§ 12-15-16-1 — Disproportionate share provider status

Indiana § 12-15-16-1

• Jurisdiction: Indiana
• Art. 15: MEDICAID
• Ch. 16: Disproportionate Share Providers; Eligibility

Text

(a) A provider that is an acute care hospital
licensed under IC 16-21, a state mental health institution under IC 12-24-1-3, or a private psychiatric institution licensed under IC 12-25
is a disproportionate share provider if the provider meets either of the
following conditions:
(1) The provider's Medicaid inpatient utilization rate is at least
one (1) standard deviation above the mean Medicaid inpatient
utilization rate for providers receiving Medicaid payments in
Indiana. However, the Medicaid inpatient utilization rate of
providers whose low income utilization rate exceeds twenty-five
percent (25%) must be excluded in calculating the statewide
mean Medicaid inpatient utilization rate.
(2) The provider's low income utilization rate exceeds twenty-five
percent (25%).
(b) An acute care hospital licensed under IC 16-21 is a municipal
disproportionate share provider if the hospital:
(1) has a Medicaid utilization rate greater than one percent (1%);
and
(2) is established and operated under IC 16-22-2 or IC 16-23.
(c) A community mental health center:
(1) that is identified in IC 12-29-2-1;
(2) for which a county provides funds under:
(A) IC 12-29-1-7(b) before January 1, 2004; or
(B) IC 12-29-2 after December 31, 2018;
or from other county sources; and
(3) that provides inpatient services to Medicaid patients;
is a community mental health center disproportionate share provider if
the community mental health center's Medicaid inpatient utilization
rate is greater than one percent (1%).
(d) A disproportionate share provider under IC 12-15-17 must have
at least two (2) obstetricians who have staff privileges and who have
agreed to provide obstetric services under the Medicaid program. For
a hospital located in a rural area (as defined in Section 1886 of the
Social Security Act), an obstetrician includes a physician with staff
privileges at the hospital who has agreed to perform nonemergency
obstetric procedures. However, this obstetric service requirement does
not apply to a provider whose inpatients are predominantly individuals
less than eighteen (18) years of age or that did not offer nonemergency
obstetric services as of December 21, 1987.
(e) The determination of a provider's status as a disproportionate
share provider under this section shall be based on utilization and
revenue data from the most recent year for which an audited cost report
from the provider is on file with the office.
(f) Except as provided in section 7.3 of this chapter, no payments
shall be made to disproportionate share hospitals for any state fiscal
year for which the state directed payment program under IC 16-21-10-8.5 is in effect.
[Pre-1992 Revision Citation: 12-1-7-60(a).]

Legislative History

As added by P.L.2-1992, SEC.9. Amended by P.L.27-1992, SEC.12; P.L.277-1993(ss), SEC.71; P.L.126-1998, SEC.6; P.L.113-2000, SEC.5; P.L.78-2004, SEC.8; P.L.123-2008, SEC.1; P.L.76-2018, SEC.2; P.L.216-2025, SEC.3.