IC 12-16-7.5
    Chapter 7.5. Hospital Care for the Indigent; Cost of Care andPayment

IC 12-16-7.5-1
Repealed
    (Repealed by P.L.145-2005, SEC.31.)

IC 12-16-7.5-1.2
Eligible patient not financially obligated; payment
    Sec. 1.2. (a) A person determined to be eligible under the hospitalcare for the indigent program is not financially obligated for servicesprovided to the person during the person's eligibility under theprogram, if the items or services were:
        (1) identified in a claim filed with the division underIC 12-16-4.5; and
        (2) determined:
            (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).
    (b) Hospitals may receive a payment from the office calculatedand made under IC 12-15-15-9 and, if applicable, IC 12-15-15-9.5.Hospitals shall not file claims for payments under IC 12-15-15-9 andIC 12-15-15-9.5 for payments attributable to state fiscal yearsbeginning after June 30, 2007.
    (c) Based on a physician's services identified in a claim undersubsection (a), the physician may receive a payment from thedivision calculated and made under section 5 of this chapter.
    (d) Based on the transportation services identified in a claimunder subsection (a), the transportation provider may receive apayment from the division calculated and made under section 5 ofthis chapter.
As added by P.L.145-2005, SEC.23. Amended by P.L.212-2007,SEC.25; P.L.218-2007, SEC.36.

IC 12-16-7.5-2
Repealed
    (Repealed by P.L.255-2003, SEC.55.)

IC 12-16-7.5-2.5
Segregation of payable claims by fiscal year; divisiondetermination of amount of payment
    Sec. 2.5. (a) Payable claims shall be segregated by state fiscalyear.
    (b) For purposes of this chapter, IC 12-15-15-9, IC 12-15-15-9.5,and IC 12-16-14, "payable claim" refers to the following:        (1) Subject to subdivision (2), a claim for payment for physiciancare, hospital care, or transportation services under this chapter:
            (A) that includes, on forms prescribed by the division, all theinformation required for timely payment;
            (B) that is for a period during which the person isdetermined to be financially and medically eligible for thehospital care for the indigent program; and
            (C) for which the payment amounts for the care and servicesare determined by the division.
        This subdivision applies for the state fiscal year ending June 30,2004.
        (2) For state fiscal years ending after June 30, 2004, and beforeJuly 1, 2007, a claim for payment for physician care, hospitalcare, or transportation services under this chapter:
            (A) provided to a person under the hospital care for theindigent program under this article during the person'seligibility under the program;
            (B) identified in a claim filed with the division; and
            (C) determined to:
                (i) 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
                (ii) 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).
        (3) For state fiscal years beginning after June 30, 2007, a claimfor payment for physician care or transportation services underthis chapter:
            (A) provided to a person under the hospital care for theindigent program under this article during the person'seligibility under the program;
            (B) identified in a claim filed with the division; and
            (C) determined to:
                (i) be necessary after the onset of a medical condition thatwas manifested by symptoms of sufficient severity that theabsence of immediate medical attention would probablyresult in any of the outcomes described 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
                (ii) be a direct consequence of the onset of a medicalcondition that was manifested by symptoms of sufficientseverity that the absence of immediate medical attentionwould probably result in any of the outcomes listed inIC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3).
    (c) For purposes of this chapter, IC 12-15-15-9, IC 12-15-15-9.5,and IC 12-16-14, "amount" when used in regard to a claim or payableclaim means an amount calculated under STEP THREE of thefollowing formula:
            STEP ONE: Identify the items and services identified in a

claim or payable claim.
            STEP TWO: Using the applicable Medicaid fee for servicereimbursement rates, calculate the reimbursement amountsfor each of the items and services identified in STEP ONE.
            STEP THREE: Calculate the sum of the amounts identifiedin STEP TWO.
    (d) For purposes of this chapter, IC 12-15-15-9, IC 12-15-15-9.5,and IC 12-16-14, a provider that submits a claim to the division isconsidered to have submitted the claim during the state fiscal yearduring which the amount of the claim was determined underIC 12-16-5.5-1.2(b) or, if successfully appealed by a provider, thestate fiscal year in which the appeal was decided.
    (e) The division shall determine the amount of a claim underIC 12-16-5.5-1.2(b).
As added by P.L.255-2003, SEC.36. Amended by P.L.145-2005,SEC.24; P.L.1-2006, SEC.189; P.L.212-2007, SEC.26;P.L.218-2007, SEC.37.

IC 12-16-7.5-3
Warrant on fund; payment
    Sec. 3. (a) A payment made to a physician or a transportationprovider under this chapter must be on a warrant drawn on the statehospital care for the indigent fund established by IC 12-16-14.
    (b) A payment made to a hospital under this chapter shall be madeunder IC 12-15-15-9 and IC 12-15-15-9.5.
As added by P.L.120-2002, SEC.23. Amended by P.L.255-2003,SEC.37.

IC 12-16-7.5-4
Repealed
    (Repealed by P.L.255-2003, SEC.55.)

IC 12-16-7.5-4.5
Calculation and allocation of funds available for payments fromthe state hospital care for the indigent fund
    Sec. 4.5. (a) Not later than October 31 following the end of eachstate fiscal year, the division shall:
        (1) calculate for each county the total amount of payable claimssubmitted to the division during the state fiscal year attributedto:
            (A) patients who were residents of the county; and
            (B) patients:
                (i) who were not residents of Indiana;
                (ii) whose state of residence could not be determined bythe division; and
                (iii) who were residents of Indiana but whose county ofresidence in Indiana could not be determined by thedivision;
            and whose medical condition that necessitated the care orservice occurred in the county;        (2) notify each county of the amount of payable claimsattributed to the county under the calculation made undersubdivision (1); and
        (3) with respect to payable claims attributed to a county undersubdivision (1):
            (A) calculate the total amount of payable claims submittedduring the state fiscal year for:
                (i) each hospital;
                (ii) each physician; and
                (iii) each transportation provider; and
            (B) determine the amount of each payable claim for eachhospital, physician, and transportation provider listed inclause (A).
    (b) For the state fiscal years beginning after June 30, 2005, butbefore July 1, 2007, and before November 1 following the end of astate fiscal year, the division shall allocate the funds transferred froma county's hospital care for the indigent fund to the state hospital carefor the indigent fund under IC 12-16-14 during or for the followingstate fiscal years:
        (1) For the state fiscal year ending June 30, 2006, as requiredunder the following STEPS:
            STEP ONE: Determine the total amount of funds transferredfrom all counties' hospital care for the indigent funds by thecounties to the state hospital care for the indigent fund underIC 12-16-14 during or for the state fiscal year.
            STEP TWO: Of the total amount of payable claimssubmitted to the division during the state fiscal year from allcounties under subsection (a), determine the amount that isthe lesser of:
                (A) the amount of total physician payable claims and totaltransportation provider payable claims; or
                (B) three million dollars ($3,000,000).
            The amount determined under this STEP shall be used by thedivision to make payments under section 5 of this chapter.
            STEP THREE: Transfer an amount equal to the sum of:
                (A) the non-federal share of the payments made underclause (A) of STEP FIVE of IC 12-15-15-1.5(b);
                (B) the amount transferred under IC 12-15-20-2(8)(F); and
                (C) the non-federal share of the payments made underIC 12-15-15-9 and IC 12-15-15-9.5;
            to the Medicaid indigent care trust fund for funding thetransfer to the office and the non-federal share of thepayments identified in this STEP.
            STEP FOUR: Transfer an amount equal to sixty-one milliondollars ($61,000,000) less the sum of:
                (A) the amount determined in STEP TWO; and
                (B) the amount transferred under STEP THREE;
            to the Medicaid indigent care trust fund for funding thenon-federal share of payments under clause (B) of STEPFIVE of IC 12-15-15-1.5(b).            STEP FIVE: Transfer to the Medicaid indigent care trustfund for the programs referenced at IC 12-15-20-2(8)(D)(vi)and funded in accordance with IC 12-15-20-2(8)(H) theamount determined under STEP ONE, less the sum of theamount:
                (A) determined in STEP TWO;
                (B) transferred in STEP THREE; and
                (C) transferred in STEP FOUR.
        (2) For the state fiscal year ending June 30, 2007, as requiredunder the following steps:
            STEP ONE: Determine the total amount of funds transferredfrom all counties' hospital care for the indigent funds by thecounties to the state hospital care for the indigent fund underIC 12-16-14 during or for the state fiscal year.
            STEP TWO: Of the total amount of payable claimssubmitted to the division during the state fiscal year from allcounties under subsection (a), determine the amount that isthe lesser of:
                (A) the amount of total physician payable claims and totaltransportation provider payable claims; or
                (B) three million dollars ($3,000,000).
            The amount determined under this STEP shall be used by thedivision for making payments under section 5 of this chapteror for the non-federal share of Medicaid payments forphysicians and transportation providers, as determined bythe office.
            STEP THREE: Transfer an amount equal to the sum of:
                (A) the non-federal share of five million dollars($5,000,000) for the payment made under clause (A) ofSTEP FIVE of IC 12-15-15-1.5(b);
                (B) the amount transferred under IC 12-15-20-2(8)(F); and
                (C) the non-federal share of the payments made underIC 12-15-15-9 and IC 12-15-15-9.5;
            to the Medicaid indigent care trust fund for funding thetransfer to the office and the non-federal share of thepayments identified in this STEP.
            STEP FOUR: Transfer an amount equal to the amountdetermined under STEP ONE less the sum of:
                (A) the amount determined in STEP TWO; and
                (B) the amount transferred under STEP THREE;
            to the Medicaid indigent care trust fund for funding thenon-federal share of payments under clause (B) of STEPFIVE of IC 12-15-15-1.5(b).
    (c) For the state fiscal years beginning after June 30, 2007, beforeNovember 1 following the end of the state fiscal year, the divisionshall allocate the funds transferred to the state hospital care for theindigent fund for the state fiscal year as required under the followingSTEPS:
        STEP ONE: Determine the total amount of funds transferred tothe state hospital care for the indigent fund for the state fiscal

year.
        STEP TWO: Determine the amount specified in STEP THREE.
        STEP THREE: The amount to be used under STEP TWO isthree million dollars ($3,000,000).
        STEP FOUR: Transfer to the Medicaid indigent care trust fundfor purposes of IC 12-15-20-2(8)(G) an amount equal to theamount calculated under STEP ONE, minus an amount equal tothe amount specified under STEP THREE.
        STEP FIVE: The division shall retain an amount equal to theamount remaining in the state hospital care for the indigent fundafter the transfer in STEP FOUR for purposes of makingpayments under section 5 of this chapter or for the non-federalshare of Medicaid payments for physicians and transportationproviders, as determined by the office.
    (d) The costs of administering the hospital care for the indigentprogram, including the processing of claims, shall be paid from thefunds transferred to the state hospital care for the indigent fund.
As added by P.L.255-2003, SEC.38. Amended by P.L.212-2007,SEC.27; P.L.218-2007, SEC.38; P.L.146-2008, SEC.388.

IC 12-16-7.5-5
Pro rata payments to physicians and transportation providers;limitation
    Sec. 5. Before December 15 following the end of each state fiscalyear, the division shall, from the amounts combined from thecounties' hospital care for the indigent funds and retained undersection 4.5(b) or 4.5(c) of this chapter, pay each physician andtransportation provider a pro rata part of that amount. The totalpayments available under this section may not exceed three milliondollars ($3,000,000).
As added by P.L.120-2002, SEC.23. Amended by P.L.255-2003,SEC.39; P.L.212-2007, SEC.28; P.L.218-2007, SEC.39.

IC 12-16-7.5-6
Repealed
    (Repealed by P.L.255-2003, SEC.55.)

IC 12-16-7.5-7
Responsibility for the payment of hospital care; limitations
    Sec. 7. The division is not responsible under the hospital care forthe indigent program for the payment of any part of the costs ofproviding care in a hospital to an individual who is not either of thefollowing:
        (1) A citizen of the United States.
        (2) A lawfully admitted alien.
As added by P.L.120-2002, SEC.23. Amended by P.L.255-2003,SEC.40.

IC 12-16-7.5-8
No liability for cost of care provided to patient described in

specified rules
    Sec. 8. The division is not liable for any part of the cost of careprovided to an individual who has been determined to be a patientdescribed in the rules adopted under IC 12-16-10.5.
As added by P.L.120-2002, SEC.23. Amended by P.L.255-2003,SEC.41.

IC 12-16-7.5-9
Repealed
    (Repealed by P.L.146-2008, SEC.819.)

IC 12-16-7.5-10
Repealed
    (Repealed by P.L.146-2008, SEC.819.)

IC 12-16-7.5-11
Repealed
    (Repealed by P.L.255-2003, SEC.55.)

IC 12-16-7.5-12
Agreement to accept payment as payment in full
    Sec. 12. All providers receiving payment under section 1.2 of thischapter agree to accept, as payment in full, the payment referred toin section 1.2 of this chapter for the health care items or servicesidentified in payable claims submitted to the division.
As added by P.L.120-2002, SEC.23. Amended by P.L.145-2005,SEC.25.

IC 12-16-7.5-13
Repealed
    (Repealed by P.L.255-2003, SEC.55.)