Section 405IAC10-7-9. Emergency room visits; copayments

   (a) Except as provided under subsection (g), a member shall be subject to an eight dollar ($8) copayment for the member's first nonemergency use of a hospital emergency department and a twenty-five dollar ($25) copayment for each subsequent nonemergency use of a hospital emergency department during the benefit period.

  (b) The following members shall be exempt from paying the copayments described under subsection (a) or (g):

(1) Pregnant women.

(2) American Indians/Alaskan Natives.

(3) Individuals who meet the requirements of 405 IAC 10-10-3(f).

  (c) The copayments described under subsection (a) shall not apply if:

(1) the member is found to have an emergency medical condition;

(2) the member is admitted to the hospital within twenty-four (24) hours of the emergency department visit; or

(3) the member contacted the member's insurer's twenty-four (24) hour nurse hotline prior to seeking services from a hospital emergency department regarding the emergency medical condition for which the member is seeking emergency department services.

  (d) A hospital provider shall conduct an appropriate medical screening examination as provided under 42 U.S.C. 1395dd prior to rendering any medical services. If the provider determines that the member does not have an emergency medical condition, the provider shall inform the member of the informational requirements under 42 U.S.C. 1396o-1(e) prior to rendering any medical services.

  (e) Hospital providers shall be responsible for collecting emergency room copayments incurred under this section.

  (f) A member may not use the member's POWER account to pay for emergency room copayments incurred under this section.

  (g) Effective through January 31, 2017, and under the approval of the Centers for Medicare and Medicaid Services, the office may exempt randomly selected members from the graduated copayment requirement described in subsection (a). This group shall consist of no fewer than five thousand (5,000) members. Such members shall be subject to an eight dollar ($8) copayment for each nonemergency use of a hospital emergency department during the benefit period. Subsections (b) through (f) shall apply to this group. (Office of the Secretary of Family and Social Services; 405 IAC 10-7-9; filed May 18, 2015, 12:34 p.m.: 20150617-IR-405140339FRA)