2007 Session

Budget Amendments - HB1650 (Member Request)

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Chief Patron: Hamilton
Reimbursement of Emergency Room Claims

Item 302 #1h

Item 302 #1h

First Year - FY2007 Second Year - FY2008
Health And Human Resources
Medical Assistance Services, Department of FY2007 $0 FY2008 $2,000,000 GF
FY2007 $0 FY2008 $2,000,000 NGF

Page 313, line 30, strike "$5,433,850,896" and insert "$5,437,850,896".
Page 333, after line 25, insert:  
"PPP.  The Department of Medical Assistance Services shall amend the State Plan for Medical Assistance Services to eliminate the requirement for pending and reviewing emergency room level 3 claims prior to payment.  The Department may adopt retrospective audit procedures for emergency claims similar to those used by private health care insurers."

(This amendment provides funding in the second year to offset savings assumed in the Department of Medical Assistance Services budget from pending and holding hospital emergency room claims prior to payment. Language is added to restrict this practice. Emergency room physicians have no choice in treating individuals who present in emergency rooms. Delay of payment for these level 3 Medicaid claims places an unreasonable financial burden on these providers. However, the Department may continue to retrospectively review and audit claims to ensure payments are appropriate and accurate.)