§ 12-15-44.5-5.7 — Nonemergency services received in an emergency room; copayment

Indiana § 12-15-44.5-5.7

• Jurisdiction: Indiana
• Art. 15: MEDICAID
• Ch. 44.5: Healthy Indiana Plan 2.0

Text

7. Subject to appeal to the office, an
individual may be held responsible under the plan for receiving
nonemergency services in an emergency room setting, including
prohibiting the individual from using funds in the individual's health
care account to pay for the nonemergency services and paying a
copayment for the services of at least eight dollars ($8) for the
nonemergency use of a hospital emergency department. However, an
individual may not be prohibited from using funds in the individual's
health care account to pay for nonemergency services provided in an
emergency room setting for a medical condition that arises suddenly
and unexpectedly and manifests itself by acute symptoms of such
severity, including severe pain, that the absence of immediate medical
attention could reasonably be expected by a prudent layperson who
possesses an average knowledge of health and medicine to:
(1) place an individual's health in serious jeopardy;
(2) result in serious impairment to the individual's bodily
functions; or
(3) result in serious dysfunction of a bodily organ or part of the
individual.

Legislative History

As added by P.L.30-2016, SEC.34. Amended by P.L.114-2018, SEC.7.