emergency department of a hospital to enrollees in the Medicaid
primary care case management program must be at a rate of one
hundred percent (100%) of the Medicaid fee structure rates, provided
the service is authorized, prospectively or retrospectively, by the
enrollee's primary medical provider.
(e) This section does not apply to a person enrolled in the Medicaid
risk-based managed care program.
(f) This section expires July 1, 2001.
(1) through (13) and professional corporations comprised of
persons described in subdivisions (1) through (13);
(15) a private psychiatric hospital licensed under IC 12-25;
(16) a preferred provider organization (including a preferred
provider arrangement or reimbursement agreement under
IC 27-8-11
);
(17) a health maintenance organization (as defined in
IC 27-13-1-19
) or a limited service health maintenance
organization (as defined in
IC 27-13-34-4
);
(18) a respiratory care practitioner licensed under IC 25-34.5;
(19) an occupational therapist certified under IC 25-23.5;
(20) a state institution (as defined in
IC 12-7-2-184
);
(21) a clinical social worker who is licensed under
IC 25-23.6-5-2
;
(22) a managed care provider (as defined in
IC 12-7-2-127
(b)); or
(23) a nonprofit health care organization affiliated with a hospital
that is owned or operated by a religious order, whose members are
members of that religious order; or
(24) a nonprofit health care organization with one (1) or more
hospital affiliates.".
Renumber all SECTIONS consecutively.
(Reference is to EHB 1872 as printed April 6, 2001.)
____________________________ ____________________________
Representative Brown C Senator Miller
Chairperson
____________________________ ____________________________
Representative Dillon Senator Smith S
House Conferees Senate Conferees