§ 12-15-16-2 — Inpatient utilization rate

Indiana § 12-15-16-2

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

Text

(a) For purposes of disproportionate share
eligibility, a provider's Medicaid inpatient utilization rate is a fraction
(expressed as a percentage) where:
(1) the numerator is the provider's total number of Medicaid
inpatient days in the most recent year for which an audited cost
report is on file with the office; and
(2) the denominator is the total number of the provider's inpatient
days in the most recent year for which an audited cost report is on
file with the office.
(b) For purposes of this section, "Medicaid inpatient days" includes
all acute care days attributable to individuals eligible for Medicaid
benefits under a state plan approved under 42 U.S.C. 1396a on the days
of service:
(1) whether attributable to individuals eligible for Medicaid in
Indiana or any other state;
(2) even if the office did not make payment for any services,
including inpatient days that are determined to be medically
necessary but for which payment is denied by the office for other
reasons; and
(3) including days attributable to Medicaid beneficiaries receiving
services through a managed care organization or health
maintenance organization.
[Pre-1992 Revision Citation: 12-1-7-60(b).]

Legislative History

As added by P.L.2-1992, SEC.9. Amended by P.L.277-1993(ss), SEC.72; P.L.156-1995, SEC.2; P.L.126-1998, SEC.7; P.L.113-2000, SEC.6; P.L.283-2001, SEC.22; P.L.153-2011, SEC.18.