SB 242 Indiana Senate · 2025 Regular Session

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