Citations Affected: IC 12-7; IC 12-15; IC 12-17.6.
Synopsis: Medicaid and children's health insurance program. Defines
"emergency" for purposes of the children's health insurance program
(CHIP). Prohibits cost sharing under CHIP for emergency services
provided within a hospital emergency department. Requires the office
of Medicaid policy and planning and the office administering CHIP to
request repayment of an overpayment made to a provider under the
Medicaid program or CHIP.
Effective: July 1, 2000.
January 10, 2000, read first time and referred to Committee on Health and Provider
January 20, 2000, amended, reported favorably _ Do Pass.
A BILL FOR AN ACT to amend the Indiana Code concerning
SECTION 1. IC 12-7-2-76.5 IS AMENDED TO READ AS
FOLLOWS [EFFECTIVE JULY 1, 2000]: Sec. 76.5. (a) "Emergency",
for purposes of IC 12-20, means an unpredictable circumstance or a
series of unpredictable circumstances that:
(1) place the health or safety of a household or a member of a household in jeopardy; and
(2) cannot be remedied in a timely manner by means other than township assistance.
(b) "Emergency", for purposes of IC 12-17.6, has the meaning set forth in IC 12-17.6-1-2.6.
SECTION 2. IC 12-15-23-2 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2000]: Sec. 2. If the administrator determines that a provider has received payments the provider is not entitled to, the administrator may:
(1) request in writing that the provider repay the amount of the overpayment; and
(2) enter into an agreement with the provider stating that the
amount of the overpayment shall be deducted from subsequent
payments to the provider.
SECTION 3. IC 12-17.6-1-2.6 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2000]: Sec. 2.6. "Emergency" means 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 lay person 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.
SECTION 4. IC 12-17.6-2-13 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2000]: Sec. 13. If the office determines that an overpayment has been made to a provider, the office shall request in writing that the provider repay the amount of the overpayment.
SECTION 5. IC 12-17.6-4-3, AS ADDED BY P.L.273-1999, SECTION 177, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2000]: Sec. 3. Premium and cost sharing amounts established by the office are limited by the following:
(1) Deductibles, coinsurance, or other cost sharing is not permitted with respect to benefits for:
(A) well-baby and well-child care, including age appropriate immunizations; and
(B) services provided for treatment of an emergency in an emergency department of a hospital licensed under IC 16-21.
(2) Premiums and other cost sharing may be imposed based on family income. However, the total annual aggregate cost sharing with respect to all children in a family under this article may not exceed five percent (5%) of the family's income for the year.