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HOUSE BILL No. 1477

Citations Affected: IC 12-15-11.

Synopsis: Provider direct billing of Medicaid recipients. Allows a Medicaid provider to contract with a Medicaid recipient before a service is provided to bill the Medicaid recipient directly instead of Medicaid for providing services to the Medicaid recipient for specified office visits.

Effective: July 1, 2011.

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Brown T

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    January 20, 2011, read first time and referred to Committee on Public Health.

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PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana Constitution) is being amended, the text of the existing provision will appear in this style type, additions will appear in this style type, and deletions will appear in this style type.
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Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts between statutes enacted by the 2010 Regular Session of the General Assembly.

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    A BILL FOR AN ACT to amend the Indiana Code concerning Medicaid.

SOURCE: IC 12-15-11-3; (11)IN1477.1.1. -->     SECTION 1. IC 12-15-11-3 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2011]: Sec. 3. A provider agreement must do the following:
        (1) Include information that the office determines necessary to facilitate carrying out of IC 12-15.
        (2) Except as provided in section 3.5 of this chapter, prohibit the provider from requiring payment from a recipient of Medicaid, except where a copayment is required by law.

SOURCE: IC 12-15-11-3.5; (11)IN1477.1.2. -->     SECTION 2. IC 12-15-11-3.5 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2011]: Sec. 3.5. (a) Notwithstanding any other law, before a service is provided, a provider may contract with a Medicaid recipient in writing to charge the Medicaid recipient directly for services instead of billing the Medicaid program if the services are for the following Current Procedural Terminology (CPT) office visit diagnostic codes described in the Current Procedural Terminology Manual published annually by

the American Medical Association:
        (1) CPT code 99211 or its subsequent code.
        (2) CPT code 99212 or its subsequent code.
        (3) CPT code 99213 or its subsequent code.
        (4) CPT code 99214 or its subsequent code.
        (5) CPT code 99215 or its subsequent code.
    (b) The contract described in subsection (a) must satisfy the following requirements:
        (1) Be in writing.
        (2) Specify each service covered by the contract and state the date that the service is being provided.
        (3) Specify the dollar amount charged for each service and the total amount owed.
     (c) A Medicaid provider who enters into a contract with a Medicaid recipient under subsection (a):
        (1) does not commit fraud or abuse solely by entering into a contract described in this section; and
        (2) is considered a Medicaid provider for purposes of providing services not specified in the contract and covered under the Medicaid program.