IC 12-15-16
Chapter 16. Disproportionate Share Providers; Eligibility
IC 12-15-16-1 Disproportionate share provider status
Sec. 1. (a) A provider that is an acute care hospital licensed under
IC 16-21, a state mental health institution under IC 12-24-1-3, or a
private psychiatric institution licensed under IC 12-25 is a
disproportionate share provider if the provider meets either of the
following conditions:
(1) The provider's Medicaid inpatient utilization rate is at least
one (1) standard deviation above the mean Medicaid inpatient
utilization rate for providers receiving Medicaid payments in
Indiana. However, the Medicaid inpatient utilization rate of
providers whose low income utilization rate exceeds
twenty-five percent (25%) must be excluded in calculating the
statewide mean Medicaid inpatient utilization rate.
(2) The provider's low income utilization rate exceeds
twenty-five percent (25%).
(b) An acute care hospital licensed under 16-21 is a municipal
disproportionate share provider if the hospital:
(1) has a Medicaid utilization rate greater than one percent
(1%); and
(2) is established and operated under IC 16-22-2 or IC 16-23.
(c) A community mental health center:
(1) that is identified in IC 12-29-2-1;
(2) for which a county provides funds under:
(A) IC 12-29-1-7(b) before January 1, 2004; or
(B) IC 12-29-2-20(d) after December 31, 2003;
or from other county sources; and
(3) that provides inpatient services to Medicaid patients;
is a community mental health center disproportionate share provider
if the community mental health center's Medicaid inpatient
utilization rate is greater than one percent (1%).
(d) A disproportionate share provider under IC 12-15-17 must
have at least two (2) obstetricians who have staff privileges and who
have agreed to provide obstetric services under the Medicaid
program. For a hospital located in a rural area (as defined in Section
1886 of the Social Security Act), an obstetrician includes a physician
with staff privileges at the hospital who has agreed to perform
nonemergency obstetric procedures. However, this obstetric service
requirement does not apply to a provider whose inpatients are
predominantly individuals less than eighteen (18) years of age or that
did not offer nonemergency obstetric services as of December 21,
1987.
(e) The determination of a provider's status as a disproportionate
share provider under this section shall be based on utilization and
revenue data from the most recent year for which an audited cost
report from the provider is on file with the office. As added by P.L.2-1992, SEC.9. Amended by P.L.27-1992, SEC.12;
IC 12-15-16-2 Inpatient utilization rate
Sec. 2. (a) For purposes of disproportionate share eligibility, a
provider's Medicaid inpatient utilization rate is a fraction (expressed
as a percentage) where:
(1) the numerator is the provider's total number of Medicaid
inpatient days in the most recent year for which an audited cost
report is on file with the office; and
(2) the denominator is the total number of the provider's
inpatient days in the most recent year for which an audited cost
report is on file with the office.
(b) For purposes of this section, "Medicaid inpatient days"
includes all acute care days attributable to individuals eligible for
Medicaid benefits under a state plan approved under 42 U.S.C. 1396a
on the days of service:
(1) whether attributable to individuals eligible for Medicaid in
Indiana or any other state;
(2) even if the office did not make payment for any services,
including inpatient days that are determined to be medically
necessary but for which payment is denied by the office for
other reasons; and
(3) including days attributable to Medicaid beneficiaries
receiving services through a managed care organization or
health maintenance organization.
However, a day is not a Medicaid inpatient day for purposes of this
section if the patient was entitled to both Medicare Part A (as defined
in 42 U.S.C. 1395c) and Medicaid on that day. As added by P.L.2-1992, SEC.9. Amended by P.L.277-1993(ss),
SEC.72; P.L.156-1995, SEC.2; P.L.126-1998, SEC.7; P.L.113-2000,
SEC.6; P.L.283-2001, SEC.22.
IC 12-15-16-3 Low income utilization rate; contractual allowances and discounts
Sec. 3. (a) For purposes of disproportionate share eligibility, a
provider's low income utilization rate is the sum of the following,
based on the most recent year for which an audited cost report is on
file with the office:
(1) A fraction (expressed as a percentage) for which:
(A) the numerator is the sum of:
(i) the total Medicaid patient revenues paid to the
provider; plus
(ii) the amount of the cash subsidies received directly from
state and local governments, including payments made
under the hospital care for the indigent program (IC
12-16-2) (before its repeal) and IC 12-16-2.5; and
(B) the denominator is the total amount of the provider's
patient revenues paid to the provider, including cash
subsidies; and
(2) A fraction (expressed as a percentage) for which:
(A) the numerator is the total amount of the provider's
charges for inpatient services that are attributable to care
provided to individuals who have no source of payment; and
(B) the denominator is the total amount of charges for
inpatient services.
(b) The numerator in subsection (a)(1)(A) does not include
contractual allowances and discounts other than for indigent patients
not eligible for Medicaid. As added by P.L.2-1992, SEC.9. Amended by P.L.277-1993(ss),
SEC.73; P.L.113-2000, SEC.7; P.L.283-2001, SEC.23;
P.L.120-2002, SEC.16.
IC 12-15-16-4
Repealed
(Repealed by P.L.156-1995, SEC.9.)
IC 12-15-16-5 Implementation; federal Health Care Financing Administration
approval; percentage reduction of payments to Medicaid indigent
care trust fund
Sec. 5. (a) The office may not implement this chapter,
IC 12-15-17, IC 12-15-18, IC 12-15-19, or IC 12-15-20 until the
federal Centers for Medicare and Medicaid Services has issued its
approval of the amended state plan for medical assistance.
(b) The office may determine not to continue to implement this
chapter, IC 12-15-17, IC 12-15-18, IC 12-15-19, and IC 12-15-20 if
federal financial participation is not available.
(c) If federal financial participation is approved for less than all
of the amounts paid into the Medicaid indigent care trust fund with
respect to a fiscal year, the office may reduce payments attributable
to that fiscal year under IC 12-15-19-1 by a percentage sufficient to
compensate for the aggregate reduction in federal financial
participation. If additional federal financial participation is
subsequently approved with respect to payments into the Medicaid
indigent care trust fund for the same fiscal year, the office shall
distribute such amounts using the percentage that was used to
compensate for the prior reduction in federal financial participation. As added by P.L.2-1992, SEC.9. Amended by P.L.277-1993(ss),
SEC.74; P.L.156-1995, SEC.3; P.L.126-1998, SEC.8; P.L.66-2002,
SEC.7.
IC 12-15-16-6 Basic disproportionate payments to hospitals; amount
Sec. 6. (a) As used in this section, "low income utilization rate"
refers to the low income utilization rate described in section 3 of this
chapter.
(b) Hospitals that qualify for basic disproportionate share under
section 1(a) of this chapter shall receive disproportionate share
payments as follows:
(1) For the state fiscal year ending June 30, 1999, a pool not
exceeding twenty-one million dollars ($21,000,000) shall be
distributed to all hospitals licensed under IC 16-21 that qualify
under section 1(a)(1) of this chapter. The funds in the pool must
be distributed to qualifying hospitals in proportion to each
hospital's Medicaid day utilization rate and Medicaid
discharges, as determined based on data from the most recent
audited cost report on file with the office. Any funds remaining
in the pool referred to in this subdivision following distribution
to all qualifying hospitals shall be transferred to the pool
distributed under subdivision (3).
(2) Hospitals licensed under IC 16-21 that qualify under both
section 1(a)(1) and 1(a)(2) of this chapter shall receive a
disproportionate share payment in accordance with subdivision
(1).
(3) For the state fiscal year ending June 30, 1999, a pool not
exceeding five million dollars ($5,000,000), subject to
adjustment by the transfer of any funds remaining in the pool
referred to in subdivision (1), following distribution to all
qualifying hospitals, shall be distributed to all hospitals licensed
under IC 16-21 that:
(A) qualify under section 1(a)(1) or 1(a)(2) of this chapter;
and
(B) have at least twenty-five thousand (25,000) Medicaid
inpatient days per year, based on data from each hospital's
Medicaid cost report for the fiscal year ended during state
fiscal year 1996.
The funds in the pool must be distributed to qualifying hospitals in
proportion to each hospital's Medicaid day utilization rate and total
Medicaid patient days, as determined based on data from the most
recent audited cost report on file with the office. Payments under this
subdivision are in place of the payments made under subdivisions (1)
and (2).
(c) Other institutions that qualify as disproportionate share
providers under section 1 of this chapter, in each state fiscal year,
shall receive disproportionate share payments as follows:
(1) For each of the state fiscal years ending after June 30, 1995,
a pool not exceeding two million dollars ($2,000,000) shall be
distributed to all private psychiatric institutions licensed under
IC 12-25 that qualify under section 1(a)(1) or 1(a)(2) of this
chapter. The funds in the pool must be distributed to the
qualifying institutions in proportion to each institution's
Medicaid day utilization rate as determined based on data from
the most recent audited cost report on file with the office.
(2) A pool not exceeding one hundred ninety-one million
dollars ($191,000,000) for all state fiscal years ending after
June 30, 1995, shall be distributed to all state mental health
institutions under IC 12-24-1-3 that qualify under either section
1(a)(1) or 1(a)(2) of this chapter. The funds in the pool must be
distributed to each qualifying institution in proportion to each
institution's low income utilization rate, as determined based on
the most recent data on file with the office.
(d) Disproportionate share payments described in this section
shall be made on an interim basis throughout the year, as provided by
the office. As added by P.L.277-1993(ss), SEC.75. Amended by P.L.156-1995,
SEC.4; P.L.24-1997, SEC.49; P.L.126-1998, SEC.9; P.L.113-2000,
SEC.8.
IC 12-15-16
Chapter 16. Disproportionate Share Providers; Eligibility
IC 12-15-16-1 Disproportionate share provider status
Sec. 1. (a) A provider that is an acute care hospital licensed under
IC 16-21, a state mental health institution under IC 12-24-1-3, or a
private psychiatric institution licensed under IC 12-25 is a
disproportionate share provider if the provider meets either of the
following conditions:
(1) The provider's Medicaid inpatient utilization rate is at least
one (1) standard deviation above the mean Medicaid inpatient
utilization rate for providers receiving Medicaid payments in
Indiana. However, the Medicaid inpatient utilization rate of
providers whose low income utilization rate exceeds
twenty-five percent (25%) must be excluded in calculating the
statewide mean Medicaid inpatient utilization rate.
(2) The provider's low income utilization rate exceeds
twenty-five percent (25%).
(b) An acute care hospital licensed under 16-21 is a municipal
disproportionate share provider if the hospital:
(1) has a Medicaid utilization rate greater than one percent
(1%); and
(2) is established and operated under IC 16-22-2 or IC 16-23.
(c) A community mental health center:
(1) that is identified in IC 12-29-2-1;
(2) for which a county provides funds under:
(A) IC 12-29-1-7(b) before January 1, 2004; or
(B) IC 12-29-2-20(d) after December 31, 2003;
or from other county sources; and
(3) that provides inpatient services to Medicaid patients;
is a community mental health center disproportionate share provider
if the community mental health center's Medicaid inpatient
utilization rate is greater than one percent (1%).
(d) A disproportionate share provider under IC 12-15-17 must
have at least two (2) obstetricians who have staff privileges and who
have agreed to provide obstetric services under the Medicaid
program. For a hospital located in a rural area (as defined in Section
1886 of the Social Security Act), an obstetrician includes a physician
with staff privileges at the hospital who has agreed to perform
nonemergency obstetric procedures. However, this obstetric service
requirement does not apply to a provider whose inpatients are
predominantly individuals less than eighteen (18) years of age or that
did not offer nonemergency obstetric services as of December 21,
1987.
(e) The determination of a provider's status as a disproportionate
share provider under this section shall be based on utilization and
revenue data from the most recent year for which an audited cost
report from the provider is on file with the office. As added by P.L.2-1992, SEC.9. Amended by P.L.27-1992, SEC.12;
IC 12-15-16-2 Inpatient utilization rate
Sec. 2. (a) For purposes of disproportionate share eligibility, a
provider's Medicaid inpatient utilization rate is a fraction (expressed
as a percentage) where:
(1) the numerator is the provider's total number of Medicaid
inpatient days in the most recent year for which an audited cost
report is on file with the office; and
(2) the denominator is the total number of the provider's
inpatient days in the most recent year for which an audited cost
report is on file with the office.
(b) For purposes of this section, "Medicaid inpatient days"
includes all acute care days attributable to individuals eligible for
Medicaid benefits under a state plan approved under 42 U.S.C. 1396a
on the days of service:
(1) whether attributable to individuals eligible for Medicaid in
Indiana or any other state;
(2) even if the office did not make payment for any services,
including inpatient days that are determined to be medically
necessary but for which payment is denied by the office for
other reasons; and
(3) including days attributable to Medicaid beneficiaries
receiving services through a managed care organization or
health maintenance organization.
However, a day is not a Medicaid inpatient day for purposes of this
section if the patient was entitled to both Medicare Part A (as defined
in 42 U.S.C. 1395c) and Medicaid on that day. As added by P.L.2-1992, SEC.9. Amended by P.L.277-1993(ss),
SEC.72; P.L.156-1995, SEC.2; P.L.126-1998, SEC.7; P.L.113-2000,
SEC.6; P.L.283-2001, SEC.22.
IC 12-15-16-3 Low income utilization rate; contractual allowances and discounts
Sec. 3. (a) For purposes of disproportionate share eligibility, a
provider's low income utilization rate is the sum of the following,
based on the most recent year for which an audited cost report is on
file with the office:
(1) A fraction (expressed as a percentage) for which:
(A) the numerator is the sum of:
(i) the total Medicaid patient revenues paid to the
provider; plus
(ii) the amount of the cash subsidies received directly from
state and local governments, including payments made
under the hospital care for the indigent program (IC
12-16-2) (before its repeal) and IC 12-16-2.5; and
(B) the denominator is the total amount of the provider's
patient revenues paid to the provider, including cash
subsidies; and
(2) A fraction (expressed as a percentage) for which:
(A) the numerator is the total amount of the provider's
charges for inpatient services that are attributable to care
provided to individuals who have no source of payment; and
(B) the denominator is the total amount of charges for
inpatient services.
(b) The numerator in subsection (a)(1)(A) does not include
contractual allowances and discounts other than for indigent patients
not eligible for Medicaid. As added by P.L.2-1992, SEC.9. Amended by P.L.277-1993(ss),
SEC.73; P.L.113-2000, SEC.7; P.L.283-2001, SEC.23;
P.L.120-2002, SEC.16.
IC 12-15-16-4
Repealed
(Repealed by P.L.156-1995, SEC.9.)
IC 12-15-16-5 Implementation; federal Health Care Financing Administration
approval; percentage reduction of payments to Medicaid indigent
care trust fund
Sec. 5. (a) The office may not implement this chapter,
IC 12-15-17, IC 12-15-18, IC 12-15-19, or IC 12-15-20 until the
federal Centers for Medicare and Medicaid Services has issued its
approval of the amended state plan for medical assistance.
(b) The office may determine not to continue to implement this
chapter, IC 12-15-17, IC 12-15-18, IC 12-15-19, and IC 12-15-20 if
federal financial participation is not available.
(c) If federal financial participation is approved for less than all
of the amounts paid into the Medicaid indigent care trust fund with
respect to a fiscal year, the office may reduce payments attributable
to that fiscal year under IC 12-15-19-1 by a percentage sufficient to
compensate for the aggregate reduction in federal financial
participation. If additional federal financial participation is
subsequently approved with respect to payments into the Medicaid
indigent care trust fund for the same fiscal year, the office shall
distribute such amounts using the percentage that was used to
compensate for the prior reduction in federal financial participation. As added by P.L.2-1992, SEC.9. Amended by P.L.277-1993(ss),
SEC.74; P.L.156-1995, SEC.3; P.L.126-1998, SEC.8; P.L.66-2002,
SEC.7.
IC 12-15-16-6 Basic disproportionate payments to hospitals; amount
Sec. 6. (a) As used in this section, "low income utilization rate"
refers to the low income utilization rate described in section 3 of this
chapter.
(b) Hospitals that qualify for basic disproportionate share under
section 1(a) of this chapter shall receive disproportionate share
payments as follows:
(1) For the state fiscal year ending June 30, 1999, a pool not
exceeding twenty-one million dollars ($21,000,000) shall be
distributed to all hospitals licensed under IC 16-21 that qualify
under section 1(a)(1) of this chapter. The funds in the pool must
be distributed to qualifying hospitals in proportion to each
hospital's Medicaid day utilization rate and Medicaid
discharges, as determined based on data from the most recent
audited cost report on file with the office. Any funds remaining
in the pool referred to in this subdivision following distribution
to all qualifying hospitals shall be transferred to the pool
distributed under subdivision (3).
(2) Hospitals licensed under IC 16-21 that qualify under both
section 1(a)(1) and 1(a)(2) of this chapter shall receive a
disproportionate share payment in accordance with subdivision
(1).
(3) For the state fiscal year ending June 30, 1999, a pool not
exceeding five million dollars ($5,000,000), subject to
adjustment by the transfer of any funds remaining in the pool
referred to in subdivision (1), following distribution to all
qualifying hospitals, shall be distributed to all hospitals licensed
under IC 16-21 that:
(A) qualify under section 1(a)(1) or 1(a)(2) of this chapter;
and
(B) have at least twenty-five thousand (25,000) Medicaid
inpatient days per year, based on data from each hospital's
Medicaid cost report for the fiscal year ended during state
fiscal year 1996.
The funds in the pool must be distributed to qualifying hospitals in
proportion to each hospital's Medicaid day utilization rate and total
Medicaid patient days, as determined based on data from the most
recent audited cost report on file with the office. Payments under this
subdivision are in place of the payments made under subdivisions (1)
and (2).
(c) Other institutions that qualify as disproportionate share
providers under section 1 of this chapter, in each state fiscal year,
shall receive disproportionate share payments as follows:
(1) For each of the state fiscal years ending after June 30, 1995,
a pool not exceeding two million dollars ($2,000,000) shall be
distributed to all private psychiatric institutions licensed under
IC 12-25 that qualify under section 1(a)(1) or 1(a)(2) of this
chapter. The funds in the pool must be distributed to the
qualifying institutions in proportion to each institution's
Medicaid day utilization rate as determined based on data from
the most recent audited cost report on file with the office.
(2) A pool not exceeding one hundred ninety-one million
dollars ($191,000,000) for all state fiscal years ending after
June 30, 1995, shall be distributed to all state mental health
institutions under IC 12-24-1-3 that qualify under either section
1(a)(1) or 1(a)(2) of this chapter. The funds in the pool must be
distributed to each qualifying institution in proportion to each
institution's low income utilization rate, as determined based on
the most recent data on file with the office.
(d) Disproportionate share payments described in this section
shall be made on an interim basis throughout the year, as provided by
the office. As added by P.L.277-1993(ss), SEC.75. Amended by P.L.156-1995,
SEC.4; P.L.24-1997, SEC.49; P.L.126-1998, SEC.9; P.L.113-2000,
SEC.8.
IC 12-15-16
Chapter 16. Disproportionate Share Providers; Eligibility
IC 12-15-16-1 Disproportionate share provider status
Sec. 1. (a) A provider that is an acute care hospital licensed under
IC 16-21, a state mental health institution under IC 12-24-1-3, or a
private psychiatric institution licensed under IC 12-25 is a
disproportionate share provider if the provider meets either of the
following conditions:
(1) The provider's Medicaid inpatient utilization rate is at least
one (1) standard deviation above the mean Medicaid inpatient
utilization rate for providers receiving Medicaid payments in
Indiana. However, the Medicaid inpatient utilization rate of
providers whose low income utilization rate exceeds
twenty-five percent (25%) must be excluded in calculating the
statewide mean Medicaid inpatient utilization rate.
(2) The provider's low income utilization rate exceeds
twenty-five percent (25%).
(b) An acute care hospital licensed under 16-21 is a municipal
disproportionate share provider if the hospital:
(1) has a Medicaid utilization rate greater than one percent
(1%); and
(2) is established and operated under IC 16-22-2 or IC 16-23.
(c) A community mental health center:
(1) that is identified in IC 12-29-2-1;
(2) for which a county provides funds under:
(A) IC 12-29-1-7(b) before January 1, 2004; or
(B) IC 12-29-2-20(d) after December 31, 2003;
or from other county sources; and
(3) that provides inpatient services to Medicaid patients;
is a community mental health center disproportionate share provider
if the community mental health center's Medicaid inpatient
utilization rate is greater than one percent (1%).
(d) A disproportionate share provider under IC 12-15-17 must
have at least two (2) obstetricians who have staff privileges and who
have agreed to provide obstetric services under the Medicaid
program. For a hospital located in a rural area (as defined in Section
1886 of the Social Security Act), an obstetrician includes a physician
with staff privileges at the hospital who has agreed to perform
nonemergency obstetric procedures. However, this obstetric service
requirement does not apply to a provider whose inpatients are
predominantly individuals less than eighteen (18) years of age or that
did not offer nonemergency obstetric services as of December 21,
1987.
(e) The determination of a provider's status as a disproportionate
share provider under this section shall be based on utilization and
revenue data from the most recent year for which an audited cost
report from the provider is on file with the office. As added by P.L.2-1992, SEC.9. Amended by P.L.27-1992, SEC.12;
IC 12-15-16-2 Inpatient utilization rate
Sec. 2. (a) For purposes of disproportionate share eligibility, a
provider's Medicaid inpatient utilization rate is a fraction (expressed
as a percentage) where:
(1) the numerator is the provider's total number of Medicaid
inpatient days in the most recent year for which an audited cost
report is on file with the office; and
(2) the denominator is the total number of the provider's
inpatient days in the most recent year for which an audited cost
report is on file with the office.
(b) For purposes of this section, "Medicaid inpatient days"
includes all acute care days attributable to individuals eligible for
Medicaid benefits under a state plan approved under 42 U.S.C. 1396a
on the days of service:
(1) whether attributable to individuals eligible for Medicaid in
Indiana or any other state;
(2) even if the office did not make payment for any services,
including inpatient days that are determined to be medically
necessary but for which payment is denied by the office for
other reasons; and
(3) including days attributable to Medicaid beneficiaries
receiving services through a managed care organization or
health maintenance organization.
However, a day is not a Medicaid inpatient day for purposes of this
section if the patient was entitled to both Medicare Part A (as defined
in 42 U.S.C. 1395c) and Medicaid on that day. As added by P.L.2-1992, SEC.9. Amended by P.L.277-1993(ss),
SEC.72; P.L.156-1995, SEC.2; P.L.126-1998, SEC.7; P.L.113-2000,
SEC.6; P.L.283-2001, SEC.22.
IC 12-15-16-3 Low income utilization rate; contractual allowances and discounts
Sec. 3. (a) For purposes of disproportionate share eligibility, a
provider's low income utilization rate is the sum of the following,
based on the most recent year for which an audited cost report is on
file with the office:
(1) A fraction (expressed as a percentage) for which:
(A) the numerator is the sum of:
(i) the total Medicaid patient revenues paid to the
provider; plus
(ii) the amount of the cash subsidies received directly from
state and local governments, including payments made
under the hospital care for the indigent program (IC
12-16-2) (before its repeal) and IC 12-16-2.5; and
(B) the denominator is the total amount of the provider's
patient revenues paid to the provider, including cash
subsidies; and
(2) A fraction (expressed as a percentage) for which:
(A) the numerator is the total amount of the provider's
charges for inpatient services that are attributable to care
provided to individuals who have no source of payment; and
(B) the denominator is the total amount of charges for
inpatient services.
(b) The numerator in subsection (a)(1)(A) does not include
contractual allowances and discounts other than for indigent patients
not eligible for Medicaid. As added by P.L.2-1992, SEC.9. Amended by P.L.277-1993(ss),
SEC.73; P.L.113-2000, SEC.7; P.L.283-2001, SEC.23;
P.L.120-2002, SEC.16.
IC 12-15-16-4
Repealed
(Repealed by P.L.156-1995, SEC.9.)
IC 12-15-16-5 Implementation; federal Health Care Financing Administration
approval; percentage reduction of payments to Medicaid indigent
care trust fund
Sec. 5. (a) The office may not implement this chapter,
IC 12-15-17, IC 12-15-18, IC 12-15-19, or IC 12-15-20 until the
federal Centers for Medicare and Medicaid Services has issued its
approval of the amended state plan for medical assistance.
(b) The office may determine not to continue to implement this
chapter, IC 12-15-17, IC 12-15-18, IC 12-15-19, and IC 12-15-20 if
federal financial participation is not available.
(c) If federal financial participation is approved for less than all
of the amounts paid into the Medicaid indigent care trust fund with
respect to a fiscal year, the office may reduce payments attributable
to that fiscal year under IC 12-15-19-1 by a percentage sufficient to
compensate for the aggregate reduction in federal financial
participation. If additional federal financial participation is
subsequently approved with respect to payments into the Medicaid
indigent care trust fund for the same fiscal year, the office shall
distribute such amounts using the percentage that was used to
compensate for the prior reduction in federal financial participation. As added by P.L.2-1992, SEC.9. Amended by P.L.277-1993(ss),
SEC.74; P.L.156-1995, SEC.3; P.L.126-1998, SEC.8; P.L.66-2002,
SEC.7.
IC 12-15-16-6 Basic disproportionate payments to hospitals; amount
Sec. 6. (a) As used in this section, "low income utilization rate"
refers to the low income utilization rate described in section 3 of this
chapter.
(b) Hospitals that qualify for basic disproportionate share under
section 1(a) of this chapter shall receive disproportionate share
payments as follows:
(1) For the state fiscal year ending June 30, 1999, a pool not
exceeding twenty-one million dollars ($21,000,000) shall be
distributed to all hospitals licensed under IC 16-21 that qualify
under section 1(a)(1) of this chapter. The funds in the pool must
be distributed to qualifying hospitals in proportion to each
hospital's Medicaid day utilization rate and Medicaid
discharges, as determined based on data from the most recent
audited cost report on file with the office. Any funds remaining
in the pool referred to in this subdivision following distribution
to all qualifying hospitals shall be transferred to the pool
distributed under subdivision (3).
(2) Hospitals licensed under IC 16-21 that qualify under both
section 1(a)(1) and 1(a)(2) of this chapter shall receive a
disproportionate share payment in accordance with subdivision
(1).
(3) For the state fiscal year ending June 30, 1999, a pool not
exceeding five million dollars ($5,000,000), subject to
adjustment by the transfer of any funds remaining in the pool
referred to in subdivision (1), following distribution to all
qualifying hospitals, shall be distributed to all hospitals licensed
under IC 16-21 that:
(A) qualify under section 1(a)(1) or 1(a)(2) of this chapter;
and
(B) have at least twenty-five thousand (25,000) Medicaid
inpatient days per year, based on data from each hospital's
Medicaid cost report for the fiscal year ended during state
fiscal year 1996.
The funds in the pool must be distributed to qualifying hospitals in
proportion to each hospital's Medicaid day utilization rate and total
Medicaid patient days, as determined based on data from the most
recent audited cost report on file with the office. Payments under this
subdivision are in place of the payments made under subdivisions (1)
and (2).
(c) Other institutions that qualify as disproportionate share
providers under section 1 of this chapter, in each state fiscal year,
shall receive disproportionate share payments as follows:
(1) For each of the state fiscal years ending after June 30, 1995,
a pool not exceeding two million dollars ($2,000,000) shall be
distributed to all private psychiatric institutions licensed under
IC 12-25 that qualify under section 1(a)(1) or 1(a)(2) of this
chapter. The funds in the pool must be distributed to the
qualifying institutions in proportion to each institution's
Medicaid day utilization rate as determined based on data from
the most recent audited cost report on file with the office.
(2) A pool not exceeding one hundred ninety-one million
dollars ($191,000,000) for all state fiscal years ending after
June 30, 1995, shall be distributed to all state mental health
institutions under IC 12-24-1-3 that qualify under either section
1(a)(1) or 1(a)(2) of this chapter. The funds in the pool must be
distributed to each qualifying institution in proportion to each
institution's low income utilization rate, as determined based on
the most recent data on file with the office.
(d) Disproportionate share payments described in this section
shall be made on an interim basis throughout the year, as provided by
the office. As added by P.L.277-1993(ss), SEC.75. Amended by P.L.156-1995,
SEC.4; P.L.24-1997, SEC.49; P.L.126-1998, SEC.9; P.L.113-2000,
SEC.8.
