Bill Text: IN HB1327 | 2013 | Regular Session | Amended
Bill Title: Hospital and health facility assessment fees.
Spectrum: Partisan Bill (Republican 2-0)
Status: (Introduced - Dead) 2013-01-28 - Representative Davisson added as coauthor [HB1327 Detail]
Download: Indiana-2013-HB1327-Amended.html
Citations Affected: IC 12-8; IC 12-15; IC 16-21; IC 16-28.
Synopsis: Hospital and health facility assessment fees. Extends the
hospital assessment fee. (Under current law, the fee expires on June 30,
2013.) Extends the health facility quality assessment fee. (Under
current law, the fee expires on June 30, 2014.) Repeals a provision that
provides for the expiration of the health facility quality assessment fee.
Updates statutory references to the hospital assessment fee.
Effective: Upon passage.
January 17, 2013, read first time and referred to Committee on Public Health.
January 24, 2013, reported _ Do Pass. Referred to Committee on Ways and Means
pursuant to Rule 127.
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A BILL FOR AN ACT to amend the Indiana Code concerning
health.
(b) Notwithstanding the expiration of SECTION 281, the office of Medicaid policy and planning may:
(1) collect an unpaid hospital assessment fee under SECTION 281 owed by a hospital;
(2) refund a hospital assessment fee paid by the hospital under SECTION 281;
(3) make payments for programs described in subsection (f) of SECTION 281; and
(4) make distributions to hospitals under subsection (m) of SECTION 281;
at any time, including after the expiration of SECTION 281.
(c) The office of Medicaid policy and planning may:
(1) collect an unpaid hospital assessment fee under
IC 16-21-10 owed by a hospital;
(2) refund a hospital assessment fee paid by a hospital under
IC 16-21-10;
(3) make payments for programs described in
IC 16-21-10-8(a); and
(4) make distributions to a hospital under IC 16-21-10-11;
at any time.
(1) licensed under IC 16-21; and
(2) established and operated under IC 16-22-2, IC 16-22-8, or IC 16-23.
This section does not apply during the period that the office is assessing a hospital fee authorized by
(b) For a state fiscal year ending after June 30, 2003, in addition to reimbursement received under section 1 of this chapter, a hospital is entitled to reimbursement in an amount calculated as follows:
STEP ONE: The office shall identify the aggregate inpatient hospital services, reimbursable under this article and under the state Medicaid plan, that were provided during the state fiscal year by hospitals established and operated under IC 16-22-2, IC 16-22-8, or IC 16-23.
STEP TWO: For the aggregate inpatient hospital services identified under STEP ONE, the office shall calculate the aggregate payments made under this article and under the state Medicaid plan to hospitals established and operated under IC 16-22-2, IC 16-22-8, or IC 16-23, excluding payments under IC 12-15-16, IC 12-15-17, and IC 12-15-19.
STEP THREE: The office shall calculate a reasonable estimate of the amount that would have been paid in the aggregate by the office for the inpatient hospital services described in STEP ONE under Medicare payment principles.
STEP FOUR: Subtract the amount calculated under STEP TWO from the amount calculated under STEP THREE.
STEP FIVE: Subject to subsection (g), from the amount calculated under STEP FOUR, allocate to a hospital established and operated under IC 16-22-8 an amount not to exceed one hundred percent (100%) of the difference between:
(A) the total cost for the hospital's provision of inpatient services covered under this article for the hospital's fiscal year
ending during the state fiscal year; and
(B) the total payment to the hospital for its provision of
inpatient services covered under this article for the hospital's
fiscal year ending during the state fiscal year, excluding
payments under IC 12-15-16, IC 12-15-17, and IC 12-15-19.
STEP SIX: Subtract the amount calculated under STEP FIVE
from the amount calculated under STEP FOUR.
STEP SEVEN: Distribute an amount equal to the amount
calculated under STEP SIX to the eligible hospitals established
and operated under IC 16-22-2 or IC 16-23 described in
subsection (c) in an amount not to exceed each hospital's
Medicaid shortfall as defined in subsection (f).
(c) Subject to subsection (e), reimbursement for a state fiscal year
under this section consists of payments made after the close of each
state fiscal year. A hospital is not eligible for a payment described in
this subsection unless an intergovernmental transfer or certification of
expenditures is made under subsection (d).
(d) Subject to subsection (e):
(1) an intergovernmental transfer may be made by or on behalf of
the hospital; or
(2) a certification of expenditures as eligible for federal financial
participation may be made;
after the close of each state fiscal year. An intergovernmental transfer
under this subsection must be made to the Medicaid indigent care trust
fund in an amount equal to a percentage, as determined by the office,
of the amount to be distributed to the hospital under this section. The
office shall use the intergovernmental transfer to fund payments made
under this section.
(e) A hospital that makes a certification of expenditures or makes or
has an intergovernmental transfer made on the hospital's behalf under
this section may appeal under IC 4-21.5 the amount determined by the
office to be paid the hospital under subsection (b). The periods
described in subsections (c) and (d) for the hospital or another entity to
make an intergovernmental transfer or certification of expenditures are
tolled pending the administrative appeal and any judicial review
initiated by the hospital under IC 4-21.5. The distribution to other
hospitals under subsection (b) may not be delayed due to an
administrative appeal or judicial review instituted by a hospital under
this subsection. If necessary, the office may make a partial distribution
to the other eligible hospitals under subsection (b) pending the
completion of a hospital's administrative appeal or judicial review, at
which time the remaining portion of the payments due to the eligible
hospitals shall be made. A partial distribution may be based upon
estimates and trends calculated by the office.
(f) For purposes of this section:
(1) the Medicaid shortfall of a hospital established and operated
under IC 16-22-2 or IC 16-23 is calculated as follows:
STEP ONE: The office shall identify the inpatient hospital
services, reimbursable under this article and under the state
Medicaid plan, that were provided during the state fiscal year
by the hospital.
STEP TWO: For the inpatient hospital services identified
under STEP ONE, the office shall calculate the payments
made under this article and under the state Medicaid plan to
the hospital, excluding payments under IC 12-15-16,
IC 12-15-17, and IC 12-15-19.
STEP THREE: The office shall calculate a reasonable estimate
of the amount that would have been paid by the office for the
inpatient hospital services described in STEP ONE under
Medicare payment principles; and
(2) a hospital's Medicaid shortfall is equal to the amount by which
the amount calculated in STEP THREE of subdivision (1) is
greater than the amount calculated in STEP TWO of subdivision
(1).
(g) The actual distribution of the amount calculated under STEP
FIVE of subsection (b) to a hospital established and operated under
IC 16-22-8 shall be made under the terms and conditions provided for
the hospital in the state plan for medical assistance. Payment to a
hospital under STEP FIVE of subsection (b) is not a condition
precedent to the tender of payments to hospitals under STEP SEVEN
of subsection (b).
(1) licensed under IC 16-21; and
(2) established and operated under IC 16-22-2, IC 16-22-8, or IC 16-23.
This section does not apply during the period that the office is assessing a hospital fee authorized by
(b) For a state fiscal year ending after June 30, 2003, in addition to reimbursement received under section 1 of this chapter, a hospital is entitled to reimbursement in an amount calculated as follows:
STEP ONE: The office shall identify the aggregate outpatient
hospital services, reimbursable under this article and under the
state Medicaid plan, that were provided during the state fiscal
year by hospitals established and operated under IC 16-22-2,
IC 16-22-8, or IC 16-23.
STEP TWO: For the aggregate outpatient hospital services
identified under STEP ONE, the office shall calculate the
aggregate payments made under this article and under the state
Medicaid plan to hospitals established and operated under
IC 16-22-2, IC 16-22-8, or IC 16-23, excluding payments under
IC 12-15-16, IC 12-15-17, and IC 12-15-19.
STEP THREE: The office shall calculate a reasonable estimate of
the amount that would have been paid in the aggregate by the
office under Medicare payment principles for the outpatient
hospital services described in STEP ONE.
STEP FOUR: Subtract the amount calculated under STEP TWO
from the amount calculated under STEP THREE.
STEP FIVE: Subject to subsection (g), from the amount
calculated under STEP FOUR, allocate to a hospital established
and operated under IC 16-22-8 an amount not to exceed one
hundred percent (100%) of the difference between:
(A) the total cost for the hospital's provision of outpatient
services covered under this article for the hospital's fiscal year
ending during the state fiscal year; and
(B) the total payment to the hospital for its provision of
outpatient services covered under this article for the hospital's
fiscal year ending during the state fiscal year, excluding
payments under IC 12-15-16, IC 12-15-17, and IC 12-15-19.
STEP SIX: Subtract the amount calculated under STEP FIVE
from the amount calculated under STEP FOUR.
STEP SEVEN: Distribute an amount equal to the amount
calculated under STEP SIX to the eligible hospitals established
and operated under IC 16-22-2 or IC 16-23 described in
subsection (c) in an amount not to exceed each hospital's
Medicaid shortfall as defined in subsection (f).
(c) A hospital is not eligible for a payment described in this section
unless:
(1) an intergovernmental transfer is made by the hospital or on
behalf of the hospital; or
(2) the hospital or another entity certifies the hospital's
expenditures as eligible for federal financial participation.
(d) Subject to subsection (e):
(1) an intergovernmental transfer may be made by or on behalf of
the hospital; or
(2) a certification of expenditures as eligible for federal financial
participation may be made;
after the close of each state fiscal year. An intergovernmental transfer
under this subsection must be made to the Medicaid indigent care trust
fund in an amount equal to a percentage, as determined by the office,
of the amount to be distributed to the hospital under subsection (b). The
office shall use the intergovernmental transfer to fund payments made
under this section.
(e) A hospital that makes a certification of expenditures or makes or
has an intergovernmental transfer made on the hospital's behalf under
this section may appeal under IC 4-21.5 the amount determined by the
office to be paid by the hospital under subsection (b). The periods
described in subsections (c) and (d) for the hospital or other entity to
make an intergovernmental transfer or certification of expenditures are
tolled pending the administrative appeal and any judicial review
initiated by the hospital under IC 4-21.5. The distribution to other
hospitals under subsection (b) may not be delayed due to an
administrative appeal or judicial review instituted by a hospital under
this subsection. If necessary, the office may make a partial distribution
to the other eligible hospitals under subsection (b) pending the
completion of a hospital's administrative appeal or judicial review, at
which time the remaining portion of the payments due to the eligible
hospitals must be made. A partial distribution may be calculated by the
office based upon estimates and trends.
(f) For purposes of this section:
(1) the Medicaid shortfall of a hospital established and operated
under IC 16-22-2 or IC 16-23 is calculated as follows:
STEP ONE: The office shall identify the outpatient hospital
services, reimbursable under this article and under the state
Medicaid plan, that were provided during the state fiscal year
by the hospital.
STEP TWO: For the outpatient hospital services identified
under STEP ONE, the office shall calculate the payments
made under this article and under the state Medicaid plan to
the hospital, excluding payments under IC 12-15-16,
IC 12-15-17, and IC 12-15-19.
STEP THREE: The office shall calculate a reasonable estimate
of the amount that would have been paid by the office for the
outpatient hospital services described in STEP ONE under
Medicare payment principles; and
(2) a hospital's Medicaid shortfall is equal to the amount by which
the amount calculated in STEP THREE of subdivision (1) is
greater than the amount calculated in STEP TWO of subdivision
(1).
(g) The actual distribution of the amount calculated under STEP
FIVE of subsection (b) to a hospital established and operated under
IC 16-22-8 shall be made under the terms and conditions provided for
the hospital in the state plan for medical assistance. Payment to a
hospital under STEP FIVE of subsection (b) is not a condition
precedent to the tender of payments to hospitals under STEP SEVEN
of subsection (b).
(1) is licensed under IC 16-21;
(2) is not a unit of state or local government; and
(3) is not owned or operated by a unit of state or local government.
This section does not apply during the period that the office is assessing a hospital fee authorized by
(b) For a state fiscal year ending after June 30, 2003, and before July 1, 2007, in addition to reimbursement received under section 1 of this chapter, a hospital eligible under this section is entitled to reimbursement in an amount calculated as follows:
STEP ONE: The office shall identify the total inpatient hospital services and the total outpatient hospital services, reimbursable under this article and under the state Medicaid plan, that were provided during the state fiscal year by the hospitals described in subsection (a).
STEP TWO: For the total inpatient hospital services and the total outpatient hospital services identified under STEP ONE, the office shall calculate the aggregate payments made under this article and under the state Medicaid plan to hospitals described in subsection (a), excluding payments under IC 12-15-16, IC 12-15-17, and IC 12-15-19.
STEP THREE: The office shall calculate a reasonable estimate of the amount that would have been paid in the aggregate by the office for the inpatient hospital services and the outpatient hospital services identified in STEP ONE under Medicare payment principles.
STEP FOUR: Subtract the amount calculated under STEP TWO from the amount calculated under STEP THREE.
STEP FIVE: Distribute an amount equal to the amount calculated under STEP FOUR to the eligible hospitals described in subsection (a) as follows:
(A) Subject to the availability of funds under IC 12-15-20-2(8)(D) to serve as the nonfederal share of such payment, the first ten million dollars ($10,000,000) of the amount calculated under STEP FOUR for a state fiscal year shall be paid to a hospital described in subsection (a) that has more than sixty thousand (60,000) Medicaid inpatient days.
(B) Following the payment to the hospital under clause (A) and subject to the availability of funds under IC 12-15-20-2(8)(D) to serve as the nonfederal share of such payments, the remaining amount calculated under STEP FOUR for a state fiscal year shall be paid to all hospitals described in subsection (a). The payments shall be made on a pro rata basis based on the hospitals' Medicaid inpatient days or other payment methodology approved by the Centers for Medicare and Medicaid Services. For purposes of this clause, a hospital's Medicaid inpatient days are the hospital's in-state and paid Medicaid fee for service and managed care days for the state fiscal year for which services are identified under STEP ONE, as determined by the office.
(C) Subject to IC 12-15-20.7, in the event the entirety of the amount calculated under STEP FOUR is not distributed following the payments made under clauses (A) and (B), the remaining amount may be paid to hospitals described in subsection (a) that are eligible under this clause. A hospital is eligible for a payment under this clause only if the nonfederal share of the hospital's payment is provided by or on behalf of the hospital. The remaining amount shall be paid to those eligible hospitals:
(i) on a pro rata basis in relation to all hospitals eligible under this clause based on the hospitals' Medicaid inpatient days; or
(ii) other payment methodology determined by the office and approved by the Centers for Medicare and Medicaid Services.
(c) As used in this subsection, "Medicaid supplemental payments" means Medicaid payments for hospitals that are in addition to Medicaid fee-for-service payments, Medicaid risk-based managed care payments, and Medicaid disproportionate share payments, and that are included in the Medicaid state plan, including Medicaid safety-net payments,
and payments made under this section and sections 1.1, 1.3, 9, and 9.5
of this chapter. For a state fiscal year ending after June 30, 2007, in
addition to the reimbursement received under section 1 of this chapter,
a hospital eligible under this section is entitled to reimbursement in an
amount calculated as follows:
STEP ONE: The office shall identify the total inpatient hospital
services and the total outpatient hospital services reimbursable
under this article and under the state Medicaid plan that were
provided during the state fiscal year for all hospitals described in
subsection (a).
STEP TWO: For the total inpatient hospital services and the total
outpatient hospital services identified in STEP ONE, the office
shall calculate the total payments made under this article and
under the state Medicaid plan to all hospitals described in
subsection (a). A calculation under this STEP excludes a payment
made under the following:
(A) IC 12-15-16.
(B) IC 12-15-17.
(C) IC 12-15-19.
STEP THREE: The office shall calculate, under Medicare
payment principles, a reasonable estimate of the total amount that
would have been paid by the office for the inpatient hospital
services and the outpatient hospital services identified in STEP
ONE.
STEP FOUR: Subtract the amount calculated under STEP TWO
from the amount calculated under STEP THREE.
STEP FIVE: Distribute an amount equal to the amount calculated
under STEP FOUR to the eligible hospitals described in
subsection (a) as follows:
(A) As used in this clause, "Medicaid inpatient days" are the
hospital's in-state paid Medicaid fee for service and risk-based
managed care days for the state fiscal year for which services
are identified under STEP ONE, as determined by the office.
Subject to the availability of funds transferred to the Medicaid
indigent care trust fund under STEP FOUR of
IC 12-16-7.5-4.5(c) and remaining in the Medicaid indigent
care trust fund under IC 12-15-20-2(8)(G) to serve as the
nonfederal share of the payments, the amount calculated under
STEP FOUR for a state fiscal year shall be paid to all hospitals
described in subsection (a). The payments shall be made on a
pro rata basis, based on the hospitals' Medicaid inpatient days
or in accordance with another payment methodology
determined by the office and approved by the Centers for
Medicare and Medicaid Services.
(B) Subject to IC 12-15-20.7, if the entire amount calculated
under STEP FOUR is not distributed following the payments
made under clause (A), the remaining amount shall be paid as
described in clauses (C) and (D) to a hospital that is described
in subsection (a) and that is described as eligible under this
clause. A hospital is eligible for a payment under clause (C)
only if the hospital:
(i) has less than sixty thousand (60,000) Medicaid inpatient
days annually;
(ii) was eligible for Medicaid disproportionate share hospital
payments in the state fiscal year ending June 30, 1998, or
the hospital met the office's Medicaid disproportionate share
payment criteria based upon state fiscal year 1998 data and
received a Medicaid disproportionate share payment for the
state fiscal year ending June 30, 2001; and
(iii) received a Medicaid disproportionate share payment
under IC 12-15-19-2.1 for state fiscal years 2001, 2002,
2003, and 2004.
The payment amount under clause (C) for an eligible hospital
is subject to the availability of the nonfederal share of the
hospital's payment being provided by the hospital or on behalf
of the hospital.
(C) For state fiscal years ending after June 30, 2007, but
before July 1, 2009, payments to eligible hospitals described
in clause (B) shall be made as follows:
(i) The payment to an eligible hospital that merged two (2)
hospitals under a single Medicaid provider number effective
January 1, 2004, shall equal one hundred percent (100%) of
the hospital's hospital-specific limit for the state fiscal year
ending June 30, 2005, when the payment is combined with
any Medicaid disproportionate share payment made under
IC 12-15-19-2.1, Medicaid, and other Medicaid
supplemental payments, paid or to be paid to the hospital for
a state fiscal year.
(ii) The payment to an eligible hospital described in clause
(B) other than a hospital described in item (i) shall equal one
hundred percent (100%) of the hospital's hospital specific
limit for the state fiscal year ending June 30, 2004, when the
payment is combined with any Medicaid disproportionate
share payment made under IC 12-15-19-2.1, Medicaid, and
other Medicaid supplemental payments, paid or to be paid
to the hospital for a state fiscal year.
(D) For state fiscal years beginning after June 30, 2009,
payments to an eligible hospital described in clause (B) shall
be made in a manner determined by the office.
(E) Subject to IC 12-15-20.7, if the entire amount calculated
under STEP FOUR is not distributed following the payments
made under clause (A) and clauses (C) or (D), the remaining
amount may be paid as described in clause (F) to a hospital
described in subsection (a) that is described as eligible under
this clause. A hospital is eligible for a payment for a state
fiscal year under clause (F) if the hospital:
(i) is eligible to receive Medicaid disproportionate share
payments for the state fiscal year for which the Medicaid
disproportionate share payment is attributable under
IC 12-15-19-2.1, for a state fiscal year ending after June 30,
2007; and
(ii) does not receive a payment under clauses (C) or (D) for
the state fiscal year.
A payment to a hospital under this clause is subject to the
availability of nonfederal matching funds.
(F) Payments to eligible hospitals described in clause (E) shall
be made:
(i) to best use federal matching funds available for hospitals
that are eligible for Medicaid disproportionate share
payments under IC 12-15-19-2.1; and
(ii) by using a methodology that allocates available funding
under this clause, Medicaid supplemental payments, and
payments under IC 12-15-19-2.1, in a manner in which all
hospitals eligible under clause (E) receive payments in a
manner that takes into account the situation of eligible
hospitals that have historically qualified for Medicaid
disproportionate share payments and ensures that payments
for eligible hospitals are equitable.
(G) If the Centers for Medicare and Medicaid Services does
not approve the payment methodologies in clauses (A) through
(F), the office may implement alternative payment
methodologies that are eligible for federal financial
participation to implement a program consistent with the
payments for hospitals described in clauses (A) through (F).
(d) A hospital described in subsection (a) may appeal under
IC 4-21.5 the amount determined by the office to be paid to the hospital
under STEP FIVE of subsections (b) or (c). The distribution to other
hospitals under STEP FIVE of subsection (b) or (c) may not be delayed
due to an administrative appeal or judicial review instituted by a
hospital under this subsection. If necessary, the office may make a
partial distribution to the other eligible hospitals under STEP FIVE of
subsection (b) or (c) pending the completion of a hospital's
administrative appeal or judicial review, at which time the remaining
portion of the payments due to the eligible hospitals shall be made. A
partial distribution may be based on estimates and trends calculated by
the office.
(b) If the office determines that payments made under section 1.5(b) STEP FIVE (A) of this chapter will not be approved for federal financial participation, the office may make alternative payments to payments under section 1.5(b) STEP FIVE (A) of this chapter if:
(1) the payments for a state fiscal year are made only to a hospital that would have been eligible for a payment for that state fiscal year under section 1.5(b) STEP FIVE (A) of this chapter; and
(2) the payments for a state fiscal year to each hospital are an amount that is as equal as possible to the amount each hospital would have received under section 1.5(b) STEP FIVE (A) of this chapter for that state fiscal year.
(c) If the office determines that payments made under section 1.5(b) STEP FIVE (B) of this chapter will not be approved for federal financial participation, the office may make alternative payments to payments under section 1.5(b) STEP FIVE (B) of this chapter if:
(1) the payments for a state fiscal year are made only to a hospital that would have been eligible for a payment for that state fiscal year under section 1.5(b) STEP FIVE (B) of this chapter; and
(2) the payments for a state fiscal year to each hospital are an amount that is as equal as possible to the amount each hospital would have received under section 1.5(b) STEP FIVE (B) of this chapter for that state fiscal year.
(d) If the office determines that payments made under section 1.5(b)
STEP FIVE (C) of this chapter will not be approved for federal
financial participation, the office may make alternative payments to
payments under section 1.5(b) STEP FIVE (C) of this chapter if:
(1) the payments for a state fiscal year are made only to a hospital
that would have been eligible for a payment for that state fiscal
year under section 1.5(b) STEP FIVE (C) of this chapter; and
(2) the payments for a state fiscal year to each hospital are an
amount that is as equal as possible to the amount each hospital
would have received under section 1.5(b) STEP FIVE (C) of this
chapter for that state fiscal year.
(e) If the office determines, based on information received from the
United States Centers for Medicare and Medicaid Services, that
payments made under subsection (b), (c), or (d) will not be approved
for federal financial participation, the office shall use the funds that
would have served as the nonfederal share of these payments for a state
fiscal year to serve as the nonfederal share of a payment program for
hospitals to be established by the office. The payment program must
distribute payments to hospitals for a state fiscal year based upon a
methodology determined by the office to be equitable under the
circumstances.
(1) who is a resident of the county;
(2) who is not a resident of the county and for whom the onset of the medical condition that necessitated the care occurred in the county; or
(3) whose residence cannot be determined by the division and for whom the onset of the medical condition that necessitated the care occurred in the county.
This section does not apply during the period that the office is assessing a hospital fee authorized by
(b) For each state fiscal year ending after June 30, 2003, and before July 1, 2007, a hospital licensed under IC 16-21-2 that submits to the division during the state fiscal year a payable claim under IC 12-16-7.5 is entitled to a payment under subsection (c).
(c) Except as provided in section 9.8 of this chapter and subject to
section 9.6 of this chapter, for a state fiscal year, the office shall pay to
a hospital referred to in subsection (b) an amount equal to the amount,
based on information obtained from the division and the calculations
and allocations made under IC 12-16-7.5-4.5, that the office determines
for the hospital under STEP SIX of the following STEPS:
STEP ONE: Identify:
(A) each hospital that submitted to the division one (1) or
more payable claims under IC 12-16-7.5 during the state fiscal
year; and
(B) the county to which each payable claim is attributed.
STEP TWO: For each county identified in STEP ONE, identify:
(A) each hospital that submitted to the division one (1) or
more payable claims under IC 12-16-7.5 attributed to the
county during the state fiscal year; and
(B) the total amount of all hospital payable claims submitted
to the division under IC 12-16-7.5 attributed to the county
during the state fiscal year.
STEP THREE: For each county identified in STEP ONE, identify
the amount of county funds transferred to the Medicaid indigent
care trust fund under IC 12-16-7.5-4.5.
STEP FOUR: For each hospital identified in STEP ONE, with
respect to each county identified in STEP ONE, calculate the
hospital's percentage share of the county's funds transferred to the
Medicaid indigent care trust fund under IC 12-16-7.5-4.5. Each
hospital's percentage share is based on the total amount of the
hospital's payable claims submitted to the division under
IC 12-16-7.5 attributed to the county during the state fiscal year,
calculated as a percentage of the total amount of all hospital
payable claims submitted to the division under IC 12-16-7.5
attributed to the county during the state fiscal year.
STEP FIVE: Subject to subsection (j), for each hospital identified
in STEP ONE, with respect to each county identified in STEP
ONE, multiply the hospital's percentage share calculated under
STEP FOUR by the amount of the county's funds transferred to
the Medicaid indigent care trust fund under IC 12-16-7.5-4.5.
STEP SIX: Determine the sum of all amounts calculated under
STEP FIVE for each hospital identified in STEP ONE with
respect to each county identified in STEP ONE.
(d) For state fiscal years beginning after June 30, 2007, a hospital
that received a payment determined under STEP SIX of subsection (c)
for the state fiscal year ending June 30, 2007, shall be paid in an
amount equal to the amount determined for the hospital under STEP
SIX of subsection (c) for the state fiscal year ending June 30, 2007.
(e) A hospital's payment under subsection (c) or (d) is in the form
of a Medicaid supplemental payment. The amount of a hospital's
Medicaid supplemental payment is subject to the availability of funding
for the non-federal share of the payment under subsection (f). The
office shall make the payments under subsection (c) and (d) before
December 15 that next succeeds the end of the state fiscal year.
(f) The non-federal share of a payment to a hospital under
subsection (c) or (d) is funded from the funds transferred to the
Medicaid indigent care trust fund under IC 12-16-7.5-4.5.
(g) The amount of a county's transferred funds available to be used
to fund the non-federal share of a payment to a hospital under
subsection (c) is an amount that bears the same proportion to the total
amount of funds of the county transferred to the Medicaid indigent care
trust fund under IC 12-16-7.5-4.5 that the total amount of the hospital's
payable claims under IC 12-16-7.5 attributed to the county submitted
to the division during the state fiscal year bears to the total amount of
all hospital payable claims under IC 12-16-7.5 attributed to the county
submitted to the division during the state fiscal year.
(h) Any county's funds identified in subsection (g) that remain after
the non-federal share of a hospital's payment has been funded are
available to serve as the non-federal share of a payment to a hospital
under section 9.5 of this chapter.
(i) For purposes of this section, "payable claim" has the meaning set
forth in IC 12-16-7.5-2.5(b)(1).
(j) For purposes of subsection (c):
(1) the amount of a payable claim is an amount equal to the
amount the hospital would have received under the state's
fee-for-service Medicaid reimbursement principles for the
hospital care for which the payable claim is submitted under
IC 12-16-7.5 if the individual receiving the hospital care had been
a Medicaid enrollee; and
(2) a payable hospital claim under IC 12-16-7.5 includes a
payable claim under IC 12-16-7.5 for the hospital's care submitted
by an individual or entity other than the hospital, to the extent
permitted under the hospital care for the indigent program.
(k) The amount calculated under STEP FIVE of subsection (c) for
a hospital with respect to a county may not exceed the total amount of
the hospital's payable claims attributed to the county during the state
fiscal year.
[EFFECTIVE UPON PASSAGE]: Sec. 9.5. (a) For purposes of this
section and IC 12-16-7.5-4.5, a payable claim is attributed to a county
if the payable claim is submitted to the division by a hospital licensed
under IC 16-21-2 for payment under IC 12-16-7.5 for care provided by
the hospital to an individual who qualifies for the hospital care for the
indigent program under IC 12-16-3.5-1 or IC 12-16-3.5-2 and:
(1) who is a resident of the county;
(2) who is not a resident of the county and for whom the onset of
the medical condition that necessitated the care occurred in the
county; or
(3) whose residence cannot be determined by the division and for
whom the onset of the medical condition that necessitated the care
occurred in the county.
This section does not apply during the period that the office is
assessing a hospital fee authorized by HEA 1001-2011. IC 16-21-10.
(b) For each state fiscal year ending after June 30, 2003, but before
July 1, 2007, a hospital licensed under IC 16-21-2:
(1) that submits to the division during the state fiscal year a
payable claim under IC 12-16-7.5; and
(2) whose payment under section 9(c) of this chapter was less
than the total amount of the hospital's payable claims under
IC 12-16-7.5 submitted by the hospital to the division during the
state fiscal year;
is entitled to a payment under subsection (c).
(c) Subject to section 9.6 of this chapter, for a state fiscal year, the
office shall pay to a hospital referred to in subsection (b) an amount
equal to the amount, based on information obtained from the division
and the calculations and allocations made under IC 12-16-7.5-4.5, that
the office determines for the hospital under STEP EIGHT of the
following STEPS:
STEP ONE: Identify each county whose transfer of funds to the
Medicaid indigent care trust fund under IC 12-16-7.5-4.5 for the
state fiscal year was less than the total amount of all hospital
payable claims attributed to the county and submitted to the
division during the state fiscal year.
STEP TWO: For each county identified in STEP ONE, calculate
the difference between the amount of funds of the county
transferred to the Medicaid indigent care trust fund under
IC 12-16-7.5-4.5 and the total amount of all hospital payable
claims attributed to the county and submitted to the division
during the state fiscal year.
STEP THREE: Calculate the sum of the amounts calculated for
the counties under STEP TWO.
STEP FOUR: Identify each hospital whose payment under section
9(c) of this chapter was less than the total amount of the hospital's
payable claims under IC 12-16-7.5 submitted by the hospital to
the division during the state fiscal year.
STEP FIVE: Calculate for each hospital identified in STEP FOUR
the difference between the hospital's payment under section 9(c)
of this chapter and the total amount of the hospital's payable
claims under IC 12-16-7.5 submitted by the hospital to the
division during the state fiscal year.
STEP SIX: Calculate the sum of the amounts calculated for each
of the hospitals under STEP FIVE.
STEP SEVEN: For each hospital identified in STEP FOUR,
calculate the hospital's percentage share of the amount calculated
under STEP SIX. Each hospital's percentage share is based on the
amount calculated for the hospital under STEP FIVE calculated
as a percentage of the sum calculated under STEP SIX.
STEP EIGHT: For each hospital identified in STEP FOUR,
multiply the hospital's percentage share calculated under STEP
SEVEN by the sum calculated under STEP THREE. The amount
calculated under this STEP for a hospital may not exceed the
amount by which the hospital's total payable claims under
IC 12-16-7.5 submitted during the state fiscal year exceeded the
amount of the hospital's payment under section 9(c) of this
chapter.
(d) For state fiscal years beginning after June 30, 2007, a hospital
that received a payment determined under STEP EIGHT of subsection
(c) for the state fiscal year ending June 30, 2007, shall be paid an
amount equal to the amount determined for the hospital under STEP
EIGHT of subsection (c) for the state fiscal year ending June 30, 2007.
(e) A hospital's payment under subsection (c) or (d) is in the form
of a Medicaid supplemental payment. The amount of the hospital's
add-on payment is subject to the availability of funding for the
nonfederal share of the payment under subsection (f). The office shall
make the payments under subsection (c) or (d) before December 15
that next succeeds the end of the state fiscal year.
(f) The nonfederal share of a payment to a hospital under subsection
(c) or (d) is derived from funds transferred to the Medicaid indigent
care trust fund under IC 12-16-7.5-4.5 and not expended under section
9 of this chapter.
(g) Except as provided in subsection (h), the office may not make a
payment under this section until the payments due under section 9 of
this chapter for the state fiscal year have been made.
(h) If a hospital appeals a decision by the office regarding the
hospital's payment under section 9 of this chapter, the office may make
payments under this section before all payments due under section 9 of
this chapter are made if:
(1) a delay in one (1) or more payments under section 9 of this
chapter resulted from the appeal; and
(2) the office determines that making payments under this section
while the appeal is pending will not unreasonably affect the
interests of hospitals eligible for a payment under this section.
(i) Any funds transferred to the Medicaid indigent care trust fund
under IC 12-16-7.5-4.5 remaining after payments are made under this
section shall be used as provided in IC 12-15-20-2(8).
(j) For purposes of subsection (c):
(1) "payable claim" has the meaning set forth in
IC 12-16-7.5-2.5(b);
(2) the amount of a payable claim is an amount equal to the
amount the hospital would have received under the state's
fee-for-service Medicaid reimbursement principles for the
hospital care for which the payable claim is submitted under
IC 12-16-7.5 if the individual receiving the hospital care had been
a Medicaid enrollee; and
(3) a payable hospital claim under IC 12-16-7.5 includes a
payable claim under IC 12-16-7.5 for the hospital's care submitted
by an individual or entity other than the hospital, to the extent
permitted under the hospital care for the indigent program.
(b) Hospitals that qualify for basic disproportionate share under section 1(a) of this chapter shall receive disproportionate share payments as follows:
(1) For the state fiscal year ending June 30, 1999, a pool not exceeding twenty-one million dollars ($21,000,000) shall be distributed to all hospitals licensed under IC 16-21 that qualify under section 1(a)(1) of this chapter. The funds in the pool must be distributed to qualifying hospitals in proportion to each hospital's Medicaid day utilization rate and Medicaid discharges, as determined based on data from the most recent audited cost report on file with the office. Any funds remaining in the pool
referred to in this subdivision following distribution to all
qualifying hospitals shall be transferred to the pool distributed
under subdivision (3).
(2) Hospitals licensed under IC 16-21 that qualify under both
section 1(a)(1) and 1(a)(2) of this chapter shall receive a
disproportionate share payment in accordance with subdivision
(1).
(3) For the state fiscal year ending June 30, 1999, a pool not
exceeding five million dollars ($5,000,000), subject to adjustment
by the transfer of any funds remaining in the pool referred to in
subdivision (1), following distribution to all qualifying hospitals,
shall be distributed to all hospitals licensed under IC 16-21 that:
(A) qualify under section 1(a)(1) or 1(a)(2) of this chapter; and
(B) have at least twenty-five thousand (25,000) Medicaid
inpatient days per year, based on data from each hospital's
Medicaid cost report for the fiscal year ended during state
fiscal year 1996.
The funds in the pool must be distributed to qualifying hospitals in
proportion to each hospital's Medicaid day utilization rate and total
Medicaid patient days, as determined based on data from the most
recent audited cost report on file with the office. Payments under this
subdivision are in place of the payments made under subdivisions (1)
and (2).
(c) This subsection does not apply during the period that the office
is assessing a hospital fee authorized by HEA 1001-2011. IC 16-21-10.
Other institutions that qualify as disproportionate share providers under
section 1 of this chapter, in each state fiscal year, shall receive
disproportionate share payments as follows:
(1) For each of the state fiscal years ending after June 30, 1995,
a pool not exceeding two million dollars ($2,000,000) shall be
distributed to all private psychiatric institutions licensed under
IC 12-25 that qualify under section 1(a)(1) or 1(a)(2) of this
chapter. The funds in the pool must be distributed to the
qualifying institutions in proportion to each institution's Medicaid
day utilization rate as determined based on data from the most
recent audited cost report on file with the office.
(2) A pool not exceeding one hundred ninety-one million dollars
($191,000,000) for all state fiscal years ending after June 30,
1995, shall be distributed to all state mental health institutions
under IC 12-24-1-3 that qualify under either section 1(a)(1) or
1(a)(2) of this chapter. The funds in the pool must be distributed
to each qualifying institution in proportion to each institution's
low income utilization rate, as determined based on the most
recent data on file with the office.
(d) This subsection does not apply during the period that the office
is assessing a hospital fee authorized by HEA 1001-2011. IC 16-21-10.
Disproportionate share payments described in this section shall be
made on an interim basis throughout the year, as provided by the office.
(1) a hospital licensed under IC 16-21;
(2) a state mental health institution under IC 12-24-1-3; and
(3) a private psychiatric institution licensed under IC 12-25;
that serves a disproportionate share of Medicaid recipients and other low income patients as determined under IC 12-15-16-1. However, a provider may not be defined as a disproportionate share provider under IC 12-15-16-1 unless the provider has a Medicaid inpatient utilization rate (as defined in 42 U.S.C. 1396r-4(b)(2)) of at least one percent (1%). Subdivisions (2) and (3) do not apply during the period that the office is assessing a hospital fee authorized by
(1) maximize disproportionate share hospital payments to qualifying hospitals to the extent practicable;
(2) take into account the situation of those qualifying hospitals that have historically qualified for Medicaid disproportionate share payments; and
(3) ensure that payments for qualifying hospitals are equitable.
(b) Total disproportionate share payments to a hospital under this chapter shall not exceed the hospital specific limit provided under 42 U.S.C. 1396r-4(g). The hospital specific limit for a state fiscal year
shall be determined by the office taking into account data provided by
each hospital that is considered reliable by the office based on a system
of periodic audits, the use of trending factors, and an appropriate base
year determined by the office. The office may require independent
certification of data provided by a hospital to determine the hospital's
hospital specific limit.
(c) The office shall include a provision in each amendment to the
state plan regarding Medicaid disproportionate share payments that the
office submits to the federal Centers for Medicare and Medicaid
Services that, as provided in 42 CFR 447.297(d)(3), allows the state to
make additional disproportionate share expenditures after the end of
each federal fiscal year that relate back to a prior federal fiscal year.
However, the total disproportionate share payments to:
(1) each individual hospital; and
(2) all qualifying hospitals in the aggregate;
may not exceed the limits provided by federal law and regulation.
(b) For state fiscal years beginning after June 30, 2006, if:
(1) sufficient deposits have not been received; or
(2) the statewide Medicaid disproportionate share allocation is insufficient to provide federal financial participation for the entirety of all eligible disproportionate share hospitals' hospital-specific limits;
the office shall reduce disproportionate share payments made under IC 12-15-19-2.1 and Medicaid safety-net payments made in accordance with the Medicaid state plan to eligible institutions using an equitable methodology consistent with subsection (c).
(c) For state fiscal years beginning after June 30, 2006, payments reduced under this section shall, in accordance with the Medicaid state plan, be made:
(1) to best utilize federal matching funds available for hospitals eligible for Medicaid disproportionate share payments under
IC 12-15-19-2.1; and
(2) by utilizing a methodology that allocates available funding
under this subdivision, and Medicaid supplemental payments as
defined in IC 12-15-15-1.5, in a manner that all hospitals eligible
for Medicaid disproportionate share payments under
IC 12-15-19-2.1 receive payments using a methodology that:
(A) takes into account the situation of the eligible hospitals
that have historically qualified for Medicaid disproportionate
share payments; and
(B) ensures that payments for eligible hospitals are equitable.
(d) The percentage reduction shall be sufficient to ensure that
payments do not exceed the statewide Medicaid disproportionate share
allocation or the amounts that can be financed with:
(1) the amount transferred from the hospital care for the indigent
trust fund;
(2) other intergovernmental transfers;
(3) certifications of public expenditures; or
(4) any other permissible sources of non-federal match.
(1) For each state fiscal year ending on or after June 30, 1998, an amount shall be distributed to each provider qualifying as a municipal disproportionate share provider under IC 12-15-16-1. The total amount distributed shall not exceed the sum of all hospital specific limits for all qualifying providers.
(2) For each municipal disproportionate share provider qualifying under IC 12-15-16-1 to receive disproportionate share payments, the amount in subdivision (1) shall be reduced by the amount of disproportionate share payments received by the provider under IC 12-15-16-6 or sections 1 or 2.1 of this chapter. The office shall develop a disproportionate share provider payment methodology that ensures that each municipal disproportionate share provider receives disproportionate share payments that do not exceed the provider's hospital specific limit specified in subsection (b). The methodology developed by the office shall ensure that a
municipal disproportionate share provider receives, to the extent
possible, disproportionate share payments that, when combined
with any other disproportionate share payments owed to the
provider, equals the provider's hospital specific limits.
(b) Total disproportionate share payments to a provider under this
chapter and IC 12-15-16 shall not exceed the hospital specific limit
provided under 42 U.S.C. 1396r-4(g). The hospital specific limit for
state fiscal years ending on or before June 30, 1999, shall be
determined by the office taking into account data provided by each
hospital for the hospital's most recent fiscal year or, if a change in fiscal
year causes the most recent fiscal period to be less than twelve (12)
months, twelve (12) months of data compiled to the end of the
provider's fiscal year that ends within the most recent state fiscal year,
as certified to the office by an independent certified public accounting
firm. The hospital specific limit for all state fiscal years ending on or
after June 30, 2000, shall be determined by the office taking into
account data provided by each hospital that is deemed reliable by the
office based on a system of periodic audits, the use of trending factors,
and an appropriate base year determined by the office. The office may
require independent certification of data provided by a hospital to
determine the hospital's hospital specific limit.
(c) For each of the state fiscal years:
(1) beginning July 1, 1998, and ending June 30, 1999; and
(2) beginning July 1, 1999, and ending June 30, 2000;
the total municipal disproportionate share payments available under
this section to qualifying municipal disproportionate share providers is
twenty-two million dollars ($22,000,000).
(1) The state shall make municipal disproportionate share provider payments to providers qualifying under IC 12-15-16-1(b) until the state exceeds the state disproportionate share allocation (as defined in 42 U.S.C. 1396r-4(f)(2)).
(2) After the state makes all payments under subdivision (1), if the state fails to exceed the state disproportionate share allocation (as defined in 42 U.S.C. 1396r-4(f)(2)), the state shall make disproportionate share provider payments to providers qualifying under IC 12-15-16-1(a).
(3) After the state makes all payments under subdivision (2), if the state fails to exceed the state disproportionate share allocation (as defined in 42 U.S.C. 1396r-4(f)(2)), or the state limit on disproportionate share expenditures for institutions for mental diseases (as defined in 42 U.S.C. 1396r-4(h)), the state shall make community mental health center disproportionate share provider payments to providers qualifying under IC 12-15-16-1(c).
(1) Enhanced disproportionate share payments to providers under IC 12-15-19-1.
(2) Subject to subdivision (8), disproportionate share payments to providers under IC 12-15-19-2.1.
(3) Medicaid payments for pregnant women described in IC 12-15-2-13 and infants and children described in IC 12-15-2-14.
(4) Municipal disproportionate share payments to providers under IC 12-15-19-8.
(5) Payments to hospitals under IC 12-15-15-9.
(6) Payments to hospitals under IC 12-15-15-9.5.
(7) Payments, funding, and transfers as otherwise provided in clauses (8)(D), (8)(F), and (8)(G).
(8) Of the intergovernmental transfers deposited into the Medicaid indigent care trust fund, the following apply:
(A) The entirety of the intergovernmental transfers deposited into the Medicaid indigent care trust fund for state fiscal years ending on or before June 30, 2000, shall be used to fund the state's share of the disproportionate share payments to providers under IC 12-15-19-2.1.
(B) Of the intergovernmental transfers deposited into the Medicaid indigent care trust fund for the state fiscal year ending June 30, 2001, an amount equal to one hundred percent (100%) of the total intergovernmental transfers deposited into the Medicaid indigent care trust fund for the state fiscal year beginning July 1, 1998, and ending June 30, 1999, shall be used to fund the state's share of disproportionate share payments to providers under IC 12-15-19-2.1. The remainder of the intergovernmental transfers, if any, for the state fiscal year shall be used to fund the state's share of additional Medicaid payments to hospitals licensed under IC 16-21
pursuant to a methodology adopted by the office.
(C) Of the intergovernmental transfers deposited into the
Medicaid indigent care trust fund, for state fiscal years
beginning July 1, 2001, and July 1, 2002, an amount equal to:
(i) one hundred percent (100%) of the total
intergovernmental transfers deposited into the Medicaid
indigent care trust fund for the state fiscal year beginning
July 1, 1998; minus
(ii) an amount equal to the amount deposited into the
Medicaid indigent care trust fund under IC 12-15-15-9(d)
for the state fiscal years beginning July 1, 2001, and July 1,
2002;
shall be used to fund the state's share of disproportionate share
payments to providers under IC 12-15-19-2.1. The remainder
of the intergovernmental transfers, if any, must be used to fund
the state's share of additional Medicaid payments to hospitals
licensed under IC 16-21 pursuant to a methodology adopted by
the office.
(D) The intergovernmental transfers, which shall include
amounts transferred under IC 12-16-7.5-4.5, deposited into the
Medicaid indigent care trust fund and the certifications of
public expenditures deemed to be made to the medicaid
indigent care trust fund, for the state fiscal years ending after
June 30, 2005, but before July 1, 2007, shall be used, in
descending order of priority, as follows:
(i) As provided in clause (B) of STEP THREE of
IC 12-16-7.5-4.5(b)(1) and clause (B) of STEP THREE of
IC 12-16-7.5-4.5(b)(2), to fund the amount to be transferred
to the office.
(ii) As provided in clause (C) of STEP THREE of
IC 12-16-7.5-4.5(b)(1) and clause (C) of STEP THREE of
IC 12-16-7.5-4.5(b)(2), to fund the non-federal share of the
payments made under IC 12-15-15-9 and IC 12-15-15-9.5.
(iii) To fund the non-federal share of the payments made
under IC 12-15-15-1.1, IC 12-15-15-1.3, and IC 12-15-19-8.
(iv) As provided under clause (A) of STEP THREE of
IC 12-16-7.5-4.5(b)(1) and clause (A) of STEP THREE of
IC 12-16-7.5-4.5(b)(2), for the payment to be made under
clause (A) of STEP FIVE of IC 12-15-15-1.5(b).
(v) As provided under STEP FOUR of
IC 12-16-7.5-4.5(b)(1) and STEP FOUR of
IC 12-16-7.5-4.5(b)(2), to fund the payments to be made
under clause (B) of STEP FIVE of IC 12-15-15-1.5(b).
(vi) To fund, in an order of priority determined by the office
to best use the available non-federal share, the programs
listed in clause (H).
(E) For state fiscal years ending after June 30, 2007, the total
amount of intergovernmental transfers used to fund the
non-federal share of payments to hospitals under
IC 12-15-15-9 and IC 12-15-15-9.5 shall not exceed the
amount provided in clause (G)(ii).
(F) As provided in clause (D), for the following:
(i) Each state fiscal year ending after June 30, 2003, but
before July 1, 2005, an amount equal to the amount
calculated under STEP THREE of the following formula
shall be transferred to the office:
STEP ONE: Calculate the product of thirty-five million dollars
($35,000,000) multiplied by the federal medical assistance
percentage for federal fiscal year 2003.
STEP TWO: Calculate the sum of the amounts, if any,
reasonably estimated by the office to be transferred or
otherwise made available to the office for the state fiscal year,
and the amounts, if any, actually transferred or otherwise made
available to the office for the state fiscal year, under
arrangements whereby the office and a hospital licensed under
IC 16-21-2 agree that an amount transferred or otherwise made
available to the office by the hospital or on behalf of the
hospital shall be included in the calculation under this STEP.
STEP THREE: Calculate the amount by which the product
calculated under STEP ONE exceeds the sum calculated under
STEP TWO.
(ii) The state fiscal years ending after June 30, 2005, but
before July 1, 2007, an amount equal to thirty million dollars
($30,000,000) shall be transferred to the office.
(G) Subject to IC 12-15-20.7-2(b), for each state fiscal year
ending after June 30, 2007, the total amount in the Medicaid
indigent care trust fund, including the amount of
intergovernmental transfers of funds transferred, and the
amounts of certifications of expenditures eligible for federal
financial participation deemed to be transferred, to the
Medicaid indigent care trust fund, shall be used to fund the
following:
(i) Thirty million dollars ($30,000,000) transferred to the
office for the Medicaid budget.
(ii) An amount not to exceed the non-federal share of payments to hospitals under IC 12-15-15-9 and IC 12-15-15-9.5.
(iii) An amount not to exceed the non-federal share of payments to hospitals made under IC 12-15-15-1.1 and IC 12-15-15-1.3.
(iv) An amount not to exceed the non-federal share of disproportionate share payments to hospitals under IC 12-15-19-8.
(v) An amount not to exceed the non-federal share of payments to hospitals under clause (A) of STEP FIVE of IC 12-15-15-1.5(c).
(vi) An amount not to exceed the non-federal share of Medicaid safety-net payments.
(vii) An amount not to exceed the non-federal share of payments to hospitals made under clauses (C) or (D) of STEP FIVE of IC 12-15-15-1.5(c).
(viii) An amount not to exceed the non-federal share of payments to hospitals made under clause (F) of STEP FIVE of IC 12-15-15-1.5(c).
(ix) An amount not to exceed the non-federal share of disproportionate share payments to hospitals under IC 12-15-19-2.1.
(x) If additional funds are available after making payments under items (i) through (ix), to fund other Medicaid supplemental payments for hospitals approved by the office and included in the Medicaid state plan.
Items (ii) through (x) do not apply during the period that the office is assessing a hospital fee authorized by
(H) This clause does not apply during the period that the office is assessing a hospital fee authorized by
(i) An amount equal to the non-federal share of the payments to the hospital that is eligible under this item, for payments made under clause (C) of STEP FIVE of IC 12-15-15-1.5(b) under an agreement with the office, Medicaid safety-net payments and any payment made under IC 12-15-19-2.1. The amount of the payments to the hospital under this item shall be equal to one hundred percent (100%) of the hospital's hospital-specific limit for state
fiscal year 2005, when the payments are combined with
payments made under IC 12-15-15-9, IC 12-15-15-9.5, and
clause (B) of STEP FIVE of IC 12-15-15-1.5(b) for a state
fiscal year. A hospital is eligible under this item if the
hospital was eligible for Medicaid disproportionate share
hospital payments for the state fiscal year ending June 30,
1998, the hospital received a Medicaid disproportionate
share payment under IC 12-15-19-2.1 for state fiscal years
2001, 2002, 2003, and 2004, and the hospital merged two
(2) hospitals under a single Medicaid provider number,
effective January 1, 2004.
(ii) An amount equal to the non-federal share of payments to
hospitals that are eligible under this item, for payments
made under clause (C) of STEP FIVE of IC 12-15-15-1.5(b)
under an agreement with the office, Medicaid safety-net
payments, and any payment made under IC 12-15-19-2.1.
The amount of payments to each hospital under this item
shall be equal to one hundred percent (100%) of the
hospital's hospital-specific limit for state fiscal year 2004,
when the payments are combined with payments made to the
hospital under IC 12-15-15-9, IC 12-15-15-9.5, and clause
(B) of STEP FIVE of IC 12-15-15-1.5(b) for a state fiscal
year. A hospital is eligible under this item if the hospital did
not receive a payment under item (i), the hospital has less
than sixty thousand (60,000) Medicaid inpatient days
annually, the hospital either was eligible for Medicaid
disproportionate share hospital payments for the state fiscal
year ending June 30, 1998 or the hospital met the office's
Medicaid disproportionate share payment criteria based on
state fiscal year 1998 data and received a Medicaid
disproportionate share payment for the state fiscal year
ending June 30, 2001, and the hospital received a Medicaid
disproportionate share payment under IC 12-15-19-2.1 for
state fiscal years 2001, 2002, 2003, and 2004.
(iii) Subject to IC 12-15-19-6, an amount not less than the
non-federal share of Medicaid safety-net payments in
accordance with the Medicaid state plan.
(iv) An amount not less than the non-federal share of
payments made under clause (C) of STEP FIVE of
IC 12-15-15-1.5(b) under an agreement with the office to a
hospital having sixty thousand (60,000) Medicaid inpatient
days annually.
(v) An amount not less than the non-federal share of Medicaid disproportionate share payments for hospitals eligible under this item, and made under IC 12-15-19-6 and the approved Medicaid state plan. A hospital is eligible for a payment under this item if the hospital is eligible for payments under IC 12-15-19-2.1.
(vi) If additional funds remain after the payments made under (i) through (v), payments approved by the office and under the Medicaid state plan, to fund the non-federal share of other Medicaid supplemental payments for hospitals.
(1) First, payments under IC 12-15-15-9 and IC 12-15-15-9.5.
(2) Second, payments under clauses (A) and (B) of STEP FIVE of IC 12-15-15-1.5(b).
(3) Third, Medicaid inpatient payments for safety-net hospitals and Medicaid outpatient payments for safety-net hospitals.
(4) Fourth, payments under IC 12-15-15-1.1 and IC 12-15-15-1.3.
(5) Fifth, payments under IC 12-15-19-8 for municipal disproportionate share hospitals.
(6) Sixth, payments under IC 12-15-19-2.1 for disproportionate share hospitals.
(7) Seventh, payments under clause (C) of STEP FIVE of IC 12-15-15-1.5(b).
(b) For each state fiscal year ending after June 30, 2007, the office shall make the payments for the programs identified in IC 12-15-20-2(8)(G) in the order of priority that best utilizes available non-federal share, Medicaid supplemental payments, and Medicaid disproportionate share payments, and may change the order or priority at any time as necessary for the proper administration of one (1) or more of the payment programs listed in IC 12-15-20-2(8)(G).
Chapter 10. Hospital Assessment Fee
Sec. 1. As used in this chapter, "committee" refers to the
hospital assessment fee committee established by section 7 of this
chapter.
Sec. 2. As used in this chapter, "fee" refers to the hospital
assessment fee authorized by this chapter.
Sec. 3. As used in this chapter, "fee period" means the time
frame in which a fee is collected under this chapter.
Sec. 4. (a) As used in this chapter, "hospital" means an entity
that meets the definition set forth in IC 16-18-2-179(b) and is
licensed under this article. The term may include a private
psychiatric hospital licensed under IC 12-25.
(b) The term does not include the following:
(1) A state mental health institution operated under
IC 12-24-1-3.
(2) A hospital:
(A) designated by the Medicaid program as a long term
care hospital;
(B) that has an average inpatient length of stay that is
greater than twenty-five (25) days, as determined by the
office of Medicaid policy and planning under the Medicaid
program;
(C) that is a Medicare certified, freestanding rehabilitation
hospital; or
(D) that is a hospital operated by the federal government.
Sec. 5. As used in this chapter, "office" refers to the office of
Medicaid policy and planning established by IC 12-8-6.5-1.
Sec. 6. (a) Subject to subsection (b) and section 8(b) of this
chapter, the office may assess a hospital assessment fee to hospitals
during the fee period if the following conditions are met:
(1) The fee may be used only for the purposes described in the
following:
(A) Section 8(c) of this chapter.
(B) Section 9 of this chapter.
(C) Section 11 of this chapter.
(D) Section 14 of this chapter.
(2) The Medicaid state plan amendments and waiver requests
required for the implementation of this chapter are submitted
by the office to the United States Department of Health and
Human Services before October 1, 2013.
(3) The United States Department of Health and Human
Services approves the Medicaid state plan amendments and
waiver requests, or revisions of the Medicaid state plan
amendments and waiver requests, described in subdivision
(2):
(A) not later than October 1, 2014; or
(B) after October 1, 2014, if a date is established by the
committee.
The funds generated from the fee do not revert to the general fund.
(b) The office shall stop collecting a fee, the programs described
in section 8(a) of this chapter shall be reconciled and terminated,
and the operation of section 11 of this chapter ends if any of the
following occur:
(1) An appellate court makes a final determination that
either:
(A) the fee; or
(B) any of the programs described in section 8(a) of this
chapter;
cannot be implemented or maintained.
(2) The United States Department of Health and Human
Services makes a final determination that the Medicaid state
plan amendments or waivers submitted under this chapter are
not approved or cannot be validly implemented.
(3) The fee is not collected because of circumstances described
in section 8(d) of this chapter.
(c) The office shall keep records of the fees collected by the
office and report the amount of fees collected under this chapter.
Sec. 7. (a) The hospital assessment fee committee is established.
The committee consists of the following four (4) voting members:
(1) The secretary of family and social services established by
IC 12-8-1.5-1 or the secretary's designee, who shall serve as
the chair of the committee.
(2) The budget director or the budget director's designee.
(3) Two (2) individuals appointed by the governor from a list
of at least four (4) individuals submitted by the Indiana
Hospital Association.
(b) The committee shall review any Medicaid state plan
amendments, waiver requests, or revisions to any Medicaid state
plan amendments or waiver requests, to implement or continue the
implementation of this chapter for the purpose of establishing
favorable review of the amendments, requests, and revisions by the
United States Department of Health and Human Services.
(c) The committee shall meet at the call of the chair. The
members serve without compensation.
(d) A quorum consists of at least three (3) members. An
affirmative vote of at least three (3) members of the committee is
necessary to approve Medicaid state plan amendments or waiver
requests.
Sec. 8. (a) Subject to subsection (b), the office shall develop the
following programs designed to increase, to the extent allowable
under federal law, Medicaid reimbursement for inpatient and
outpatient hospital services provided by a hospital to Medicaid
recipients:
(1) A program concerning reimbursement for the Medicaid
fee-for-service program that, in the aggregate, will result in
payments equivalent to the level of reimbursement that would
be paid under federal Medicare payment principles.
(2) A program concerning reimbursement for the Medicaid
risk based managed care program that, in the aggregate, will
result in payments equivalent to the level of reimbursement
that would be paid under federal Medicare payment
principles.
( b) The office shall not submit to the United States Department
of Health and Human Services any Medicaid state plan
amendments, waiver requests, or revisions to any Medicaid state
plan amendments or waiver requests, to implement or continue the
implementation of this chapter until the committee has reviewed
and approved the amendments, waivers, or revisions described in
this subsection and has submitted a written report to the budget
committee concerning the amendments, waivers, or revisions
described in this subsection, including the following:
(1) The methodology to be used by the office in calculating the
increased Medicaid reimbursement under the programs
described in subsection (a).
( 2) The methodology to be used by the office in calculating,
imposing, collecting, or any other matter relating to the fee
authorized by this chapter.
(3) The determination of Medicaid disproportionate share
allotments under section 11 of this chapter that are to be
funded by the fee authorized by this chapter, including the
formula for distributing the Medicaid disproportionate share
allotments.
(4) The distribution to private psychiatric institutions under
section 13 of this chapter.
(c) This subsection applies to the programs described in
subsection (a). The state share dollars for the programs must
consist of the following:
(1) Fees paid under this chapter.
(2) The hospital care for the indigent funds allocated under
section 10 of this chapter.
(3) Other sources of state share dollars available to the office,
excluding intergovernmental transfers of funds made by or on
behalf of a hospital.
The money described in subdivisions (1) and (2) may be used only
to fund the part of the payments that exceed the Medicaid
reimbursement rates in effect on June 30, 2011.
(d) This subsection applies to the programs described in
subsection (a). If the state is unable to maintain the funding under
subsection (c)(3) for the payments at Medicaid reimbursement
levels in effect on June 30, 2011, because of budgetary constraints,
the office shall reduce inpatient and outpatient hospital Medicaid
reimbursement rates under subsection (a)(1) or (a)(2) or request
approval from the committee and the United States Department of
Health and Human Services to increase the fee to prevent a
decrease in Medicaid reimbursement for hospital services. If:
(1) the committee:
(A) does not approve a reimbursement reduction; or
(B) does not approve an increase in the fee; or
(2) the United States Department of Health and Human
Services does not approve an increase in the fee;
the office shall cease to collect the fee and the programs described
in subsection (a) end.
Sec. 9. (a) This section is effective upon implementation of the
fee. The hospital Medicaid fee fund is established for the purpose
of holding fees collected under this chapter that are not necessary
to match federal funds.
(b) The office shall administer the fund.
(c) Money in the fund at the end of a state fiscal year does not
revert to the state general fund. However, money remaining in the
fund after the cessation of the collection of the fee under section
6(b) of this chapter shall be used for the payments described in
sections 8(a) and 11 of this chapter. Any money not required for
the payments described in sections 8(a) and 11 of this chapter after
the cessation of the collection of the fee under section 6(b) of this
chapter shall be distributed to the hospitals on a pro rata basis
based upon the fees paid by each hospital for the state fiscal year
that ended immediately before the cessation of the collection of the
fee under section 6(b) of this chapter.
Sec. 10. This section:
(1) is effective upon implementation of the fee; and
(2) does not apply to funds under IC 12-16-17.
Notwithstanding any other law, the part of the amounts
appropriated for or transferred to the hospital care for the
indigent program for the state fiscal years beginning July 1, 2013,
and each state fiscal year thereafter that are not required to be
paid to the office by law shall be used exclusively as state share
dollars for the payments described in sections 8(a) and 11 of this
chapter. Any hospital care for the indigent funds that are not
required for the payments described in sections 8(a) and 11 of this
chapter after the cessation of the collection of the fee under section
6(b) of this chapter shall be used for the state share dollars of the
payments in IC 12-15-20-2(8)(G)(ii) through
IC 12-15-20-2(8)(G)(x).
Sec. 11. (a) This section:
(1) is effective upon the implementation of the fee; and
(2) applies to the Medicaid disproportionate share payments
for the state fiscal years beginning July 1, 2013, and each state
fiscal year thereafter.
(b) The state share dollars used to fund disproportionate share
payments to acute care hospitals licensed under IC 16-21-2 that
qualify as disproportionate share providers or municipal
disproportionate share providers under IC 12-15-16-1(a) or
IC 12-15-16-1(b) shall be paid with money collected through the fee
under this chapter and the hospital care for the indigent dollars
described in section 10 of this chapter.
(c) Subject to section 12 of this chapter and except as provided
in section 12 of this chapter, the federal Medicaid disproportionate
share allotments for the state fiscal years beginning July 1, 2013,
and each state fiscal year thereafter shall be allocated in their
entirety to acute care hospitals licensed under IC 16-21-2 that
qualify as disproportionate share providers or municipal
disproportionate share providers under IC 12-15-16-1(a) or
IC 12-15-16-1(b). No part of the federal disproportionate share
allotments applicable for disproportionate share payments for the
state fiscal years beginning July 1, 2013, and each state fiscal year
thereafter may be allocated to institutions for mental disease or
other mental health facilities, as defined by applicable federal law.
Sec. 12. For purposes of this chapter, the entire federal
Medicaid disproportionate share allotment for Indiana does not
include the part of allotments that are required to be diverted
under the following:
(1) The federally-approved Indiana "Special Terms and
Conditions" Medicaid demonstration project (Number
11-W-00237/5).
(2) Any extension after December 31, 2012, of the Indiana
check-up plan Medicaid waiver established by IC 12-15-44.2.
The office shall inform the committee and the budget committee
concerning any extension of the Indiana check-up plan after
December 31, 2013.
Sec. 13. Notwithstanding IC 12-15-16-6(c), the annual two
million dollar ($2,000,000) pool of disproportionate share dollars
under IC 12-15-16-6(c) shall not be available to eligible private
psychiatric institutions. The office shall annually distribute two
million dollars ($2,000,000) to eligible private psychiatric
institutions that would have been eligible for payment under
IC 12-15-16-6(c).
Sec. 14. The fees collected under this chapter may be used only
as described in this chapter or to pay the state's share of the cost
for Medicaid services provided under the federal Medicaid
program (42 U.S.C. 1396 et seq.) as follows:
(1) Twenty-eight and five-tenths percent (28.5%) may be used
by the office for Medicaid expenses.
(2) Seventy-one and five-tenths percent (71.5%) to hospitals.
Sec. 15. This chapter may not be construed to authorize any
county, municipality, district, or authority to impose a fee, tax, or
assessment on a hospital.
Sec. 16. Subject to section 8(b) of this chapter, the office may
adopt rules, including emergency rules adopted in the manner
provided under IC 4-22-2-37.1, necessary to implement this
chapter. Rules adopted under this section may be retroactive to the
effective date of the Medicaid state plan amendments or waivers
approved under this chapter.
Sec. 17. The office may enter into an agreement with a hospital
to pay the fee in installments.
Sec. 18. (a) If a hospital fails to pay the fee after not later than
ten (10) days after the payment date, the hospital shall pay to the
office interest on the fee at the same rate as the rate determined
under IC 12-15-21-3(6)(A).
(b) The office shall report to the state department of health each
hospital that fails to pay the fee not later than one hundred twenty
(120) days after the date the payment is due. The state department
shall do the following concerning a hospital described in this
subsection:
( 1) Notify the hospital that the hospital's license under
IC 16-21 will be revoked if the fee is not paid.
(2) Revoke the hospital's license under IC 16-21 if the hospital
fails to pay the fee. IC 4-21.5-3-8 and IC 4-21.5-4 apply to this
subdivision.
Sec. 19. Payments for the programs described in section 8(a) of
this chapter are limited to claims for dates of services provided
during the fee period and that are timely filed with the office or a
contractor of the office. Payments for the programs described in
section 8(a) of this chapter and distributions to hospitals in
accordance with this chapter may occur at any time, including
after the cessation of the collection of a fee under this chapter.
Sec. 20. The office may collect unpaid fees owed by a hospital
under this chapter and may refund fees paid by a hospital under
this chapter at any time, including after the cessation of the
collection of a fee under this chapter.
(1) Sixty-seven and one-tenth percent (67.1%) to pay the state's share of costs for Medicaid nursing facility services provided under Title XIX of the federal Social Security Act (42 U.S.C. 1396 et seq.).
(2) Twenty-three and eight-tenths percent (23.8%) to pay the state's share of costs for other Medicaid services provided under Title XIX of the federal Social Security Act (42 U.S.C. 1396 et seq.).
(3) Nine and one-tenth percent (9.1%) to pay prior year state nursing facility expenditures.
(b) The money collected from the quality assessment fee during
(1) Sixty-six and five-tenths percent (66.5%) to pay the state's share of costs for Medicaid nursing facility services provided under Title XIX of the federal Social Security Act (42 U.S.C. 1396 et seq.).
(2) Twenty-nine and four-tenths percent (29.4%) to pay the state's share of costs for other Medicaid services provided under Title XIX of the federal Social Security Act (42 U.S.C. 1396 et seq.).
(3) Four and one-tenth percent (4.1%) to pay prior year state nursing facility expenditures.
(c) The money collected from the quality assessment fee after
(1) Seventy and six-tenths percent (70.6%) to pay the state's share of the costs for Medicaid nursing facility services provided under Title XIX of the federal Social Security Act (42 U.S.C. 1396 et seq.).
(2) Twenty-nine and four-tenths percent (29.4%) to pay the state's share of costs for other Medicaid services provided under Title XIX of the federal Social Security Act (42 U.S.C. 1396 et seq.).
(d) Any increase in reimbursement for Medicaid nursing facility services resulting from maximizing the quality assessment rate under section 6(b) of this chapter shall be directed exclusively to initiatives determined by the office to promote and enhance improvements in quality of care to nursing facility residents.
(e) The office may establish a method to allow a health facility to enter into an agreement to pay the quality assessment fee collected under this chapter under an installment plan.
