IN
Indiana Senate Bill SB0242

Indiana 2025 Regular Session

Indiana Senate Bill SB0242 Compare Versions

OldNewDifferences
1-*SB0242.1*
2-February 7, 2025
1+
2+Introduced Version
33 SENATE BILL No. 242
44 _____
5-DIGEST OF SB 242 (Updated February 5, 2025 12:34 pm - DI 104)
6-Citations Affected: IC 12-15.
7-Synopsis: Payment for Medicaid physician services. Requires the
8-office of Medicaid policy and planning (office) or a managed care
9-organization to promptly cover physician services rendered in a
10-hospital emergency department by a physician who has entered into a
11-provider agreement with the office or managed care organization,
12-without limiting what constitutes an emergency medical condition.
13-Specifies considerations that must be made in determining whether the
14-prudent layperson standard has been met. Prohibits any delay in or
15-denial of compensation to the physician unless the cause of the delay
16-or denial is specifically provided for in: (1) the Medicaid managed care
17-law; (2) an administrative rule adopted under the Medicaid managed
18-care law; (3) the federal administrative rules on Medicaid managed
19-care; or (4) the provider agreement. Prohibits a managed care
20-organization from denying an emergency services claim solely because
21-the claim code is not listed on the autopay list.
5+DIGEST OF INTRODUCED BILL
6+Citations Affected: IC 12-15-12-24.
7+Synopsis: Payment for Medicaid physician services claims. Provides
8+that if a physician has entered into a provider agreement with the office
9+of Medicaid policy and planning (office) or a managed care
10+organization and the physician, subject to the provider agreement,
11+provides physician services to individuals participating in the state
12+Medicaid program, the office or the managed care organization shall
13+promptly compensate the physician for the physician services rendered
14+in the emergency department of a hospital in accordance with the
15+provider agreement. Requires a managed care organization to
16+reimburse the physician in accordance with an autopay list published
17+by the office. Prohibits any delay in or denial of compensation to the
18+physician unless the cause of the delay or denial is specifically
19+provided for in: (1) the Medicaid managed care law; (2) an
20+administrative rule adopted under the Medicaid managed care law; (3)
21+the federal administrative rules on Medicaid managed care; or (4) the
22+provider agreement. Prohibits a managed care organization from
23+denying an emergency services claim solely because the claim code is
24+not listed on the autopay list.
2225 Effective: July 1, 2025.
23-Johnson T, Busch
26+Johnson T
2427 January 13, 2025, read first time and referred to Committee on Health and Provider
2528 Services.
26-February 6, 2025, amended, reported favorably — Do Pass; reassigned to Committee on
27-Appropriations.
28-SB 242—LS 6673/DI 147 February 7, 2025
29+2025 IN 242—LS 6673/DI 147 Introduced
2930 First Regular Session of the 124th General Assembly (2025)
3031 PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
3132 Constitution) is being amended, the text of the existing provision will appear in this style type,
3233 additions will appear in this style type, and deletions will appear in this style type.
3334 Additions: Whenever a new statutory provision is being enacted (or a new constitutional
3435 provision adopted), the text of the new provision will appear in this style type. Also, the
3536 word NEW will appear in that style type in the introductory clause of each SECTION that adds
3637 a new provision to the Indiana Code or the Indiana Constitution.
3738 Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts
3839 between statutes enacted by the 2024 Regular Session of the General Assembly.
3940 SENATE BILL No. 242
4041 A BILL FOR AN ACT to amend the Indiana Code concerning
4142 human services.
4243 Be it enacted by the General Assembly of the State of Indiana:
4344 1 SECTION 1. IC 12-15-12-24 IS ADDED TO THE INDIANA
4445 2 CODE AS A NEW SECTION TO READ AS FOLLOWS
4546 3 [EFFECTIVE JULY 1, 2025]: Sec. 24. (a) This section applies after
4647 4 June 30, 2026.
4748 5 (b) As used in this section, "office" refers to the office of
4849 6 Medicaid policy and planning established by IC 12-8-6.5-1.
4950 7 (c) If:
5051 8 (1) a physician has entered into a provider agreement with:
5152 9 (A) the office; or
5253 10 (B) a managed care organization;
5354 11 under IC 12-15-11-4(a) for the provision of physician services;
5455 12 and
5556 13 (2) the physician, subject to the provider agreement referred
5657 14 to in subdivision (1), provides physician services to individuals
5758 15 participating in the state Medicaid program;
58-16 the office or the managed care organization shall cover physician
59-17 services rendered in a hospital emergency department without
60-SB 242—LS 6673/DI 147 2
61-1 limiting what constitutes an emergency medical condition based
62-2 solely on the diagnosis code. Any determination of whether the
63-3 prudent layperson standard has been met must be based on the
64-4 relevant medical documentation, with a focus on the symptoms
65-5 presented by the individual, and not solely based on the final
66-6 diagnosis.
67-7 (d) A physician's compensation under subsection (c) shall not be
68-8 delayed due to the retrospective review of the medical services
69-9 provided or for any other reason unless the cause of the delay is
70-10 specifically provided for in:
71-11 (1) this article;
72-12 (2) a rule adopted under this article;
73-13 (3) 42 CFR 438; or
74-14 (4) the provider agreement referred to in subsection (c)(1).
75-15 (e) A physician shall not be denied compensation for physician
76-16 services rendered in the emergency department of a hospital to
77-17 which subsection (c) applies unless the cause of the denial is
78-18 specifically provided for in:
79-19 (1) this article;
80-20 (2) a rule adopted under this article;
81-21 (3) 42 CFR 438; or
82-22 (4) the provider agreement referred to in subsection (c)(1).
83-23 (f) A managed care organization:
84-24 (1) may not deny a claim solely because the claim code is not
85-25 included on the office's autopay list; and
86-26 (2) shall consider each claim based on the prudent layperson
87-27 standard.
88-SB 242—LS 6673/DI 147 3
89-COMMITTEE REPORT
90-Mr. President: The Senate Committee on Health and Provider
91-Services, to which was referred Senate Bill No. 242, has had the same
92-under consideration and begs leave to report the same back to the
93-Senate with the recommendation that said bill be AMENDED as
94-follows:
95-Page 1, line 16, delete "promptly" and insert "cover physician
96-services rendered in a hospital emergency department without
97-limiting what constitutes an emergency medical condition based
98-solely on the diagnosis code. Any determination of whether the
99-prudent layperson standard has been met must be based on the
100-relevant medical documentation, with a focus on the symptoms
101-presented by the individual, and not solely based on the final
102-diagnosis.".
103-Page 1, delete line 17.
104-Page 2, delete lines 1 through 4.
105-and when so amended that said bill do pass and be reassigned to the
106-Senate Committee on Appropriations.
107-(Reference is to SB 242 as introduced.)
108-CHARBONNEAU, Chairperson
109-Committee Vote: Yeas 12, Nays 0.
110-SB 242—LS 6673/DI 147
59+16 the office or the managed care organization shall promptly
60+17 compensate the physician for the physician services rendered in the
61+2025 IN 242—LS 6673/DI 147 2
62+1 emergency department of a hospital in accordance with the
63+2 provider agreement. A managed care organization shall reimburse
64+3 the physician in accordance with an autopay list published by the
65+4 office.
66+5 (d) A physician's compensation under subsection (c) shall not be
67+6 delayed due to the retrospective review of the medical services
68+7 provided or for any other reason unless the cause of the delay is
69+8 specifically provided for in:
70+9 (1) this article;
71+10 (2) a rule adopted under this article;
72+11 (3) 42 CFR 438; or
73+12 (4) the provider agreement referred to in subsection (c)(1).
74+13 (e) A physician shall not be denied compensation for physician
75+14 services rendered in the emergency department of a hospital to
76+15 which subsection (c) applies unless the cause of the denial is
77+16 specifically provided for in:
78+17 (1) this article;
79+18 (2) a rule adopted under this article;
80+19 (3) 42 CFR 438; or
81+20 (4) the provider agreement referred to in subsection (c)(1).
82+21 (f) A managed care organization:
83+22 (1) may not deny a claim solely because the claim code is not
84+23 included on the office's autopay list; and
85+24 (2) shall consider each claim based on the prudent layperson
86+25 standard.
87+2025 IN 242—LS 6673/DI 147