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Indiana Code Title 12. Human Services § 12-15-16-7

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

Sec. 7. (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.

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

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