5.
(a)This section applies to a hospital that:
(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 IC 16-21-10.
(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 fisca
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5. (a) This section applies to a hospital that:
(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 IC 16-21-10.
(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.