2015 Session

Budget Amendments - SB800 (Floor Approved)

View Budget Item
View Budget Item amendments

Eliminate ER Payment Reduction for Non-Emergency Claims

Item 301 #3s

Item 301 #3s

First Year - FY2015 Second Year - FY2016
Health and Human Resources
Department of Medical Assistance Services FY2015 $0 FY2016 $2,230,000 GF
FY2015 $0 FY2016 $2,230,000 NGF

Page 257, line 32, strike "$8,515,698,638" and insert "$8,520,158,638".
Page 281, after line 10, insert:
"OOOO.  The Department of Medical Assistance Services shall amend the State Plan for Medical Assistance Services to eliminate the requirement for pending, reviewing and reducing fees for emergency room claims for 99283 codes.  The department shall have the authority to implement this reimbursement change effective July 1, 2015, and prior to the completion of any regulatory process undertaken in order to effect such change."

(This amendment provides funding in the second year and adds language to offset savings assumed in the Department of Medical Assistance Services budget from pending and reducing payment for claims from emergency room physicians who treat Medicaid recipients when a retrospective review determines that the individuals could have received care in an outpatient setting. Emergency room physicians have no choice in treating individuals who present in emergency rooms and must do so as required by federal law. Reduction of payment for certain "non-emergency" Medicaid claims places an unreasonable financial burden on these providers.)