IC 12-16-5.5
    Chapter 5.5. Hospital Care for the Indigent; EligibilityDeterminations; Investigations

IC 12-16-5.5-1
Repealed
    (Repealed by P.L.146-2008, SEC.819.)

IC 12-16-5.5-1.2
Prompt review of claim; calculation of claim
    Sec. 1.2. (a) The division shall, upon receipt of a claim pertainingto a person:
        (1) who was provided care by an eligible provider; and
        (2) whose medical condition satisfies one (1) or more of themedical conditions identified in IC 12-16-3.5-1(a)(1) throughIC 12-16-3.5-1(a)(3) or IC 12-16-3.5-2(a)(1) throughIC 12-16-3.5-2(a)(3);
promptly review the claim to determine if the health care items orservices identified in the claim were necessitated by the person'smedical condition or, if applicable, if the items or services were adirect consequence of the person's medical condition.
    (b) In conducting the review of a claim referenced in subsection(a), the division shall calculate the amount of the claim. For purposesof this section, IC 12-15-15-9, IC 12-15-15-9.5, IC 12-16-6.5, andIC 12-16-7.5, the amount of a claim shall be calculated in a mannerdescribed in IC 12-16-7.5-2.5(c).
As added by P.L.145-2005, SEC.14. Amended by P.L.212-2007,SEC.18; P.L.218-2007, SEC.29.

IC 12-16-5.5-2
Disclosure of information by provider; immunity
    Sec. 2. (a) The provider of medical care to a patient shall provideinformation the provider has that would assist in the verification ofindigency of a patient.
    (b) A provider that provides information under subsection (a) isimmune from civil and criminal liability for divulging theinformation.
As added by P.L.120-2002, SEC.21. Amended by P.L.212-2007,SEC.19; P.L.218-2007, SEC.30.

IC 12-16-5.5-3
Denial of eligibility claim; notice; eligibility information
    Sec. 3. (a) Subject to subsection (b) and IC 12-16-6.5-1.5, if thedivision is unable after prompt and diligent efforts to verifyinformation contained in the application that is reasonably necessaryto determine eligibility, the division may deny assistance under thehospital care for the indigent program. The pending expiration of theperiod specified in IC 12-16-6.5-1.5 is not a valid reason for denyinga person's eligibility for the hospital care for the indigent program.
    (b) Before denying assistance under the hospital care for the

indigent program, the division must provide the person and theprovider who submitted a claim under IC 12-16-4.5-8.5 writtennotice of:
        (1) the specific information or verification needed to determineeligibility;
        (2) the specific efforts undertaken to obtain the information orverification; and
        (3) the statute or rule requiring the information or verificationidentified under subdivision (1).
    (c) The division must provide the provider who submitted a claimunder IC 12-16-4.5-8.5 a period of time, not less than ten (10) daysbeyond the deadline established under IC 12-16-6.5-1.5, to submit tothe division information concerning the person's eligibility. If thedivision does not make a determination of the person's eligibilitywithin ten (10) days after receiving the information under thissubsection, the person is eligible without the division's determinationof the person's eligibility for the hospital care for the indigent careprogram under this article.
As added by P.L.120-2002, SEC.21. Amended by P.L.255-2003,SEC.29; P.L.145-2005, SEC.15; P.L.212-2007, SEC.20;P.L.218-2007, SEC.31.

IC 12-16-5.5-3.2
Denial of item or service claim; notice; item or service information
    Sec. 3.2. (a) Subject to subsection (b) and IC 12-16-6.5-1.7, if thedivision is unable after prompt and diligent efforts to determine thata health care item or service identified in a claim:
        (1) was necessitated by one (1) or more of the medicalconditions listed in IC 12-16-3.5-1(a)(1) throughIC 12-16-3.5-1(a)(3) or IC 12-16-3.5-2(a)(1) throughIC 12-16-3.5-2(a)(3); or
        (2) was a direct consequence of one (1) or more of the medicalconditions listed in IC 12-16-3.5-1(a)(1) throughIC 12-16-3.5-1(a)(3);
the division may deny assistance to the person under the hospital carefor the indigent program for that item or service. The pendingexpiration of the period specified in IC 12-16-6.5-1.7 is not a validreason for determining that an item or a service was not necessitatedby one (1) or more of the medical conditions listed inIC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3) orIC 12-16-3.5-2(a)(1) through IC 12-16-3.5-2(a)(3), or was not adirect consequence of one (1) or more of the medical conditionslisted in IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3).
    (b) Before denying assistance under the hospital care for theindigent program for an item or a service described in subsection (a),the division must provide the provider of the item or service writtennotice of:
        (1) the specific item or service in question; and
        (2) an explanation of the basis for the division's inability todetermine that the health care item or service was:            (A) necessitated by one (1) or more of the medicalconditions listed in IC 12-16-3.5-1(a)(1) throughIC 12-16-3.5-1(a)(3) or IC 12-16-3.5-2(a)(1) throughIC 12-16-3.5-2(a)(3); or
            (B) a direct consequence of one (1) or more of the medicalconditions listed in IC 12-16-3.5-1(a)(1) throughIC 12-16-3.5-1(a)(3);
        including, if applicable, an explanation of the basis for aconclusion by the division that an item or service, in fact, wasnot necessitated by, or, as applicable, not a direct consequenceof, one (1) or more of such medical conditions.
    (c) The division must grant the provider of the item or service aperiod of time, not less than ten (10) days beyond the deadline underIC 12-16-6.5-1.7, to submit to the division information or materialsbearing on whether the item or service was necessitated by one (1)or more of the medical conditions listed in IC 12-16-3.5-1(a)(1)through IC 12-16-3.5-1(a)(3) or IC 12-16-3.5-2(a)(1) throughIC 12-16-3.5-2(a)(3), or was a direct consequence of one (1) or moreof the medical conditions listed in IC 12-16-3.5-1(a)(1) throughIC 12-16-3.5-1(a)(3). If the division does not make its determinationregarding the item or service within ten (10) days after receivinginformation or materials provided for in this section, the item orservice is considered, without the division's determination, to havebeen necessitated by one (1) or more of the medical conditions listedin IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3) orIC 12-16-3.5-2(a)(1) through IC 12-16-3.5-2(a)(3), or to have beena direct consequence of one (1) or more of the medical conditionslisted in IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3).
As added by P.L.145-2005, SEC.16.

IC 12-16-5.5-4
Notification to person and provider; requirements
    Sec. 4. The division shall notify in writing the person and theprovider of the following:
        (1) A decision concerning eligibility.
        (2) The reasons for a denial of eligibility.
        (3) That either party has the right to appeal the decision.
As added by P.L.120-2002, SEC.21. Amended by P.L.255-2003,SEC.30; P.L.212-2007, SEC.21; P.L.218-2007, SEC.32.

IC 12-16-5.5-5
Repealed
    (Repealed by P.L.255-2003, SEC.55.)