Directed Payment for Eligible Out-of-State Children’s Hospitals Sample Clauses

Directed Payment for Eligible Out-of-State Children’s Hospitals. The Contractor is required to reimburse inpatient hospital and outpatient hospital services provided by eligible out-of-state children’s hospitals at one hundred thirty percent (130%) of the Medicaid reimbursement rate. This applies to claims for Hoosier Healthwise members that are less than 19 years of age. Per 42 CFR § 440.20, outpatient hospital services mean preventive, diagnostic, therapeutic, rehabilitative, or palliative services that: ▪ (1) are furnished to outpatients;

Directed Payment for Eligible Out-of-State Children’s Hospitals. In accordance with House Enrolled Act (HEA) 1305, Indiana Medicaid will reimburse inpatient hospital and outpatient hospital services provided to HIP members less than 19 years of age by eligible out-of-state children’s hospitals at one hundred thirty percent (130%) of the Medicaid reimbursement rate. The HIP program requires the Contractor reimburse at Medicare rates. Therefore, the HIP directed payment supersedes. The Contractor should pay the out-of-state children’s hospitals using the HIP reimbursement methodology.