Sec. 405 IAC 10-7-9 - Emergency room visits; copayments

ยง 405 IAC 10-7-9. Emergency room visits; copayments

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.

(Filed 5/18/2015, 12:34 p.m.: 20150617-IR-405140339FRA Filed 1/19/2018, 8:42 a.m.: 20180214-IR-405170484FRA Errata Filed 2/22/2018, 9:36 a.m: 20180307-IR-405180114ACA)

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