Indiana Administrative Code
Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES
Article 10 - HEALTHY INDIANA PLAN
Rule 7 - Benefits and Medical Policy
Section 7-9 - Emergency room visits; copayments

Universal Citation: 405 IN Admin Code 7-9

Current through September 18, 2024

Authority: IC 12-15-44.5-9

Affected: IC 12-15-44.5

Sec. 9.

(a) A member shall be subject to an eight dollar ($8) copayment for the member's nonemergency use of a hospital emergency department.

(b) The following members shall be exempt from paying the copayments described under subsection (a):

(1) Pregnant women.

(2) American Indians/Alaskan Natives.

(3) Individuals who meet the requirements of 405 IAC 10-10-3(f).

(c) The copayments described under subsection (a) shall not apply if:

(1) the member is found to have an emergency medical condition;

(2) the member is admitted to the hospital within twenty-four (24) hours of the emergency department visit; or

(3) the member contacted the member's managed care organization's twenty-four (24) hour nurse hotline prior to seeking services from a hospital emergency department regarding the emergency medical condition for which the member is seeking emergency department services.

(d) A hospital provider shall conduct an appropriate medical screening examination as provided under 42 U.S.C. 1395dd prior to rendering any medical services. If the provider determines that the member does not have an emergency medical condition, the provider shall inform the member of the informational requirements under 42 U.S.C. 1396o-1(e) prior to rendering any medical services.

(e) Hospital providers shall be responsible for collecting emergency room copayments incurred under this section.

(f) A member may not use the member's POWER account to pay for emergency room copayments incurred under this section.

Disclaimer: These regulations may not be the most recent version. Indiana may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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