§ 12-15-16-7 — Disproportionate share payments when hospital assessment fees are authorized; not applicable when state directed payment program in effect

Indiana § 12-15-16-7

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

Text

(a) Except as provided in subsection (j) and
section 7.7 of this chapter, this section applies to Medicaid
disproportionate share payments for the state fiscal year beginning:
(1) July 1, 2012, if hospital fees authorized under P.L.229-2011,
SECTION 281 or authorized to be transferred and used for
payments are used as state share dollars for the payments; and
(2) July 1, 2013, and for each state fiscal year after, for which
hospital fees authorized under IC 16-21-10 are used as state share
dollars for the payments.
(b) As used in this section, "hospital specific limit" refers to the
hospital specific limit provided under 42 U.S.C. 1396r-4(g).
(c) As used in this section, "municipal hospital payment amount"
means, concerning a hospital established and operated under IC 16-22-2 or IC 16-23, an amount equal to the lesser of:
(1) the hospital specific limit for the hospital for the state fiscal
year; or
(2) the hospital's net 2009 supplemental payment amount.
(d) As used in this section, "nongovernmental hospital" refers to a
hospital that is licensed under IC 16-21-2, that is not a unit of state or
local government, and is not owned or operated by a unit of state or
local government.
(e) Subject to subsection (j), the following providers are eligible for
Medicaid disproportionate share payments under this section:
(1) A hospital or psychiatric institution described in Attachment
4.19-A, Section III, page 6.1(a) of the Medicaid state plan in
effect July 1, 2011.
(2) A hospital that satisfies the following for the state fiscal year
for which Medicaid disproportionate share payments are made
under this section:
(A) A nongovernmental hospital that:
(i) has a Medicaid inpatient utilization rate for the state fiscal
year that is at least equal to the mean Medicaid inpatient
utilization rate as calculated for purposes of determining
Medicaid disproportionate share eligibility, but does not
equal or exceed one (1) standard deviation above the mean
Medicaid inpatient utilization rate; and
(ii) satisfies the obstetric service provisions of 42 U.S.C.
1396r-4(d).
(B) A hospital established and operated under IC 16-22-2 or IC 16-23 that:
(i) has a Medicaid inpatient utilization rate for the state fiscal
year greater than one percent (1%); and
(ii) satisfies the obstetric service provisions of 42 U.S.C.
1396r-4(d).
(3) A nongovernmental hospital that satisfies the following for the
state fiscal year for which Medicaid disproportionate share
payments are made under this section:
(A) The hospital has a Medicaid inpatient utilization rate for the
state fiscal year that is less than the mean Medicaid inpatient
utilization rate, as calculated for purposes of determining
Medicaid disproportionate share eligibility, but is at least
greater than one percent (1%).
(B) The hospital satisfies the obstetric service provisions of 42
U.S.C. 1396r-4(d).
(f) This subsection applies to a payment of Medicaid
disproportionate share payments, if any, to hospitals described in
subsection (e)(2) and (e)(3). For Medicaid disproportionate share
payments for the state fiscal year beginning July 1, 2012, the office
may develop and implement a Medicaid state plan amendment that
provides Medicaid disproportionate share payments for the hospitals
described in:
(1) subsection (e)(2), as long as each hospital and psychiatric
institution described in subsection (e)(1) has received a Medicaid
disproportionate share payment for the state fiscal year in an
amount equal to either:
(A) the hospital specific limit; or
(B) the municipal hospital payment amount;
for the hospital or psychiatric institution for the state fiscal year;
and
(2) subsection (e)(3), as long as each hospital described in
subsection (e)(2) has received a Medicaid disproportionate share
payment for the state fiscal year in an amount equal to the hospital
specific limit for the hospital for the state fiscal year.
(g) This subsection applies to a payment of Medicaid
disproportionate share payments, if any, to hospitals described in
subsection (e)(2) and (e)(3). For Medicaid disproportionate share
payments for the state fiscal year beginning July 1, 2013, and each state
fiscal year thereafter under this section, the office may develop and
implement a Medicaid state plan amendment that:
(1) renews, for state fiscal year beginning July 1, 2013, and each
state fiscal year thereafter under this section, the Medicaid
disproportionate share provisions of Attachment 4.19-A, Section
III, page 6.1(a) of the Medicaid state plan in effect on July 1,
2011;
(2) provides Medicaid disproportionate share payments for the
hospitals described in subsection (e)(2), as long as each hospital
and psychiatric institution described in subsection (e)(1) has
received a Medicaid disproportionate share payment for the state
fiscal year in an amount equal to the:
(A) hospital specific limit; or
(B) municipal hospital payment amount;
for the hospital or psychiatric institution for the state fiscal year;
and
(3) provides Medicaid disproportionate share payments for the
hospitals described in subsection (e)(3), as long as each hospital
described in subsection (e)(2) has received a Medicaid
disproportionate share payment for the state fiscal year in an
amount equal to the hospital specific limit of the hospital for the
state fiscal year.
(h) This subsection does not apply to Medicaid disproportionate
share payments made to hospitals described in subsection (e)(2)(B)
under Attachment 4.19-A, Section III, page 6.1(a) of the Medicaid state
plan in effect on July 1, 2011, or any renewal. Nothing in this section:
(1) requires that the hospitals described in subsection (e)(2) or
(e)(3) receive Medicaid disproportionate share payments for a
state fiscal year;
(2) requires that the hospitals described in subsection (e)(2) or
(e)(3) receive Medicaid disproportionate share payments for a
state fiscal year in an amount equal to the respective hospital
specific limits for the state fiscal year; or
(3) prescribes how Medicaid disproportionate share payments are
to be distributed among the hospitals described in:
(A) subsection (e)(2); or
(B) subsection (e)(3).
(i) Nothing in this section prohibits the use of unexpended federal
Medicaid disproportionate share allotments for a state fiscal year under
a program, as long as each hospital listed in subsection (e)(1), (e)(2),
and (e)(3) has received Medicaid disproportionate share payments for
the state fiscal year equal to the hospital specific limit for the hospital
for the state fiscal year.
(j) This section does not apply for a state fiscal year for which the
state directed payment program under IC 16-21-10-8.5 is in effect.

Legislative History

As added by P.L.205-2013, SEC.197. Amended by P.L.2-2014, SEC.64; P.L.108-2019, SEC.195; P.L.216-2025, SEC.5.