IC 12-15-19
    Chapter 19. Disproportionate Share Providers; EnhancedDisproportionate Share Payments

IC 12-15-19-1
Enhanced disproportionate share payment methodology for statefiscal years ending June 30, 1998, and June 30, 1999; limits onbasic and enhanced disproportionate share payments to hospitals
    Sec. 1. (a) For the state fiscal years ending on June 30, 1998, andJune 30, 1999, the office shall develop an enhanced disproportionateshare payment methodology that ensures that each enhanceddisproportionate share provider receives total disproportionate sharepayments that do not exceed its hospital specific limit specified insubsection (c). The methodology developed by the office shall ensurethat hospitals operated by or affiliated with the governmental entitiesdescribed in IC 12-15-18-5.1(a) receive, to the extent practicable,disproportionate share payments equal to their hospital specificlimits. The funds shall be distributed to qualifying hospitals inproportion to each qualifying hospital's percentage of the total nethospital specific limits of all qualifying hospitals. A hospital's nethospital specific limit for state fiscal years ending on or before June30, 1999, is determined under STEP THREE of the followingformula:
        STEP ONE: Determine the hospital's hospital specific limitunder subsection (c).
        STEP TWO: Subtract basic disproportionate share paymentsreceived by the hospital under IC 12-15-16-6 from the amountdetermined under STEP ONE.
        STEP THREE: Subtract intergovernmental transfers paid by oron behalf of the hospital from the amount determined underSTEP TWO.
    (b) The office shall include a provision in each amendment to thestate plan regarding disproportionate share payments, municipaldisproportionate share payments, and community mental healthcenter disproportionate share payments that the office submits to thefederal Centers for Medicare and Medicaid Services that, as providedin 42 CFR 447.297(d)(3), allows the state to make additionaldisproportionate share expenditures, municipal disproportionateshare expenditures, and community mental health centerdisproportionate share expenditures after the end of each federalfiscal year that relate back to a prior federal fiscal year. Each eligiblehospital or community mental health center may receive anadditional disproportionate share adjustment if:
        (1) additional intergovernmental transfers or certifications aremade as authorized under IC 12-15-18-5.1; and
        (2) the total disproportionate share payments to:
            (A) each individual hospital; and
            (B) all qualifying hospitals in the aggregate;
        do not exceed the limits provided by federal law and regulation.
    (c) For state fiscal years ending on or before June 30, 1999, total

basic and enhanced disproportionate share payments to a hospitalunder this chapter and IC 12-15-16 shall not exceed the hospitalspecific limit provided under 42 U.S.C. 1396r-4(g). The hospitalspecific limit for state fiscal years ending on or before June 30, 1999,shall be determined by the office taking into account any dataprovided by each hospital for each hospital's most recent fiscal year(or in cases where a change in fiscal year causes the most recentfiscal period to be less than twelve (12) months, twelve (12) monthsof data ending at the end of the most recent fiscal year) as certifiedto the office by:
        (1) an independent certified public accounting firm if thehospital is a hospital licensed under IC 16-21 that qualifiesunder IC 12-15-16-1(a); or
        (2) the budget agency if the hospital is a state mental healthinstitution listed under IC 12-24-1-3 that qualifies under eitherIC 12-15-16-1(a)(1) or IC 12-15-16-1(a)(2);
in accordance with this subsection and federal laws, regulations, andguidelines. The hospital specific limit for state fiscal years endingafter June 30, 1999, shall be determined by the office using themethodology described in section 2.1(b) of this chapter.
As added by P.L.2-1992, SEC.9. Amended by P.L.27-1992, SEC.18;P.L.2-1993, SEC.101; P.L.277-1993(ss), SEC.79; P.L.1-1994,SEC.63; P.L.156-1995, SEC.7; P.L.115-1996, SEC.2; P.L.24-1997,SEC.52; P.L.126-1998, SEC.11; P.L.113-2000, SEC.11;P.L.66-2002, SEC.9.

IC 12-15-19-2
Repealed
    (Repealed by P.L.126-1998, SEC.21.)

IC 12-15-19-2.1
Disproportionate share payment methodology for state fiscal yearsending on or after June 30, 2000; limits on total disproportionateshare payments to hospitals
    Sec. 2.1. (a) For each state fiscal year ending on or after June 30,2000, the office shall develop a disproportionate share paymentmethodology that ensures that each hospital qualifying fordisproportionate share payments under IC 12-15-16-1(a) timelyreceives total disproportionate share payments that do not exceed thehospital's hospital specific limit provided under 42 U.S.C.1396r-4(g). The payment methodology as developed by the officemust:
        (1) maximize disproportionate share hospital payments toqualifying hospitals to the extent practicable;
        (2) take into account the situation of those qualifying hospitalsthat have historically qualified for Medicaid disproportionateshare payments; and
        (3) ensure that payments for qualifying hospitals are equitable.
    (b) Total disproportionate share payments to a hospital under thischapter shall not exceed the hospital specific limit provided under 42

U.S.C. 1396r-4(g). The hospital specific limit for a state fiscal yearshall be determined by the office taking into account data providedby each hospital that is considered reliable by the office based on asystem of periodic audits, the use of trending factors, and anappropriate base year determined by the office. The office mayrequire independent certification of data provided by a hospital todetermine the hospital's hospital specific limit.
    (c) The office shall include a provision in each amendment to thestate plan regarding Medicaid disproportionate share payments thatthe office submits to the federal Centers for Medicare and MedicaidServices that, as provided in 42 CFR 447.297(d)(3), allows the stateto make additional disproportionate share expenditures after the endof each federal fiscal year that relate back to a prior federal fiscalyear. However, the total disproportionate share payments to:
        (1) each individual hospital; and
        (2) all qualifying hospitals in the aggregate;
may not exceed the limits provided by federal law and regulation.
As added by P.L.113-2000, SEC.12. Amended by P.L.283-2001,SEC.24; P.L.66-2002, SEC.10; P.L.212-2007, SEC.8; P.L.218-2007,SEC.18.

IC 12-15-19-3
Repealed
    (Repealed by P.L.27-1992, SEC.30.)

IC 12-15-19-4
Repealed
    (Repealed by P.L.156-1995, SEC.9.)

IC 12-15-19-5
Federal financial participation unavailable; withholdingdisproportionate share payment adjustments
    Sec. 5. Except as provided in section 6 of this chapter,disproportionate share payment adjustments under this chapter maynot be withheld by the office unless federal financial participationbecomes unavailable to match state money for the purpose ofproviding disproportionate share payment adjustments.
As added by P.L.2-1992, SEC.9. Amended by P.L.27-1992, SEC.21;P.L.113-2000, SEC.13.

IC 12-15-19-6
Deposits in fund; insufficiency; suspension or reduction ofpayments to eligible institutions
    Sec. 6. (a) The office is not required to make disproportionateshare payments under this chapter from the Medicaid indigent caretrust fund established by IC 12-15-20-1 until the fund has receivedsufficient deposits, including intergovernmental transfers of fundsand certifications of expenditures, to permit the office to make thestate's share of the required disproportionate share payments.
    (b) For state fiscal years beginning after June 30, 2006, if:        (1) sufficient deposits have not been received; or
        (2) the statewide Medicaid disproportionate share allocation isinsufficient to provide federal financial participation for theentirety of all eligible disproportionate share hospitals'hospital-specific limits;
the office shall reduce disproportionate share payments made underIC 12-15-19-2.1 and Medicaid safety-net payments made inaccordance with the Medicaid state plan to eligible institutions usingan equitable methodology consistent with subsection (c).
    (c) For state fiscal years beginning after June 30, 2006, paymentsreduced under this section shall, in accordance with the Medicaidstate plan, be made:
        (1) to best utilize federal matching funds available for hospitalseligible for Medicaid disproportionate share payments underIC 12-15-19-2.1; and
        (2) by utilizing a methodology that allocates available fundingunder this subdivision, and Medicaid supplemental payments asdefined in IC 12-15-15-1.5, in a manner that all hospitalseligible for Medicaid disproportionate share payments underIC 12-15-19-2.1 receive payments using a methodology that:
            (A) takes into account the situation of the eligible hospitalsthat have historically qualified for Medicaid disproportionateshare payments; and
            (B) ensures that payments for eligible hospitals areequitable.
    (d) The percentage reduction shall be sufficient to ensure thatpayments do not exceed the statewide Medicaid disproportionateshare allocation or the amounts that can be financed with:
        (1) the amount transferred from the hospital care for theindigent trust fund;
        (2) other intergovernmental transfers;
        (3) certifications of public expenditures; or
        (4) any other permissible sources of non-federal match.
As added by P.L.2-1992, SEC.9. Amended by P.L.27-1992, SEC.22;P.L.113-2000, SEC.14; P.L.212-2007, SEC.9; P.L.218-2007,SEC.19.

IC 12-15-19-7
Repealed
    (Repealed by P.L.27-1992, SEC.30.)

IC 12-15-19-8
Disproportionate share adjustments received by municipaldisproportionate share providers; limits on total disproportionateshare payments
    Sec. 8. (a) A provider that qualifies as a municipaldisproportionate share provider under IC 12-15-16-1 shall receive adisproportionate share adjustment, subject to the provider's hospitalspecific limits described in subsection (b), as follows:
        (1) For each state fiscal year ending on or after June 30, 1998,

an amount shall be distributed to each provider qualifying as amunicipal disproportionate share provider under IC 12-15-16-1.The total amount distributed shall not exceed the sum of allhospital specific limits for all qualifying providers.
        (2) For each municipal disproportionate share providerqualifying under IC 12-15-16-1 to receive disproportionateshare payments, the amount in subdivision (1) shall be reducedby the amount of disproportionate share payments received bythe provider under IC 12-15-16-6 or sections 1 or 2.1 of thischapter. The office shall develop a disproportionate shareprovider payment methodology that ensures that each municipaldisproportionate share provider receives disproportionate sharepayments that do not exceed the provider's hospital specificlimit specified in subsection (b). The methodology developedby the office shall ensure that a municipal disproportionateshare provider receives, to the extent possible, disproportionateshare payments that, when combined with any otherdisproportionate share payments owed to the provider, equalsthe provider's hospital specific limits.
    (b) Total disproportionate share payments to a provider under thischapter and IC 12-15-16 shall not exceed the hospital specific limitprovided under 42 U.S.C. 1396r-4(g). The hospital specific limit forstate fiscal years ending on or before June 30, 1999, shall bedetermined by the office taking into account data provided by eachhospital for the hospital's most recent fiscal year or, if a change infiscal year causes the most recent fiscal period to be less than twelve(12) months, twelve (12) months of data compiled to the end of theprovider's fiscal year that ends within the most recent state fiscalyear, as certified to the office by an independent certified publicaccounting firm. The hospital specific limit for all state fiscal yearsending on or after June 30, 2000, shall be determined by the officetaking into account data provided by each hospital that is deemedreliable by the office based on a system of periodic audits, the use oftrending factors, and an appropriate base year determined by theoffice. The office may require independent certification of dataprovided by a hospital to determine the hospital's hospital specificlimit.
    (c) For each of the state fiscal years:
        (1) beginning July 1, 1998, and ending June 30, 1999; and
        (2) beginning July 1, 1999, and ending June 30, 2000;
the total municipal disproportionate share payments available underthis section to qualifying municipal disproportionate share providersis twenty-two million dollars ($22,000,000).
As added by P.L.126-1998, SEC.12. Amended by P.L.113-2000,SEC.15.

IC 12-15-19-9
Repealed
    (Repealed by P.L.2-2005, SEC.131.)
IC 12-15-19-10
Priorities of payments
    Sec. 10. For state fiscal years beginning after June 30, 2000, thestate shall pay providers as follows:
        (1) The state shall make municipal disproportionate shareprovider payments to providers qualifying underIC 12-15-16-1(b) until the state exceeds the statedisproportionate share allocation (as defined in 42 U.S.C.1396r-4(f)(2)).
        (2) After the state makes all payments under subdivision (1), ifthe state fails to exceed the state disproportionate shareallocation (as defined in 42 U.S.C. 1396r-4(f)(2)), the state shallmake disproportionate share provider payments to providersqualifying under IC 12-15-16-1(a).
        (3) After the state makes all payments under subdivision (2), ifthe state fails to exceed the state disproportionate shareallocation (as defined in 42 U.S.C. 1396r-4(f)(2)), or the statelimit on disproportionate share expenditures for institutions formental diseases (as defined in 42 U.S.C. 1396r-4(h)), the stateshall make community mental health center disproportionateshare provider payments to providers qualifying underIC 12-15-16-1(c).
As added by P.L.126-1998, SEC.14. Amended by P.L.113-2000,SEC.17; P.L.283-2001, SEC.25; P.L.2-2005, SEC.49.

IC 12-15-19-10.1
Repealed
    (Repealed by P.L.283-2001, SEC.39.)