IC 12-16-5.5
Chapter 5.5. Hospital Care for the Indigent; Eligibility
Determinations; 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Repealed
(Repealed by P.L.146-2008, SEC.819.)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 pertaining
to a person:
(1) who was provided care by an eligible provider; and
(2) whose medical condition satisfies one (1) or more of the
medical conditions identified 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) through
IC 12-16-3.5-2(a)(3);
promptly review the claim to determine if the health care items or
services identified in the claim were necessitated by the person's
medical condition or, if applicable, if the items or services were a
direct 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 purposes
of this section, IC 12-15-15-9, IC 12-15-15-9.5, IC 12-16-6.5, and
IC 12-16-7.5, the amount of a claim shall be calculated in a manner
described 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 provide
information the provider has that would assist in the verification of
indigency of a patient.
(b) A provider that provides information under subsection (a) is
immune from civil and criminal liability for divulging the
information. 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 the
division is unable after prompt and diligent efforts to verify
information contained in the application that is reasonably necessary
to determine eligibility, the division may deny assistance under the
hospital care for the indigent program. The pending expiration of the
period specified in IC 12-16-6.5-1.5 is not a valid reason for denying
a 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 the
provider who submitted a claim under IC 12-16-4.5-8.5 written
notice of:
(1) the specific information or verification needed to determine
eligibility;
(2) the specific efforts undertaken to obtain the information or
verification; and
(3) the statute or rule requiring the information or verification
identified under subdivision (1).
(c) The division must provide the provider who submitted a claim
under IC 12-16-4.5-8.5 a period of time, not less than ten (10) days
beyond the deadline established under IC 12-16-6.5-1.5, to submit to
the division information concerning the person's eligibility. If the
division does not make a determination of the person's eligibility
within ten (10) days after receiving the information under this
subsection, the person is eligible without the division's determination
of the person's eligibility for the hospital care for the indigent care
program 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 the
division is unable after prompt and diligent efforts to determine that
a health care item or service identified in a claim:
(1) 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) through
IC 12-16-3.5-2(a)(3); or
(2) was a direct consequence of 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);
the division may deny assistance to the person under the hospital care
for the indigent program for that item or service. The pending
expiration of the period specified in IC 12-16-6.5-1.7 is not a valid
reason for determining that an item or a service was not 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) through IC 12-16-3.5-2(a)(3), or was not a
direct consequence of 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).
(b) Before denying assistance under the hospital care for the
indigent program for an item or a service described in subsection (a),
the division must provide the provider of the item or service written
notice of:
(1) the specific item or service in question; and
(2) an explanation of the basis for the division's inability to
determine that the health care item or service was:
(A) 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) through
IC 12-16-3.5-2(a)(3); or
(B) a direct consequence of 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);
including, if applicable, an explanation of the basis for a
conclusion by the division that an item or service, in fact, was
not necessitated by, or, as applicable, not a direct consequence
of, one (1) or more of such medical conditions.
(c) The division must grant the provider of the item or service a
period of time, not less than ten (10) days beyond the deadline under
IC 12-16-6.5-1.7, to submit to the division information or materials
bearing 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) through
IC 12-16-3.5-2(a)(3), or was a direct consequence of 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). If the division does not make its determination
regarding the item or service within ten (10) days after receiving
information or materials provided for in this section, the item or
service is considered, without the division's determination, to have
been 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) through IC 12-16-3.5-2(a)(3), or to have been
a direct consequence of 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). 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 the
provider 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.)
IC 12-16-5.5
Chapter 5.5. Hospital Care for the Indigent; Eligibility
Determinations; 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 pertaining
to a person:
(1) who was provided care by an eligible provider; and
(2) whose medical condition satisfies one (1) or more of the
medical conditions identified 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) through
IC 12-16-3.5-2(a)(3);
promptly review the claim to determine if the health care items or
services identified in the claim were necessitated by the person's
medical condition or, if applicable, if the items or services were a
direct 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 purposes
of this section, IC 12-15-15-9, IC 12-15-15-9.5, IC 12-16-6.5, and
IC 12-16-7.5, the amount of a claim shall be calculated in a manner
described 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 provide
information the provider has that would assist in the verification of
indigency of a patient.
(b) A provider that provides information under subsection (a) is
immune from civil and criminal liability for divulging the
information. 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 the
division is unable after prompt and diligent efforts to verify
information contained in the application that is reasonably necessary
to determine eligibility, the division may deny assistance under the
hospital care for the indigent program. The pending expiration of the
period specified in IC 12-16-6.5-1.5 is not a valid reason for denying
a 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 the
provider who submitted a claim under IC 12-16-4.5-8.5 written
notice of:
(1) the specific information or verification needed to determine
eligibility;
(2) the specific efforts undertaken to obtain the information or
verification; and
(3) the statute or rule requiring the information or verification
identified under subdivision (1).
(c) The division must provide the provider who submitted a claim
under IC 12-16-4.5-8.5 a period of time, not less than ten (10) days
beyond the deadline established under IC 12-16-6.5-1.5, to submit to
the division information concerning the person's eligibility. If the
division does not make a determination of the person's eligibility
within ten (10) days after receiving the information under this
subsection, the person is eligible without the division's determination
of the person's eligibility for the hospital care for the indigent care
program 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 the
division is unable after prompt and diligent efforts to determine that
a health care item or service identified in a claim:
(1) 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) through
IC 12-16-3.5-2(a)(3); or
(2) was a direct consequence of 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);
the division may deny assistance to the person under the hospital care
for the indigent program for that item or service. The pending
expiration of the period specified in IC 12-16-6.5-1.7 is not a valid
reason for determining that an item or a service was not 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) through IC 12-16-3.5-2(a)(3), or was not a
direct consequence of 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).
(b) Before denying assistance under the hospital care for the
indigent program for an item or a service described in subsection (a),
the division must provide the provider of the item or service written
notice of:
(1) the specific item or service in question; and
(2) an explanation of the basis for the division's inability to
determine that the health care item or service was:
(A) 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) through
IC 12-16-3.5-2(a)(3); or
(B) a direct consequence of 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);
including, if applicable, an explanation of the basis for a
conclusion by the division that an item or service, in fact, was
not necessitated by, or, as applicable, not a direct consequence
of, one (1) or more of such medical conditions.
(c) The division must grant the provider of the item or service a
period of time, not less than ten (10) days beyond the deadline under
IC 12-16-6.5-1.7, to submit to the division information or materials
bearing 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) through
IC 12-16-3.5-2(a)(3), or was a direct consequence of 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). If the division does not make its determination
regarding the item or service within ten (10) days after receiving
information or materials provided for in this section, the item or
service is considered, without the division's determination, to have
been 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) through IC 12-16-3.5-2(a)(3), or to have been
a direct consequence of 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). 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 the
provider 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.)
IC 12-16-5.5
Chapter 5.5. Hospital Care for the Indigent; Eligibility
Determinations; 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 pertaining
to a person:
(1) who was provided care by an eligible provider; and
(2) whose medical condition satisfies one (1) or more of the
medical conditions identified 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) through
IC 12-16-3.5-2(a)(3);
promptly review the claim to determine if the health care items or
services identified in the claim were necessitated by the person's
medical condition or, if applicable, if the items or services were a
direct 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 purposes
of this section, IC 12-15-15-9, IC 12-15-15-9.5, IC 12-16-6.5, and
IC 12-16-7.5, the amount of a claim shall be calculated in a manner
described 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 provide
information the provider has that would assist in the verification of
indigency of a patient.
(b) A provider that provides information under subsection (a) is
immune from civil and criminal liability for divulging the
information. 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 the
division is unable after prompt and diligent efforts to verify
information contained in the application that is reasonably necessary
to determine eligibility, the division may deny assistance under the
hospital care for the indigent program. The pending expiration of the
period specified in IC 12-16-6.5-1.5 is not a valid reason for denying
a 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 the
provider who submitted a claim under IC 12-16-4.5-8.5 written
notice of:
(1) the specific information or verification needed to determine
eligibility;
(2) the specific efforts undertaken to obtain the information or
verification; and
(3) the statute or rule requiring the information or verification
identified under subdivision (1).
(c) The division must provide the provider who submitted a claim
under IC 12-16-4.5-8.5 a period of time, not less than ten (10) days
beyond the deadline established under IC 12-16-6.5-1.5, to submit to
the division information concerning the person's eligibility. If the
division does not make a determination of the person's eligibility
within ten (10) days after receiving the information under this
subsection, the person is eligible without the division's determination
of the person's eligibility for the hospital care for the indigent care
program 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 the
division is unable after prompt and diligent efforts to determine that
a health care item or service identified in a claim:
(1) 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) through
IC 12-16-3.5-2(a)(3); or
(2) was a direct consequence of 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);
the division may deny assistance to the person under the hospital care
for the indigent program for that item or service. The pending
expiration of the period specified in IC 12-16-6.5-1.7 is not a valid
reason for determining that an item or a service was not 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) through IC 12-16-3.5-2(a)(3), or was not a
direct consequence of 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).
(b) Before denying assistance under the hospital care for the
indigent program for an item or a service described in subsection (a),
the division must provide the provider of the item or service written
notice of:
(1) the specific item or service in question; and
(2) an explanation of the basis for the division's inability to
determine that the health care item or service was:
(A) 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) through
IC 12-16-3.5-2(a)(3); or
(B) a direct consequence of 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);
including, if applicable, an explanation of the basis for a
conclusion by the division that an item or service, in fact, was
not necessitated by, or, as applicable, not a direct consequence
of, one (1) or more of such medical conditions.
(c) The division must grant the provider of the item or service a
period of time, not less than ten (10) days beyond the deadline under
IC 12-16-6.5-1.7, to submit to the division information or materials
bearing 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) through
IC 12-16-3.5-2(a)(3), or was a direct consequence of 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). If the division does not make its determination
regarding the item or service within ten (10) days after receiving
information or materials provided for in this section, the item or
service is considered, without the division's determination, to have
been 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) through IC 12-16-3.5-2(a)(3), or to have been
a direct consequence of 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). 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 the
provider 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.)
