Payment for Medicaid physician services.
Summary
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.
Bill status
in committee
1 of 4 stages cleared
Introduction
Jan 2025
Committee Review
Floor Vote
Governor
Introduced Jan 13, 2025
Last action Feb 6, 2025
Maddy AI version diff · 1 comparison
What changed between versions
Introduced Senate Bill (S)
→
Senate Bill (S)
·
4 edits
MODERATE
The bill was amended to clarify that Medicaid emergency services coverage cannot be limited by diagnosis codes and to strengthen protections for physicians providing emergency care. The changes expand protections against claim denials and delay compensation, ensuring coverage is based on symptoms rather than final diagnoses.
Scope change
The bill now explicitly prohibits limiting emergency medical conditions based solely on diagnosis codes and clarifies how the prudent layperson standard should be applied.
REQUIREMENT
Changed language from 'compensate' to 'cover' physician services to ensure broader protection against claim denials.
Added requirements that prudent layperson standard determinations must focus on symptoms presented rather than final diagnosis.
DEFINITION
Added explicit prohibition on limiting emergency medical conditions based solely on diagnosis codes.
ENFORCEMENT
Strengthened protections by removing specific references to delay/denial causes and replacing with broader language about what constitutes valid grounds for denial.
Floor votes
How they voted
No floor votes recorded yet.
Full legislative history
Actions timeline
Total actions
4
Key actions
1
Committee
1
Feb 6, 2025
Upper · Passed
Committee report: amend do pass adopted; reassigned to Committee on Appropriations
upper
2 primary · 0 co-sponsors
Sponsors
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