Indiana Code
Chapter 12. Managed Care
12-15-12-18. Payment for Emergency Services

Sec. 18. (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.
As added by P.L.223-2001, SEC.9. Amended by P.L.152-2017, SEC.17.

Structure Indiana Code

Indiana Code

Title 12. Human Services

Article 15. Medicaid

Chapter 12. Managed Care

12-15-12-0.3. "Emergency Medical Condition"

12-15-12-0.5. "Emergency Services"

12-15-12-0.7. "Post-Stabilization Care Services"

12-15-12-0.9. Applicability; Medicaid Law Controlling Over Conflicting Insurance Law

12-15-12-1. Providers From Whom Recipients May Obtain Services Other Than Physician Services; Exceptions

12-15-12-2. Providers From Whom Recipients May Receive Physician Services; Exceptions

12-15-12-3. List of Managed Care Providers Furnished Recipient; Providers Included; Exception

12-15-12-4. Failure by Recipient to Select Managed Care Provider Within Reasonable Time; Assignment by Office; Exception

12-15-12-4.5. Managed Care Prescription Drug Program Requirements

12-15-12-5. Circumstances Permitting Recipient to Receive Physician Services From Provider Other Than Managed Care Provider; Exceptions

12-15-12-6. Admission to Hospital by Physician Other Than Managed Care Provider; Notification of Managed Care Provider; Services for Which Payment Made

12-15-12-7. Providers From Whom Recipients May Obtain Eye Care Services Other Than Surgical Services

12-15-12-8. Providers From Whom Recipients May Obtain Foot Care Services

12-15-12-9. Providers From Whom Recipients May Obtain Psychiatric Services

12-15-12-10. Selection or Assignment of Managed Care Provider; Selection of New Provider; Exception

12-15-12-11. Waiver From Department of Health and Human Services; Implementation of Chapter

12-15-12-12. Payments to Providers

12-15-12-13. Permitted Forms

12-15-12-14. Repealed

12-15-12-15. Coverage for Emergency Services

12-15-12-17. Coverage for Post-Stabilization Care Services

12-15-12-18. Payment for Emergency Services

12-15-12-18.5. Reimbursement for Emergency Medical Services Provider Organizations; Implementation

12-15-12-19. Repealed

12-15-12-20. Child Lead Poisoning Screening

12-15-12-21. Accreditation

12-15-12-22. Accepting, Receiving, and Processing Electronic Claims

12-15-12-23. Psychiatrist Practicing in Community Mental Health Center