IC 12-16-7.5
Chapter 7.5. Hospital Care for the Indigent; Cost of Care and
Payment
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Repealed
(Repealed by P.L.145-2005, SEC.31.)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 hospital
care for the indigent program is not financially obligated for services
provided to the person during the person's eligibility under the
program, if the items or services were:
(1) identified in a claim filed with the division under
IC 12-16-4.5; and
(2) determined:
(A) 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
(B) to be 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) Hospitals may receive a payment from the office calculated
and 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 and
IC 12-15-15-9.5 for payments attributable to state fiscal years
beginning after June 30, 2007.
(c) Based on a physician's services identified in a claim under
subsection (a), the physician may receive a payment from the
division calculated and made under section 5 of this chapter.
(d) Based on the transportation services identified in a claim
under subsection (a), the transportation provider may receive a
payment from the division calculated and made under section 5 of
this 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Repealed
(Repealed by P.L.255-2003, SEC.55.)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; division
determination of amount of payment
Sec. 2.5. (a) Payable claims shall be segregated by state fiscal
year.
(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 physician
care, hospital care, or transportation services under this chapter:
(A) that includes, on forms prescribed by the division, all the
information required for timely payment;
(B) that is for a period during which the person is
determined to be financially and medically eligible for the
hospital care for the indigent program; and
(C) for which the payment amounts for the care and services
are 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 before
July 1, 2007, a claim for payment for physician care, hospital
care, or transportation services under this chapter:
(A) provided to a person under the hospital care for the
indigent program under this article during the person's
eligibility 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 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
(ii) be 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).
(3) For state fiscal years beginning after June 30, 2007, a claim
for payment for physician care or transportation services under
this chapter:
(A) provided to a person under the hospital care for the
indigent program under this article during the person's
eligibility 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 that
was manifested by symptoms of sufficient severity that the
absence of immediate medical attention would probably
result in any of the outcomes described 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
(ii) be a direct consequence of the onset of a medical
condition that was manifested by symptoms of sufficient
severity that the absence of immediate medical attention
would probably result in any of the outcomes listed in
IC 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 payable
claim means an amount calculated under STEP THREE of the
following formula:
STEP ONE: Identify the items and services identified in a
claim or payable claim.
STEP TWO: Using the applicable Medicaid fee for service
reimbursement rates, calculate the reimbursement amounts
for each of the items and services identified in STEP ONE.
STEP THREE: Calculate the sum of the amounts identified
in 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 is
considered to have submitted the claim during the state fiscal year
during which the amount of the claim was determined under
IC 12-16-5.5-1.2(b) or, if successfully appealed by a provider, the
state fiscal year in which the appeal was decided.
(e) The division shall determine the amount of a claim under
IC 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 transportation
provider under this chapter must be on a warrant drawn on the state
hospital care for the indigent fund established by IC 12-16-14.
(b) A payment made to a hospital under this chapter shall be made
under 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 from
the state hospital care for the indigent fund
Sec. 4.5. (a) Not later than October 31 following the end of each
state fiscal year, the division shall:
(1) calculate for each county the total amount of payable claims
submitted to the division during the state fiscal year attributed
to:
(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 by
the division; and
(iii) who were residents of Indiana but whose county of
residence in Indiana could not be determined by the
division;
and whose medical condition that necessitated the care or
service occurred in the county;
(2) notify each county of the amount of payable claims
attributed to the county under the calculation made under
subdivision (1); and
(3) with respect to payable claims attributed to a county under
subdivision (1):
(A) calculate the total amount of payable claims submitted
during 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 each
hospital, physician, and transportation provider listed in
clause (A).
(b) For the state fiscal years beginning after June 30, 2005, but
before July 1, 2007, and before November 1 following the end of a
state fiscal year, the division shall allocate the funds transferred from
a county's hospital care for the indigent fund to the state hospital care
for the indigent fund under IC 12-16-14 during or for the following
state fiscal years:
(1) For the state fiscal year ending June 30, 2006, as required
under the following STEPS:
STEP ONE: Determine the total amount of funds transferred
from all counties' hospital care for the indigent funds by the
counties to the state hospital care for the indigent fund under
IC 12-16-14 during or for the state fiscal year.
STEP TWO: Of the total amount of payable claims
submitted to the division during the state fiscal year from all
counties under subsection (a), determine the amount that is
the lesser of:
(A) the amount of total physician payable claims and total
transportation provider payable claims; or
(B) three million dollars ($3,000,000).
The amount determined under this STEP shall be used by the
division 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 under
clause (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 under
IC 12-15-15-9 and IC 12-15-15-9.5;
to the Medicaid indigent care trust fund for funding the
transfer to the office and the non-federal share of the
payments identified in this STEP.
STEP FOUR: Transfer an amount equal to sixty-one million
dollars ($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 the
non-federal share of payments under clause (B) of STEP
FIVE of IC 12-15-15-1.5(b).
STEP FIVE: Transfer to the Medicaid indigent care trust
fund 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) the
amount determined under STEP ONE, less the sum of the
amount:
(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 required
under the following steps:
STEP ONE: Determine the total amount of funds transferred
from all counties' hospital care for the indigent funds by the
counties to the state hospital care for the indigent fund under
IC 12-16-14 during or for the state fiscal year.
STEP TWO: Of the total amount of payable claims
submitted to the division during the state fiscal year from all
counties under subsection (a), determine the amount that is
the lesser of:
(A) the amount of total physician payable claims and total
transportation provider payable claims; or
(B) three million dollars ($3,000,000).
The amount determined under this STEP shall be used by the
division for making payments under section 5 of this chapter
or for the non-federal share of Medicaid payments for
physicians and transportation providers, as determined by
the 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) 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 under
IC 12-15-15-9 and IC 12-15-15-9.5;
to the Medicaid indigent care trust fund for funding the
transfer to the office and the non-federal share of the
payments identified in this STEP.
STEP FOUR: Transfer an amount equal to the amount
determined 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 the
non-federal share of payments under clause (B) of STEP
FIVE of IC 12-15-15-1.5(b).
(c) For the state fiscal years beginning after June 30, 2007, before
November 1 following the end of the state fiscal year, the division
shall allocate the funds transferred to the state hospital care for the
indigent fund for the state fiscal year as required under the following
STEPS:
STEP ONE: Determine the total amount of funds transferred to
the 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 is
three million dollars ($3,000,000).
STEP FOUR: Transfer to the Medicaid indigent care trust fund
for purposes of IC 12-15-20-2(8)(G) an amount equal to the
amount calculated under STEP ONE, minus an amount equal to
the amount specified under STEP THREE.
STEP FIVE: The division shall retain an amount equal to the
amount remaining in the state hospital care for the indigent fund
after the transfer in STEP FOUR for purposes of making
payments under section 5 of this chapter or for the non-federal
share of Medicaid payments for physicians and transportation
providers, as determined by the office.
(d) The costs of administering the hospital care for the indigent
program, including the processing of claims, shall be paid from the
funds 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 fiscal
year, the division shall, from the amounts combined from the
counties' hospital care for the indigent funds and retained under
section 4.5(b) or 4.5(c) of this chapter, pay each physician and
transportation provider a pro rata part of that amount. The total
payments available under this section may not exceed three million
dollars ($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 for
the indigent program for the payment of any part of the costs of
providing care in a hospital to an individual who is not either of the
following:
(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 care
provided to an individual who has been determined to be a patient
described 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 this
chapter agree to accept, as payment in full, the payment referred to
in section 1.2 of this chapter for the health care items or services
identified 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.)
IC 12-16-7.5
Chapter 7.5. Hospital Care for the Indigent; Cost of Care and
Payment
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 hospital
care for the indigent program is not financially obligated for services
provided to the person during the person's eligibility under the
program, if the items or services were:
(1) identified in a claim filed with the division under
IC 12-16-4.5; and
(2) determined:
(A) 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
(B) to be 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) Hospitals may receive a payment from the office calculated
and 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 and
IC 12-15-15-9.5 for payments attributable to state fiscal years
beginning after June 30, 2007.
(c) Based on a physician's services identified in a claim under
subsection (a), the physician may receive a payment from the
division calculated and made under section 5 of this chapter.
(d) Based on the transportation services identified in a claim
under subsection (a), the transportation provider may receive a
payment from the division calculated and made under section 5 of
this 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; division
determination of amount of payment
Sec. 2.5. (a) Payable claims shall be segregated by state fiscal
year.
(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 physician
care, hospital care, or transportation services under this chapter:
(A) that includes, on forms prescribed by the division, all the
information required for timely payment;
(B) that is for a period during which the person is
determined to be financially and medically eligible for the
hospital care for the indigent program; and
(C) for which the payment amounts for the care and services
are 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 before
July 1, 2007, a claim for payment for physician care, hospital
care, or transportation services under this chapter:
(A) provided to a person under the hospital care for the
indigent program under this article during the person's
eligibility 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 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
(ii) be 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).
(3) For state fiscal years beginning after June 30, 2007, a claim
for payment for physician care or transportation services under
this chapter:
(A) provided to a person under the hospital care for the
indigent program under this article during the person's
eligibility 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 that
was manifested by symptoms of sufficient severity that the
absence of immediate medical attention would probably
result in any of the outcomes described 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
(ii) be a direct consequence of the onset of a medical
condition that was manifested by symptoms of sufficient
severity that the absence of immediate medical attention
would probably result in any of the outcomes listed in
IC 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 payable
claim means an amount calculated under STEP THREE of the
following formula:
STEP ONE: Identify the items and services identified in a
claim or payable claim.
STEP TWO: Using the applicable Medicaid fee for service
reimbursement rates, calculate the reimbursement amounts
for each of the items and services identified in STEP ONE.
STEP THREE: Calculate the sum of the amounts identified
in 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 is
considered to have submitted the claim during the state fiscal year
during which the amount of the claim was determined under
IC 12-16-5.5-1.2(b) or, if successfully appealed by a provider, the
state fiscal year in which the appeal was decided.
(e) The division shall determine the amount of a claim under
IC 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 transportation
provider under this chapter must be on a warrant drawn on the state
hospital care for the indigent fund established by IC 12-16-14.
(b) A payment made to a hospital under this chapter shall be made
under 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 from
the state hospital care for the indigent fund
Sec. 4.5. (a) Not later than October 31 following the end of each
state fiscal year, the division shall:
(1) calculate for each county the total amount of payable claims
submitted to the division during the state fiscal year attributed
to:
(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 by
the division; and
(iii) who were residents of Indiana but whose county of
residence in Indiana could not be determined by the
division;
and whose medical condition that necessitated the care or
service occurred in the county;
(2) notify each county of the amount of payable claims
attributed to the county under the calculation made under
subdivision (1); and
(3) with respect to payable claims attributed to a county under
subdivision (1):
(A) calculate the total amount of payable claims submitted
during 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 each
hospital, physician, and transportation provider listed in
clause (A).
(b) For the state fiscal years beginning after June 30, 2005, but
before July 1, 2007, and before November 1 following the end of a
state fiscal year, the division shall allocate the funds transferred from
a county's hospital care for the indigent fund to the state hospital care
for the indigent fund under IC 12-16-14 during or for the following
state fiscal years:
(1) For the state fiscal year ending June 30, 2006, as required
under the following STEPS:
STEP ONE: Determine the total amount of funds transferred
from all counties' hospital care for the indigent funds by the
counties to the state hospital care for the indigent fund under
IC 12-16-14 during or for the state fiscal year.
STEP TWO: Of the total amount of payable claims
submitted to the division during the state fiscal year from all
counties under subsection (a), determine the amount that is
the lesser of:
(A) the amount of total physician payable claims and total
transportation provider payable claims; or
(B) three million dollars ($3,000,000).
The amount determined under this STEP shall be used by the
division 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 under
clause (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 under
IC 12-15-15-9 and IC 12-15-15-9.5;
to the Medicaid indigent care trust fund for funding the
transfer to the office and the non-federal share of the
payments identified in this STEP.
STEP FOUR: Transfer an amount equal to sixty-one million
dollars ($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 the
non-federal share of payments under clause (B) of STEP
FIVE of IC 12-15-15-1.5(b).
STEP FIVE: Transfer to the Medicaid indigent care trust
fund 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) the
amount determined under STEP ONE, less the sum of the
amount:
(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 required
under the following steps:
STEP ONE: Determine the total amount of funds transferred
from all counties' hospital care for the indigent funds by the
counties to the state hospital care for the indigent fund under
IC 12-16-14 during or for the state fiscal year.
STEP TWO: Of the total amount of payable claims
submitted to the division during the state fiscal year from all
counties under subsection (a), determine the amount that is
the lesser of:
(A) the amount of total physician payable claims and total
transportation provider payable claims; or
(B) three million dollars ($3,000,000).
The amount determined under this STEP shall be used by the
division for making payments under section 5 of this chapter
or for the non-federal share of Medicaid payments for
physicians and transportation providers, as determined by
the 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) 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 under
IC 12-15-15-9 and IC 12-15-15-9.5;
to the Medicaid indigent care trust fund for funding the
transfer to the office and the non-federal share of the
payments identified in this STEP.
STEP FOUR: Transfer an amount equal to the amount
determined 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 the
non-federal share of payments under clause (B) of STEP
FIVE of IC 12-15-15-1.5(b).
(c) For the state fiscal years beginning after June 30, 2007, before
November 1 following the end of the state fiscal year, the division
shall allocate the funds transferred to the state hospital care for the
indigent fund for the state fiscal year as required under the following
STEPS:
STEP ONE: Determine the total amount of funds transferred to
the 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 is
three million dollars ($3,000,000).
STEP FOUR: Transfer to the Medicaid indigent care trust fund
for purposes of IC 12-15-20-2(8)(G) an amount equal to the
amount calculated under STEP ONE, minus an amount equal to
the amount specified under STEP THREE.
STEP FIVE: The division shall retain an amount equal to the
amount remaining in the state hospital care for the indigent fund
after the transfer in STEP FOUR for purposes of making
payments under section 5 of this chapter or for the non-federal
share of Medicaid payments for physicians and transportation
providers, as determined by the office.
(d) The costs of administering the hospital care for the indigent
program, including the processing of claims, shall be paid from the
funds 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 fiscal
year, the division shall, from the amounts combined from the
counties' hospital care for the indigent funds and retained under
section 4.5(b) or 4.5(c) of this chapter, pay each physician and
transportation provider a pro rata part of that amount. The total
payments available under this section may not exceed three million
dollars ($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 for
the indigent program for the payment of any part of the costs of
providing care in a hospital to an individual who is not either of the
following:
(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 care
provided to an individual who has been determined to be a patient
described 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 this
chapter agree to accept, as payment in full, the payment referred to
in section 1.2 of this chapter for the health care items or services
identified 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.)
IC 12-16-7.5
Chapter 7.5. Hospital Care for the Indigent; Cost of Care and
Payment
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 hospital
care for the indigent program is not financially obligated for services
provided to the person during the person's eligibility under the
program, if the items or services were:
(1) identified in a claim filed with the division under
IC 12-16-4.5; and
(2) determined:
(A) 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
(B) to be 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) Hospitals may receive a payment from the office calculated
and 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 and
IC 12-15-15-9.5 for payments attributable to state fiscal years
beginning after June 30, 2007.
(c) Based on a physician's services identified in a claim under
subsection (a), the physician may receive a payment from the
division calculated and made under section 5 of this chapter.
(d) Based on the transportation services identified in a claim
under subsection (a), the transportation provider may receive a
payment from the division calculated and made under section 5 of
this 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; division
determination of amount of payment
Sec. 2.5. (a) Payable claims shall be segregated by state fiscal
year.
(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 physician
care, hospital care, or transportation services under this chapter:
(A) that includes, on forms prescribed by the division, all the
information required for timely payment;
(B) that is for a period during which the person is
determined to be financially and medically eligible for the
hospital care for the indigent program; and
(C) for which the payment amounts for the care and services
are 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 before
July 1, 2007, a claim for payment for physician care, hospital
care, or transportation services under this chapter:
(A) provided to a person under the hospital care for the
indigent program under this article during the person's
eligibility 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 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
(ii) be 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).
(3) For state fiscal years beginning after June 30, 2007, a claim
for payment for physician care or transportation services under
this chapter:
(A) provided to a person under the hospital care for the
indigent program under this article during the person's
eligibility 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 that
was manifested by symptoms of sufficient severity that the
absence of immediate medical attention would probably
result in any of the outcomes described 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
(ii) be a direct consequence of the onset of a medical
condition that was manifested by symptoms of sufficient
severity that the absence of immediate medical attention
would probably result in any of the outcomes listed in
IC 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 payable
claim means an amount calculated under STEP THREE of the
following formula:
STEP ONE: Identify the items and services identified in a
claim or payable claim.
STEP TWO: Using the applicable Medicaid fee for service
reimbursement rates, calculate the reimbursement amounts
for each of the items and services identified in STEP ONE.
STEP THREE: Calculate the sum of the amounts identified
in 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 is
considered to have submitted the claim during the state fiscal year
during which the amount of the claim was determined under
IC 12-16-5.5-1.2(b) or, if successfully appealed by a provider, the
state fiscal year in which the appeal was decided.
(e) The division shall determine the amount of a claim under
IC 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 transportation
provider under this chapter must be on a warrant drawn on the state
hospital care for the indigent fund established by IC 12-16-14.
(b) A payment made to a hospital under this chapter shall be made
under 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 from
the state hospital care for the indigent fund
Sec. 4.5. (a) Not later than October 31 following the end of each
state fiscal year, the division shall:
(1) calculate for each county the total amount of payable claims
submitted to the division during the state fiscal year attributed
to:
(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 by
the division; and
(iii) who were residents of Indiana but whose county of
residence in Indiana could not be determined by the
division;
and whose medical condition that necessitated the care or
service occurred in the county;
(2) notify each county of the amount of payable claims
attributed to the county under the calculation made under
subdivision (1); and
(3) with respect to payable claims attributed to a county under
subdivision (1):
(A) calculate the total amount of payable claims submitted
during 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 each
hospital, physician, and transportation provider listed in
clause (A).
(b) For the state fiscal years beginning after June 30, 2005, but
before July 1, 2007, and before November 1 following the end of a
state fiscal year, the division shall allocate the funds transferred from
a county's hospital care for the indigent fund to the state hospital care
for the indigent fund under IC 12-16-14 during or for the following
state fiscal years:
(1) For the state fiscal year ending June 30, 2006, as required
under the following STEPS:
STEP ONE: Determine the total amount of funds transferred
from all counties' hospital care for the indigent funds by the
counties to the state hospital care for the indigent fund under
IC 12-16-14 during or for the state fiscal year.
STEP TWO: Of the total amount of payable claims
submitted to the division during the state fiscal year from all
counties under subsection (a), determine the amount that is
the lesser of:
(A) the amount of total physician payable claims and total
transportation provider payable claims; or
(B) three million dollars ($3,000,000).
The amount determined under this STEP shall be used by the
division 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 under
clause (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 under
IC 12-15-15-9 and IC 12-15-15-9.5;
to the Medicaid indigent care trust fund for funding the
transfer to the office and the non-federal share of the
payments identified in this STEP.
STEP FOUR: Transfer an amount equal to sixty-one million
dollars ($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 the
non-federal share of payments under clause (B) of STEP
FIVE of IC 12-15-15-1.5(b).
STEP FIVE: Transfer to the Medicaid indigent care trust
fund 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) the
amount determined under STEP ONE, less the sum of the
amount:
(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 required
under the following steps:
STEP ONE: Determine the total amount of funds transferred
from all counties' hospital care for the indigent funds by the
counties to the state hospital care for the indigent fund under
IC 12-16-14 during or for the state fiscal year.
STEP TWO: Of the total amount of payable claims
submitted to the division during the state fiscal year from all
counties under subsection (a), determine the amount that is
the lesser of:
(A) the amount of total physician payable claims and total
transportation provider payable claims; or
(B) three million dollars ($3,000,000).
The amount determined under this STEP shall be used by the
division for making payments under section 5 of this chapter
or for the non-federal share of Medicaid payments for
physicians and transportation providers, as determined by
the 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) 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 under
IC 12-15-15-9 and IC 12-15-15-9.5;
to the Medicaid indigent care trust fund for funding the
transfer to the office and the non-federal share of the
payments identified in this STEP.
STEP FOUR: Transfer an amount equal to the amount
determined 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 the
non-federal share of payments under clause (B) of STEP
FIVE of IC 12-15-15-1.5(b).
(c) For the state fiscal years beginning after June 30, 2007, before
November 1 following the end of the state fiscal year, the division
shall allocate the funds transferred to the state hospital care for the
indigent fund for the state fiscal year as required under the following
STEPS:
STEP ONE: Determine the total amount of funds transferred to
the 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 is
three million dollars ($3,000,000).
STEP FOUR: Transfer to the Medicaid indigent care trust fund
for purposes of IC 12-15-20-2(8)(G) an amount equal to the
amount calculated under STEP ONE, minus an amount equal to
the amount specified under STEP THREE.
STEP FIVE: The division shall retain an amount equal to the
amount remaining in the state hospital care for the indigent fund
after the transfer in STEP FOUR for purposes of making
payments under section 5 of this chapter or for the non-federal
share of Medicaid payments for physicians and transportation
providers, as determined by the office.
(d) The costs of administering the hospital care for the indigent
program, including the processing of claims, shall be paid from the
funds 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 fiscal
year, the division shall, from the amounts combined from the
counties' hospital care for the indigent funds and retained under
section 4.5(b) or 4.5(c) of this chapter, pay each physician and
transportation provider a pro rata part of that amount. The total
payments available under this section may not exceed three million
dollars ($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 for
the indigent program for the payment of any part of the costs of
providing care in a hospital to an individual who is not either of the
following:
(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 care
provided to an individual who has been determined to be a patient
described 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 this
chapter agree to accept, as payment in full, the payment referred to
in section 1.2 of this chapter for the health care items or services
identified 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.)
