HB 1264 Summary

• Defines "screening services" to include professional emergency physician screening services provided under CPT codes 99281 through 99283 for Medicaid reimbursement purposes.

• Requires Medicaid risk-based managed care organizations to reimburse hospitals for emergency services and medically necessary screening services at 100% of current Medicaid fee-for-service reimbursement rates.

• Exempts from reimbursement requirements emergency services provided by contracted providers of the individual's Medicaid risk-based managed care organization.

• Makes the enrollee's risk-based managed care organization responsible for payment, while allowing subcontracting with other organizations to assume financial responsibility.

• Preserves managed care organizations' ability to review and determine medical necessity of emergency department services for coverage decisions.

• Effective July 1, 2010.