3.
(a)This section applies to a hospital that
is:
(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 IC 16-21-10.
(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
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3. (a) This section applies to a hospital that
is:
(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 IC 16-21-10.
(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).