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Indiana Code Title 12. Human Services § 12-15-16-7.7

Current as of January 02, 2024 | Updated by Findlaw Staff

Sec. 7.7. (a) As used in this section, “CMS” refers to the federal Centers for Medicare and Medicaid Services.

(b) As used in this section, “disproportionate share payment plan” refers to a plan for distributing disproportionate share payments for the state fiscal year beginning July 1, 2020, for any state fiscal year beginning after July 1, 2020, and that meets the requirements set forth in this section.

(c) As used in this section, “federal DSH allotment” refers to the allotment of federal disproportionate share funds calculated for the state under 42 U.S.C. 1396r-4.

(d) As used in this section, “reduced federal DSH allotment” refers to a federal DSH allotment for the state for the federal fiscal year beginning October 1, 2020, that, by operation of 42 U.S.C. 1396r-4(f)(7), is less than the federal DSH allotment for the state for the federal fiscal year beginning October 1, 2018.

(e) As used in this section, “terminating event” refers to federal legislation (including an amendment to 42 U.S.C. 1396r-4), a regulation or sub-regulatory policy or directive issued by CMS, or a judicial ruling, that is enacted or issued on or before March 30, 2021, that:

(1) cancels, or postpones to a subsequent federal fiscal year, a reduced federal DSH allotment;  and

(2) does not cause the state to incur a reduced federal DSH allotment.

(f) The office shall develop a disproportionate share payment plan. The following apply to the disproportionate share payment plan developed under this subsection:

(1) The disproportionate share payment plan must:

(A) specify the amount or amounts of disproportionate share payment adjustments to be paid to acute care hospitals licensed under IC 16-21-2 and private mental health institutions licensed under IC 12-25 for the state fiscal year beginning on or after July 1, 2020;  or

(B) specify the formula to be used by the office for purposes of determining the amount or amounts of disproportionate share payment adjustments to be paid to acute care hospitals licensed under IC 16-21-2 and private mental health institutions licensed under IC 12-25 for the state fiscal year beginning on or after July 1, 2020.

(2) In developing the disproportionate share payment plan, the office is not required to:

(A) follow paragraphs 1 through 7 of Subsection A of Section III of Attachment 4.19-A of the Indiana Medicaid state plan in effect on January 1, 2019;

(B) provide for disproportionate share payment adjustments to be paid to acute care hospitals licensed under IC 16-21-2 or private mental health institutions licensed under IC 12-25 that, for purposes of the state fiscal year beginning on or after July 1, 2020, do not meet the definition of a “disproportionate share hospital” as set forth in Section II(E) of Attachment 4.19-A of the Indiana Medicaid state plan in effect on January 1, 2019;  or

(C) follow the provisions set forth in section 7.5 of this chapter.

(3) In developing the disproportionate share payment plan, the office shall take into consideration the percentage of a hospital's patients whose health care coverage is provided by a governmental health care program.

(g) After the office submits the state plan amendment described in section 7.5 of this chapter, but before October 1, 2020, the office shall file with CMS and, if approved by CMS, the office shall implement, a proposed Medicaid state plan amendment that is based upon the disproportionate share payment plan developed by the office, subject to the following:

(1) The proposed Medicaid state plan amendment referred to in this subsection shall include language that, in the event a terminating event occurs after the Medicaid state plan amendment is approved by the CMS but before March 30, 2021, would operate to cause the state plan amendment to be immediately and automatically void and without effect, and to cause Subsection A of Section III of Attachment 4.19-A of the state's Medicaid state plan, in effect on January 1, 2019, to be immediately and automatically reinstated and effective.

(2) Subdivision (1) does not prevent the office from submitting a subsequent Medicaid state plan amendment for approval by CMS after CMS's approval of the state plan amendment referenced in subdivision (1) and that applies to a state fiscal year beginning on or after July 1, 2021, and that amends or replaces the state plan amendment described in this subsection.

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Cite this article: FindLaw.com - Indiana Code Title 12. Human Services § 12-15-16-7.7 - last updated January 02, 2024 | https://codes.findlaw.com/in/title-12-human-services/in-code-sect-12-15-16-7-7/

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