Section 470 IAC 11.1-2-2 - Covered hospital services; review and approvalAuthority: IC 12-13-2-3; IC 12-13-5-3
Affected: IC 12-16
Sec. 2.
(a) In-patient and out-patient hospital and physician services, when rendered in a hospital, are covered when such services are medically necessary for the treatment of a medical condition that manifested itself by symptoms of sufficient severity that the absence of immediate medical attention would probably result in: (1) placing the person's life in jeopardy;(2) serious impairment to bodily functions; or(3) serious dysfunction of any bodily organ or part.(b) A qualified resident of Indiana shall be eligible to receive assistance to pay for any part of the cost of care that is a direct consequence of the medical condition that necessitated the emergency care providing such care is rendered in the hospital. No post-hospital care shall be reimbursable under the hospital care for the indigent program.(c) Any costs of services rendered by a physician pursuant to the hospital care for the indigent program must conform to the global or single billing concept as defined in 405 IAC 1-7-1[ 405 IAC 1-7 was repealed filed Jul 25, 1997, 4:00 p.m.: 20 IR 3365.] and be included in the charges initially incurred by an eligible patient while hospitalized.(d) Any emergency medical transportation costs reasonably necessary to transport an eligible patient to a hospital for the treatment of a medical condition described in subsection (a), above, shall be reimbursed to said transportation provider if said provider is properly licensed in the state of Indiana to render the transportation service for which he seeks payment. The department shall not pay more to the transportation provider than the prevailing rate in the community for similar service.Division of Family Resources; 470 IAC 11.1-2-2; filed Dec 16, 1986, 3:35 p.m.: 10 IR 1077, eff Jan 1, 1987 [IC 4-22-2-36 suspends the effectiveness of a rule document for thirty (30) days after filing with the secretary of state. LSA Document #86-121 was filed Dec 16, 1986.]; filed Oct 3, 1997, 4:50 p.m.: 21 IR 376; readopted filed Jul 12, 2001, 1:40 p.m.: 24 IR 4235; readopted filed Oct 24, 2007, 11:25 a.m.: 20071121-IR-470070448RFA; readopted filed Aug 23, 2013, 3:36 p.m.: 20130918-IR-470130306RFA