§ 12-15-12-18 — Payment for emergency services

Indiana § 12-15-12-18

• Jurisdiction: Indiana
• Art. 15: MEDICAID
• Ch. 12: Managed Care

Text

(a) Except as provided in subsection (b),
this section applies to:
(1) emergency services provided to an individual enrolled in a
Medicaid risk based managed care program; and
(2) medically necessary screening services provided to an
individual enrolled in a Medicaid risk based managed care
program;
who presents to an emergency department with an emergency medical
condition.
(b) This section does not apply to emergency services or screening
services provided to an individual enrolled in a Medicaid risk based
managed care program by a provider who has contracted with the
individual's managed care organization to provide emergency services
to the individual.
(c) Payment for emergency services and medically necessary
screening services in the emergency department of a hospital licensed
under IC 16-21 must be in an amount equal to one hundred percent
(100%) of the current Medicaid fee for service reimbursement rates for
such services.
(d) Payment under subsection (c) is the responsibility of the
enrollee's managed care organization. This subsection does not prohibit
the managed care organization from entering into a subcontract with
another managed care organization providing for the latter managed
care organization to assume financial responsibility for making the
payments required under this section.
(e) This section does not limit the ability of the managed care
organization to:
(1) review; and
(2) make a determination of;
the medical necessity of the services provided in a hospital's emergency
department for purposes of determining coverage for such services.

Legislative History

As added by P.L.223-2001, SEC.9. Amended by P.L.152-2017, SEC.17.