Bill Text: IN SB0225 | 2012 | Regular Session | Enrolled
Bill Title: Hospital assessment fee matters.
Sponsorship: Slight Partisan Bill (Republican 2-1)
Status: (Enrolled - Dead) 2012-03-06 - Signed by the Governor [SB0225 Detail]
Download: Indiana-2012-SB0225-Enrolled.html
PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana Constitution) is being amended, the text of the existing provision will appear in this style type, additions will appear in this style type, and deletions will appear in
Additions: Whenever a new statutory provision is being enacted (or a new constitutional provision adopted), the text of the new provision will appear in this style type. Also, the word NEW will appear in that style type in the introductory clause of each SECTION that adds a new provision to the Indiana Code or the Indiana Constitution.
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AN ACT concerning human services.
(1) "Committee" refers to the hospital assessment fee committee established by this SECTION.
(2) "Fee" refers to the hospital assessment fee authorized by this SECTION.
(3) "Fee period" means the two (2) year state fiscal year period beginning July 1, 2011, and ending June 30, 2013.
(4) "Hospital" means an entity that meets the definition set forth in IC 16-18-2-179(b) and is licensed under IC 16-21-2. This term may include a private psychiatric hospital licensed under IC 12-25. The term does not include the following:
(A) A state mental health institution operated under IC 12-24-1-3.
(B) A hospital:
(i) designated by the Medicaid program as a long term care hospital;
(ii) 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;
(iii) that is a Medicare certified, freestanding rehabilitation hospital; or
(iv) that is a hospital operated by the federal government.
(5) "Office" refers to the office of Medicaid policy and planning established by IC 12-8-6-1.
(b) Subject to subsections (c) and (g), the office may charge a hospital assessment fee to hospitals under this SECTION during the fee period if the following conditions are met:
(1) The fee may be used only for the purposes described in subsections (h)(1), (k), (m), and (p).
(2) The Medicaid state plan amendments and waiver requests required for the implementation of this SECTION are submitted by the office to the United States Department of Health and Human Services before October 1, 2011.
(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, 2012;
(B) after October 1, 2012, if the date is established by the committee. The committee may establish a date:
(i) at any time before July 1, 2013; and
(ii) an unlimited number of times before July 1, 2013.
(4) The funds generated from the fee do not revert to the general fund.
(c) The office shall stop collecting a fee, the programs described in subsection (f) shall be reconciled and terminated, and the operation of subsection (m) shall end if any of the following occur:
(1) An appellate court makes a final determination that either:
(A) the fee described in this SECTION; or
(B) any of the programs described in subsection (f);
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 subsection (b) are not approved or cannot be validly implemented.
(3) The fee is not collected because of circumstances described in subsection (i).
(d) The office shall keep records of the fees collected by the office and report the amount of fees collected under this SECTION. The office may not assess a fee described in this SECTION to a hospital
after the fee period.
(e) 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 12-8-1-1 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) members appointed by the governor from a list of at
least four (4) individuals submitted by the Indiana hospital
association.
The committee shall review any Medicaid state plan amendments,
waiver requests, or any revisions to any Medicaid state plan
amendments or waiver requests, to implement or continue the
implementation of this SECTION for the purpose of establishing
favorable review of the amendments, requests, and revisions by the
United States Department of Health and Human Services. The
committee shall meet at the call of the chair. The members shall serve
without compensation. A quorum consists of at least three (3)
members. An affirmative vote of at least three (3) members of the
committee are is necessary to approve Medicaid state plan amendments
or waiver requests.
(f) Subject to subsection (g), 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 during the fee period 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.
(g) The office shall not submit to the United States Department of
Health and Human Services any Medicaid state plan amendments,
waiver requests, or any revisions to any Medicaid state plan
amendments or waiver requests, to implement or continue the
implementation of this SECTION until the committee has reviewed and
approved the amendments, waivers, or revisions described in this
subsection and submitted a written report to the state 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 (f).
(2) The methodology to be used by the office in calculating,
imposing, collecting, or any other matter relating to the fee
authorized by this SECTION.
(3) The determination of Medicaid disproportionate share
allotments for the fee period under subsection (m) that are to be
funded by the fee authorized by this SECTION, including the
formula for distributing the Medicaid disproportionate share
payments.
(4) The distribution to private psychiatric institutions under
subsection (o).
(h) This subsection applies to the programs described in subsection
(f). The state share dollars for the programs shall consist of the
following:
(1) Fees paid under this SECTION.
(2) The hospital care for the indigent funds allocated under
subsection (l).
(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 portion of the payments that are in excess to the Medicaid
reimbursement rates in effect on June 30, 2011.
(i) This subsection applies to the programs described in subsection
(f). If the state is unable to maintain the funding under subsection
(h)(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 (f)(1) or (f)(2) or request 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
the:
(1) 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 (f) shall end.
(j) Before August 1, 2011, the office, after review by the committee, shall submit to the budget committee established under IC 4-12-1-3 a written report that includes the following concerning the program described in subsection (f)(2):
(1) A reasonable estimate of the Medicaid managed care organization payments for hospital services during the fee period that will be attributable to state share dollars resulting from the fee to be collected under this SECTION. The estimate may not include payments for services provided to:
(A) adults enrolled in the Indiana check-up plan established by IC 12-15-44.2; or
(B) individuals enrolled in Medicaid who would have been receiving services under the Medicaid fee-for-service program before changes to state or federal law or policies that occur after March 1, 2011.
(2) The extent to which payments under the program will be limited by or otherwise affected by the Indiana "Special Terms and Conditions" Medicaid demonstration project (Number 11-W-00237/5), including any:
(A) trend rate amount or percentage;
(B) per member per month amount; or
(C) other limitations established by this demonstration project.
(3) Detailed explanations of any estimates, calculations, and conclusions included in the report.
(k) This subsection is effective upon implementation of the fee. The hospital Medicaid fee fund is established for the purpose of holding fees collected under this SECTION that are not necessary to match federal funds. The office shall administer the fund. 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 June 30, 2012, shall be used for the payments described in subsections (f) and (m). Any money not required for the payments described in subsections (f) and (m) upon the expiration of this SECTION or at the cessation of collection of the fee under subsection (c) shall be distributed to the hospitals on a pro rata basis based upon the fees paid by each hospital.
(l) This subsection:
(1) is effective upon implementation of the fee authorized by this SECTION; and
(2) does not apply to funds under IC 12-16-17.
Notwithstanding any other law, the portion of the amounts appropriated for or transferred to the hospital care for the indigent program for the fee period 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
subsections (f) and (m). Any hospital care for the indigent funds that
are not required for the payments described in subsections (f) and (m)
upon the expiration of this SECTION or the cessation of the collection
of the fee 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).
(m) This subsection:
(1) is effective upon the implementation of the fee authorized by
this SECTION; and
(2) applies to the Medicaid disproportionate share payments for
the fee period.
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 by the fee under this SECTION and the hospital
care for the indigent dollars described in subsection (l). Subject to
subsection (n) and except as provided in subsection (n), the federal
Medicaid disproportionate share allotments for the fee period 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 portion of the federal disproportionate share
allotments applicable for disproportionate share payments for the fee
period shall be allocated to institutions for mental disease or other
mental health facilities, as defined by applicable federal law.
(n) For purposes of this SECTION, the entire federal Medicaid
disproportionate share allotment for Indiana during the fee period does
not include the portion 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 past 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 state budget committee
concerning any extension of the Indiana check-up plan past December
31, 2012.
(o) Notwithstanding IC 12-15-16-6(c), for the fee period, the annual
two million dollars ($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).
(p) The fees collected under this SECTION may be used only as
described in this SECTION 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.
(q) Nothing in this SECTION may be construed to authorize any
county, municipality, district, authority to impose a fee, tax, or
assessment on a hospital.
(r) Subject to subsection (g), the office shall adopt rules, including
emergency rules under IC 4-22-2-37.1, necessary to implement this
SECTION. Rules adopted under this subsection may be retroactive to
the effective date of the Medicaid state plan amendments or waivers
approved under this SECTION.
(s) The office may enter into an agreement with a hospital to pay the
fee collected under this SECTION in installments.
(t) If a hospital fails to pay the fee established under this SECTION
within ten (10) days of 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).
(u) The office shall report to the state department of health each
hospital that fails to pay the fee established under this SECTION within
one hundred twenty (120) days of 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 licensed 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.
(v) Payments for the programs described in subsection (f) shall be
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 subsection (f) during the fee
period and distributions to hospitals in accordance with this SECTION
may occur after the expiration of this SECTION.
(w) This SECTION expires September 1, 2013. However, the office
may not assess a hospital a fee described in this SECTION after June
30, 2013.
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