In accordance with public notice requirements of 42 CFR 447.205 and Section 1902(a)(13)(A) of the Social Security Act, the Indiana Family and Social Services Administration, Office of Medicaid Policy and Planning (OMPP) publishes this notice of proposed changes to methods and standards governing reimbursement policy for Medicaid-enrolled Hospitals.

Effective July 1, 2009, OMPP proposes to reimburse hospitals a fee of $25 for an emergency room screen when the screen determines the Medicaid member's condition does not meet the prudent layperson definition of an emergency condition. Hospitals will not be entitled to additional reimbursement for services rendered in an emergency room for treatment of conditions that do not meet the prudent layperson standard as an emergency medical condition. This change is expected to result in an estimated total state savings in expenditures of $700,000 and $1.9 million federal total annual savings for a total of approximately $2.6 million.

This change in reimbursement is necessary in order to ensure Medicaid no longer pays for nonemergency services rendered in the emergency room setting.

A copy of this notice is now on file at the Indiana Government Center South, 402 West Washington Street, Room W451 and open for public inspection. Also, a copy of this notice is now available and may be inspected by contacting the local county division of family and children office, except in Marion County, where public inspection may be made at 402 West Washington Street, Room W374, Indianapolis, IN. Written comments may be directed to IFSSA, Office of Medicaid Policy and Planning, Attention: Pat Nolting, 402 West Washington Street, Room W374, P.O. Box 7083, Indianapolis, Indiana 46207-7083. Correspondence should be identified in the following manner: "COMMENT RE: HOSPITAL ER PAYMENT METHODOLOGY". Written comments received will be made available for public display at the address herein of the Office of Medicaid Policy and Planning.

Anne W. Murphy

Secretary

Family and Social Services Administration