SB 242

Bill Subjects

Administrative Law; Generally Agencies; Family And Social Services Administration (Fssa) Health Care Facilities; Hospitals Health Care Professionals; Doctors And Physicians Health; Billing And Costs Health; Emergency Medical Services (Ems) Health; Medicaid Insurance; Health Insurance Insurance; Health Maintenance Organizations (Hmos)

Abstract

Requires the office of Medicaid policy and planning (office) or a managed care organization to promptly cover physician services rendered in a hospital emergency department by a physician who has entered into a provider agreement with the office or managed care organization, without limiting what constitutes an emergency medical condition. Specifies considerations that must be made in determining whether the prudent layperson standard has been met. Prohibits any delay in or denial of compensation to the physician unless the cause of the delay or denial is specifically provided for in: (1) the Medicaid managed care law; (2) an administrative rule adopted under the Medicaid managed care law; (3) the federal administrative rules on Medicaid managed care; or (4) the provider agreement. Prohibits a managed care organization from denying an emergency services claim solely because the claim code is not listed on the autopay list.