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
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
12-15-12-2. Providers From Whom Recipients May Receive Physician Services; Exceptions
12-15-12-3. List of Managed Care Providers Furnished Recipient; Providers Included; Exception
12-15-12-4.5. Managed Care Prescription Drug Program Requirements
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
12-15-12-15. 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
12-15-12-20. Child Lead Poisoning Screening
12-15-12-22. Accepting, Receiving, and Processing Electronic Claims
12-15-12-23. Psychiatrist Practicing in Community Mental Health Center