IC 12-15-11.5
    Chapter 11.5. Lake County Disproportionate Share Hospitals

IC 12-15-11.5-0.5
Chapter not applicable to certain managed care contractors
    Sec. 0.5. This chapter does not apply to a managed care contractorthat, on or before July 1, 2000, did not directly contract with ahospital (as defined in section 1 of this chapter) for the provision ofservices under the office's managed care program.
As added by P.L.141-2001, SEC.1.

IC 12-15-11.5-1
"Hospital" defined
    Sec. 1. As used in this chapter, "hospital" refers to an acute carehospital provider that:
        (1) is licensed under IC 16-21;
        (2) qualifies as a disproportionate share hospital underIC 12-15-16; and
        (3) is the sole disproportionate share hospital in a city locatedin a county having a population of more than four hundredthousand (400,000) but less than seven hundred thousand(700,000).
As added by P.L.142-2000, SEC.2.

IC 12-15-11.5-2
Hospital as contracted provider to eligible individuals
    Sec. 2. The office's managed care contractor shall regard ahospital as a contracted provider in the office's managed careservices program, which provides a capitated prepayment managedcare system, for the provision of medical services to each individualwho:
        (1) is eligible to receive services under IC 12-15 and hasenrolled in the office's managed care services program;
        (2) resides in the same city in which the hospital is located; and
        (3) has selected a primary care provider who:
            (A) is a contracted provider with the office's managed carecontractor; and
            (B) has medical staff privileges at the hospital.
As added by P.L.142-2000, SEC.2. Amended by P.L.141-2001,SEC.2.

IC 12-15-11.5-3
Repealed
    (Repealed by P.L.145-2005, SEC.30.)

IC 12-15-11.5-3.1
Repealed
    (Repealed by P.L.1-2007, SEC.248.)

IC 12-15-11.5-4 Repealed
    (Repealed by P.L.1-2002, SEC.172.)

IC 12-15-11.5-4.1
Repealed
    (Repealed by P.L.145-2005, SEC.30.)

IC 12-15-11.5-4.2
Repealed
    (Repealed by P.L.1-2007, SEC.248.)

IC 12-15-11.5-5
Repealed
    (Repealed by P.L.1-2002, SEC.172.)

IC 12-15-11.5-6
Claim for reimbursement treated as disputed claim
    Sec. 6. A claim for reimbursement for services shall be treated asa disputed claim under this chapter if:
        (1) it is submitted within one hundred twenty (120) days afterthe date that services are rendered;
        (2) it is denied by the managed care contractor;
        (3) the hospital submits a written notice of dispute for the claimto the managed care contractor not more than sixty (60) daysafter the receipt of the denial notice;
        (4) it is appealed in accordance with the managed carecontractor's internal appeals process; and
        (5) payment for the claim is denied by the managed carecontractor following its internal appeals process.
As added by P.L.142-2000, SEC.2.

IC 12-15-11.5-7
Conclusion of appeal
    Sec. 7. The office's managed care contractor must conclude anappeal under section 6(4) of this chapter and notify the hospital of itsdecision not more than thirty-five (35) days after the managed carecontractor receives a notice from the hospital disputing the managedcare contractor's denial of a claim.
As added by P.L.142-2000, SEC.2.

IC 12-15-11.5-8
Dispute resolution procedure requirements
    Sec. 8. (a) A contract entered into by a hospital with the office'smanaged care contractor for the provision of services under theoffice's managed care services program must include a disputeresolution procedure for all disputed claims. Unless agreed to inwriting by the hospital and the office's managed care contractor, thedispute resolution procedure must include the followingrequirements:
        (1) That submission of disputed claims must be made to an

independent arbitrator selected under subsection (b).
        (2) Each claim must set forth with specificity the issues to bearbitrated, the amount involved, and the relief sought.
        (3) That the hospital and the office's managed care contractorshall attempt in good faith to resolve all disputed claims.
        (4) The hospital shall submit to the arbitrator any claims thatremain in dispute sixty (60) calendar days after the hospitalreceives written notice as provided under section 7 of thischapter.
        (5) That resolution of disputes by the arbitrator must occur notlater than ninety (90) calendar days after submission of disputedclaims to the arbitrator, unless the parties mutually agreeotherwise.
        (6) That determinations of the arbitrator are final and bindingand not subject to any appeal or review procedure.
        (7) That the arbitrator does not have the authority to award anypunitive or exemplary damages or to vary or ignore the terms ofany contract between the parties and shall be bound bycontrolling law.
        (8) That judgment upon the award rendered by the arbitratormay be entered and enforced in and is subject to the jurisdictionof a court with jurisdiction in Indiana.
        (9) That the cost of the arbitrator must be shared equally by theparties, and each party must bear its own attorney and witnessfees.
    (b) The parties to a contract described in subsection (a) shallmutually agree on an independent arbitrator, or, if the parties areunable to reach agreement on an independent arbitrator, thefollowing procedure must be followed:
        (1) Each party shall select an independent representative, andthe independent representatives shall select a panel of three (3)independent arbitrators who have experience in institutional andprofessional health care delivery practices and procedures andhave had no prior dealing with either party other than as anarbitrator.
        (2) The parties will each strike one (1) arbitrator from the panelselected under subdivision (1), and the remaining arbitratorserves as the arbitrator of the disputed claims under subsection(a).
        (3) The procedures for selecting an arbitrator under this sectionmust be completed not later than twenty (20) calendar days afterthe hospital provides written notice of at least one (1) disputedclaim.
As added by P.L.142-2000, SEC.2.

IC 12-15-11.5-9
Arbitration process to be followed for disputed claims betweenhospital and managed care contractor
    Sec. 9. The arbitration process described in section 8 of thischapter shall also be followed for resolution of disputed claims

between a hospital and the office's managed care contractor, if thehospital is not a contracted provider in the office's managed healthcare services program.
As added by P.L.142-2000, SEC.2.