CHAPTER 6.5. HOSPITAL CARE FOR THE INDIGENT; DENIAL OF ELIGIBILITY; APPEALS; JUDICIAL REVIEW

IC 12-16-6.5
    Chapter 6.5. Hospital Care for the Indigent; Denial of Eligibility;Appeals; Judicial Review

IC 12-16-6.5-1
Ineligibility determination; appeal to division
    Sec. 1. If the division determines that a person is not eligible forassistance for services, an affected person, or provider may appeal tothe division not later than ninety (90) days after the mailing of noticeof that determination to the affected person or provider to the lastknown address of the person or provider.
As added by P.L.120-2002, SEC.22. Amended by P.L.255-2003,SEC.31; P.L.145-2005, SEC.17; P.L.212-2007, SEC.22;P.L.218-2007, SEC.33.

IC 12-16-6.5-1.2
Appeal; notice
    Sec. 1.2. (a) If the division determines that an item or serviceidentified in a claim:
        (1) was not 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 not a direct consequence of one (1) or more of themedical conditions listed in IC 12-16-3.5-1(a)(1) throughIC 12-16-3.5-1(a)(3);
the affected person or provider may appeal to the division not laterthan ninety (90) days after the mailing of the notice of thatdetermination to the affected person or provider to the last knownaddress of the person or provider.
    (b) If the division determines that an item or service identified ina 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);
but the affected provider disagrees with the amount of the claimcalculated by the division under IC 12-16-5.5-1.2(b), the affectedprovider may appeal the calculation to the division not later thanninety (90) days after the mailing of the notice of that calculation tothe affected provider to the last known address of the provider.
As added by P.L.145-2005, SEC.18. Amended by P.L.212-2007,SEC.23; P.L.218-2007, SEC.34.

IC 12-16-6.5-1.5
Patient eligibility determination
    Sec. 1.5. Subject to IC 12-16-5.5-3(c), if the division fails to

complete an investigation and determination of a person's eligibilityfor the hospital care for the indigent program not later than forty-five(45) days after receipt of the application filed under IC 12-16-4.5, theperson is considered to be eligible without the division'sdetermination of assistance under the program.
As added by P.L.145-2005, SEC.19.

IC 12-16-6.5-1.7
Item or service eligibility determination
    Sec. 1.7. Subject to IC 12-16-5.5-3.2(c), if the division fails tocomplete an investigation and determination of one (1) or morehealth care items or services identified in a claim within forty-five(45) days after receipt of the claim filed under IC 12-16-4.5, the itemor service is considered to have been:
        (1) necessitated by 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) orIC 12-16-3.5-2(a)(1) through IC 12-16-3.5-2(a)(3); or
        (2) 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).
As added by P.L.145-2005, SEC.20.

IC 12-16-6.5-2
Repealed
    (Repealed by P.L.145-2005, SEC.31.)

IC 12-16-6.5-3
Hearing
    Sec. 3. The division shall fix a time and place for a hearing beforea hearing officer appointed by the director of the division.
As added by P.L.120-2002, SEC.22.

IC 12-16-6.5-4
Notice of hearing
    Sec. 4. A notice of the hearing shall be served upon all personsinterested in the matter, including any affected provider, at leasttwenty (20) days before the time fixed for the hearing.
As added by P.L.120-2002, SEC.22. Amended by P.L.255-2003,SEC.33; P.L.212-2007, SEC.24; P.L.218-2007, SEC.35.

IC 12-16-6.5-5
Determination of eligibility for assistance and health care items orservices; entitled to assistance
    Sec. 5. (a) If the division receives an application that was filed onbehalf of a person under IC 12-16-4.5, the division shall determine:
        (1) the eligibility of the person for assistance under the hospitalcare for the indigent program; and
        (2) if the health care items or services provided to the personand identified in a claim filed with the division underIC 12-16-4.5 were:            (A) necessitated by at least one (1) medical condition 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
            (B) the direct consequence of at least one (1) of the medicalconditions listed in IC 12-16-3.5-1(a)(1) throughIC 12-16-3.5-1(a)(3).
    (b) If:
        (1) the person, initially or upon appeal, is found eligible forassistance; and
        (2) at least one (1) of the items or services identified in theclaim is determined initially or upon appeal:
            (A) to have been necessitated by one (1) or more of themedical conditions 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) to be a direct consequence of one (1) or more of themedical conditions listed in IC 12-16-3.5-1(a)(1) throughIC 12-16-3.5-1(a)(3);
        the person is entitled to assistance for those items and services.
As added by P.L.120-2002, SEC.22. Amended by P.L.255-2003,SEC.34; P.L.145-2005, SEC.21.

IC 12-16-6.5-6
Appeal
    Sec. 6. A person, hospital, physician, or transportation provideraggrieved by a determination of an appeal taken under section 1 or1.2 of this chapter may appeal the determination under IC 4-21.5.
As added by P.L.120-2002, SEC.22. Amended by P.L.145-2005,SEC.22.

IC 12-16-6.5-7
Rules; administrative appeal procedure; provisions
    Sec. 7. (a) The division shall adopt rules under IC 4-22-2 thatprovide for an administrative appeal procedure that is responsive tothe needs of patients and providers.
    (b) The procedure must provide for the following:
        (1) The location of hearings.
        (2) The presentation of evidence.
        (3) The use of telecommunications.
As added by P.L.120-2002, SEC.22.

IC 12-16-6.5-8
Repealed
    (Repealed by P.L.255-2003, SEC.55.)