Indiana Code 12-15-12-18. Payment for emergency services
(1) emergency services provided to an individual enrolled in a Medicaid risk based managed care program; and
Terms Used In Indiana Code 12-15-12-18
- emergency medical condition: means a medical condition manifesting itself by acute symptoms, including severe pain, of sufficient severity that a prudent lay person with an average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to result in:
Indiana Code 12-15-12-0.3
- emergency services: means covered inpatient and outpatient services that are:
Indiana Code 12-15-12-0.5
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.