5111.163 Payment of nonsystem provider for emergency services.
5111.163 Payment of nonsystem provider for emergency services.
(A) As used in this section:
(1) “Emergency services” has the same meaning as in section 1932(b)(2) of the “Social Security Act,” 79 Stat. 286 (1965), 42 U.S.C. 1396u-2 (b)(2 ), as amended.
(2) “Medicaid managed care organization” has the same meaning as in section 5111.162 of the Revised Code.
(3) “Provider” means any person, institution, or entity that furnishes emergency services to a medicaid recipient enrolled in a medicaid managed care organization, regardless of whether the person, institution, or entity has a provider agreement with the department of job and family services pursuant to Title XIX of the “Social Security Act.”
(B) When a participant in the care management system established under section 5111.16 of the Revised Code is enrolled in a medicaid managed care organization and receives emergency services on or after January 1, 2007, from a provider that is not under contract with the organization, the provider shall accept from the organization, as payment in full, not more than the amounts (less any payments for indirect costs of medical education and direct costs of graduate medical education) that the provider could collect if the participant received medicaid other than through enrollment in a managed care organization.
Effective Date: 06-30-2006; 2007 HB119 09-29-2007