205.640 Medical Assistance Revolving Trust Fund (MART) -- Distribution of disproportionate share funds -- Authority for administrative regulations -- Duties of hospitals receiving funds from MART.
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205.640 Medical Assistance Revolving Trust Fund (MART) -- Distribution of disproportionate share funds -- Authority for administrative regulations -- <br>Duties of hospitals receiving funds from MART. (1) The commissioner of Medicaid services shall adopt a disproportionate share program consistent with the requirements of Title XIX of the Social Security Act <br>which shall include to the extent possible, but not limited to, the provisions of this <br>section. (2) The Medical Assistance Revolving Trust Fund (MART) shall be established in the State Treasury and all provider tax revenues collected pursuant to KRS 142.301 to <br>142.363 shall be deposited in the State Treasury and transferred on a quarterly basis <br>to the Department for Medicaid Services for use as specified in this section. All <br>investment earnings of the fund shall be credited to the fund. Provider tax revenues <br>collected in accordance with KRS 142.301 to 142.363 may be used to fund the <br>provisions of KRS 216.2920 to 216.2929 and to supplement the medical assistance-<br>related general fund appropriations for fiscal year 1994 and subsequent fiscal years. <br>Notwithstanding the provisions of KRS 48.500 and 48.600, the MART fund shall <br>be exempt from any state budget reduction acts. (3) (a) Beginning in state fiscal year 2000-2001 and continuing annually thereafter, provider tax revenues and state and federal matching funds shall be used to <br>fund the disproportionate share program established by administrative <br>regulations promulgated by the Cabinet for Health and Family Services. <br>Disproportionate share funds shall be divided into three (3) pools for <br>distribution as follows: <br>1. Forty-three and ninety-two hundredths percent (43.92%) of the total <br>disproportionate share funds shall be allocated to acute care hospitals; 2. Thirty-seven percent (37%) of the total disproportionate share funds <br>shall be allocated to university hospitals; 3. The percentage allowable by federal law pursuant to 42 U.S.C. sec. <br>1396r-4(h), up to nineteen and eight hundredths percent (19.08%) of the <br>total disproportionate share funds shall be allocated to private <br>psychiatric hospitals and state mental hospitals, with the allocation to <br>each respective group of hospitals established by the biennial budget; 4. If there are any remaining disproportionate share funds from private <br>psychiatric hospitals and state mental hospitals, fifty-four percent (54%) <br>of those funds shall be distributed to the acute care hospitals and forty-<br>six percent (46%) shall be distributed to the university hospitals; and 5. If, in any year, one (1) or both university hospitals fail to provide state <br>matching funds necessary to secure federal financial participation for the <br>funds allocated to university hospitals under this subsection, the portion <br>of the funding allocation applicable to the hospital or hospitals that fail <br>to provide state matching funds shall be made available to acute care <br>hospitals. (b) The MART fund shall be used to compensate acute care hospitals, private psychiatric hospitals, state mental hospitals, and university hospitals <br>participating in the disproportionate share program for uncompensated service <br>provided by the hospitals to individuals and families with total annual <br>incomes and resources up to one hundred percent (100%) of the federal <br>poverty level, as determined by the hospital pursuant to administrative <br>regulations promulgated by the Cabinet for Health and Family Services in <br>accordance with this section. (c) An individual hospital shall receive distributions for indigent care provided by that hospital if the hospital meets the requirements of the disproportionate <br>share program. (d) Distributions to acute care and private psychiatric hospitals shall be made as follows: <br>1. The department shall calculate an indigent care factor for each hospital <br>annually. The indigent care factor shall be determined by calculating the <br>percentage of each hospital's annual indigent care costs toward the sum <br>of the total annual indigent care costs for all hospitals within each <br>respective pool. For purposes of this paragraph, "indigent care costs" <br>means the hospital's inpatient and outpatient care as reported to the <br>department multiplied by the hospital's Medicaid rate, or at a rate <br>determined by the department in administrative regulation that, when <br>multiplied by the hospital's reported indigent care, is equivalent to the <br>amount that would be payable by the department under the fee-for-<br>service Medicaid program for the hospital's total reported indigent care. 2. Each hospital's annual distribution shall be calculated by multiplying the <br>hospital's indigent care factor by the total fund allocated to all hospitals <br>within the respective pool under paragraph (a) of this subsection. <br>a. Hospitals shall report uncompensated care provided to qualified <br>individuals and families with total annual incomes and resources <br>up to one hundred percent (100%) of the federal poverty level, <br>including care rendered to indigent persons age twenty-two (22) to <br>sixty-four (64) in a psychiatric hospital to the Cabinet for Health <br>and Family Services on a quarterly basis. However, all data for <br>care provided during the state fiscal year shall be submitted no <br>later than August 15 of each year. b. For state fiscal year 2001-2002 and each year thereafter, the <br>department shall use data reported by the hospitals for indigent <br>care services rendered for the twelve (12) month period ending <br>June 30 of each year as reported by the hospital to the department <br>by August 15 in calculating each hospital's indigent care factor. <br>The hospital shall, upon request by the Cabinet for Health and <br>Family Services, submit any supporting documentation to verify <br>the indigent care data submitted for the calculation of an indigent <br>care factor and annual payment. c. By September 1 of each year, the department shall calculate a <br>preliminary indigent care factor and preliminary annual payment <br>amount for each hospital, and shall notify each hospital of their <br>calculation. The notice shall contain a listing of each hospital's <br>indigent care costs, their indigent care factor, and the estimated <br>annual payment amount. Hospitals shall notify the department by <br>September 15 of any adjustments in the department's preliminary <br>calculations. The department shall make adjustments identified by <br>hospitals and shall make a final determination of each hospital's <br>indigent care factor and annual payment amount by October 1. The <br>department shall make a final determination of each hospital's <br>annual payment amount upon notification through the Federal <br>Register of the annual federal disproportionate share hospital <br>allotment for the Commonwealth. (e) The department shall issue to each hospital one (1) lump-sum payment on October 15, or later as soon as federal financial participation becomes <br>available through notification by publication of the Federal Register, for <br>the disproportionate share funds available during the corresponding <br>federal fiscal year. The department may pay a portion of the expected <br>annual payment prior to the publication of the annual federal allotment. (4) Notwithstanding any other provision to contrary, total annual disproportionate share payments made to state mental hospitals, university hospitals, acute care hospitals, <br>and private psychiatric hospitals in each state fiscal year shall be equal to the <br>maximum amount of disproportionate share payments established under the Federal <br>Balanced Budget Act of 1997 and any amendments thereto. Disproportionate share <br>payments shall be subject to the availability of adequate state matching funds and <br>shall not exceed total uncompensated costs. (5) Hospitals receiving reimbursement shall not bill patients for services submitted for reimbursement under this section and KRS 205.641. Services provided to <br>individuals who are eligible for medical assistance or the Kentucky Children's <br>Health Insurance Program do not qualify for reimbursement under this section and <br>KRS 205.641. Hospitals shall make a reasonable determination that an individual <br>does not qualify for these programs and shall request the individual to apply, if <br>appropriate, for medical assistance or Kentucky Children's Health Insurance on <br>forms supplied by and in accordance with procedures established by the Department <br>for Medicaid Services. The hospital shall document any refusal to apply and shall <br>inform the patient that the refusal may result in the patient being billed for any <br>services performed. The hospital shall not be eligible for reimbursement if the <br>patient was eligible for medical assistance or Kentucky Children's Health Insurance <br>and did not apply. Hospitals receiving reimbursement under this section and KRS <br>205.641 shall not bill patients for services provided to patients not eligible for <br>medical assistance with family incomes up to one hundred percent (100%) of the <br>federal poverty level. (6) The secretary of the Cabinet for Health and Family Services shall promulgate administrative regulations, pursuant to KRS Chapter 13A, for the administration <br>and implementation of this section. (7) All hospitals receiving reimbursement under this section and KRS 205.641 shall display prominently a sign which reads as follows: "This hospital will accept <br>patients regardless of race, creed, ethnic background, or ability to pay." (8) The hospital shall, upon request by the Cabinet for Health and Family Services, submit any supporting documentation to substantiate compliance with the audit <br>requirements established by 42 C.F.R. sec. 455. Effective: July 15, 2010 <br>History: Amended 2010 Ky. Acts ch. 142, sec. 1, effective July 15, 2010. -- Amended 2005 Ky. Acts ch. 99, sec. 258, effective June 20, 2005; and ch. 120, sec. 14, <br>effective June 20, 2005. -- Amended 2001 Ky. Acts ch. 164, sec. 9, effective June 21, <br>2001. -- Amended 2000 Ky. Acts ch. 310, sec. 2, effective April 4, 2000. -- Amended <br>1998 Ky. Acts ch. 82, sec. 21, effective July 15, 1998; ch. 426, sec. 217, effective <br>July 15, 1998; and ch. 545, sec. 1, effective July 15, 1998. -- Amended 1994 Ky. <br>Acts ch. 512, sec. 85, effective July 15, 1994.</div></article><aside class="right-sidebar"><div class="related-sidebar"><h3><span class="emoji">⚖️</span> State Laws</h3><ul class="state-laws-list"><li><a href="https://state-laws.laws.com/state-of-alabama">The State Laws of <!-- -->Alabama</a></li><li><a href="https://state-laws.laws.com/state-of-alaska">The State Laws of <!-- -->Alaska</a></li><li><a href="https://state-laws.laws.com/state-of-arizona">The State Laws of <!-- -->Arizona</a></li><li><a href="https://state-laws.laws.com/state-of-arkansas">The State Laws of <!-- -->Arkansas</a></li><li><a href="https://state-laws.laws.com/state-of-california">The State Laws of <!-- -->California</a></li><li><a href="https://state-laws.laws.com/state-of-colorado">The State Laws of <!-- -->Colorado</a></li><li><a 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PDF...\u003c/div\u003e\u003cscript type=\"text/javascript\"\u003e var pdf_url = 'https://law.justia.com/codes/kentucky/2009/205-00/pdf/640.pdf'; $(document).ready(function() { var embedwindow = $(\"#embed_document\"); if ($.browser.msie){ embedwindow.html('\u003cembed src=\"'+pdf_url+'\" width=\"100%\" height=\"100%\"\u003e\u003c/embed\u003e'); } else { embedwindow.html('\u003ciframe style=\"width:100%; height:100%;\" src=\"https://docs.google.com/gview?url='+window.escape(pdf_url)+'\u0026embedded=true\" frameborder=\"0\"\u003e\u003c/iframe\u003e'); } });\u003c/script\u003e\u003cbr\u003e\u003cbr\u003e\u003cnoframes\u003e205.640 Medical Assistance Revolving Trust Fund (MART) -- Distribution of disproportionate share funds -- Authority for administrative regulations -- \u003cbr\u003eDuties of hospitals receiving funds from MART. (1) The commissioner of Medicaid services shall adopt a disproportionate share program consistent with the requirements of Title XIX of the Social Security Act \u003cbr\u003ewhich shall include to the extent possible, but not limited to, the provisions of this \u003cbr\u003esection. (2) The Medical Assistance Revolving Trust Fund (MART) shall be established in the State Treasury and all provider tax revenues collected pursuant to KRS 142.301 to \u003cbr\u003e142.363 shall be deposited in the State Treasury and transferred on a quarterly basis \u003cbr\u003eto the Department for Medicaid Services for use as specified in this section. All \u003cbr\u003einvestment earnings of the fund shall be credited to the fund. Provider tax revenues \u003cbr\u003ecollected in accordance with KRS 142.301 to 142.363 may be used to fund the \u003cbr\u003eprovisions of KRS 216.2920 to 216.2929 and to supplement the medical assistance-\u003cbr\u003erelated general fund appropriations for fiscal year 1994 and subsequent fiscal years. \u003cbr\u003eNotwithstanding the provisions of KRS 48.500 and 48.600, the MART fund shall \u003cbr\u003ebe exempt from any state budget reduction acts. (3) (a) Beginning in state fiscal year 2000-2001 and continuing annually thereafter, provider tax revenues and state and federal matching funds shall be used to \u003cbr\u003efund the disproportionate share program established by administrative \u003cbr\u003eregulations promulgated by the Cabinet for Health and Family Services. \u003cbr\u003eDisproportionate share funds shall be divided into three (3) pools for \u003cbr\u003edistribution as follows: \u003cbr\u003e1. Forty-three and ninety-two hundredths percent (43.92%) of the total \u003cbr\u003edisproportionate share funds shall be allocated to acute care hospitals; 2. Thirty-seven percent (37%) of the total disproportionate share funds \u003cbr\u003eshall be allocated to university hospitals; 3. The percentage allowable by federal law pursuant to 42 U.S.C. sec. \u003cbr\u003e1396r-4(h), up to nineteen and eight hundredths percent (19.08%) of the \u003cbr\u003etotal disproportionate share funds shall be allocated to private \u003cbr\u003epsychiatric hospitals and state mental hospitals, with the allocation to \u003cbr\u003eeach respective group of hospitals established by the biennial budget; 4. If there are any remaining disproportionate share funds from private \u003cbr\u003epsychiatric hospitals and state mental hospitals, fifty-four percent (54%) \u003cbr\u003eof those funds shall be distributed to the acute care hospitals and forty-\u003cbr\u003esix percent (46%) shall be distributed to the university hospitals; and 5. If, in any year, one (1) or both university hospitals fail to provide state \u003cbr\u003ematching funds necessary to secure federal financial participation for the \u003cbr\u003efunds allocated to university hospitals under this subsection, the portion \u003cbr\u003eof the funding allocation applicable to the hospital or hospitals that fail \u003cbr\u003eto provide state matching funds shall be made available to acute care \u003cbr\u003ehospitals. (b) The MART fund shall be used to compensate acute care hospitals, private psychiatric hospitals, state mental hospitals, and university hospitals \u003cbr\u003eparticipating in the disproportionate share program for uncompensated service \u003cbr\u003eprovided by the hospitals to individuals and families with total annual \u003cbr\u003eincomes and resources up to one hundred percent (100%) of the federal \u003cbr\u003epoverty level, as determined by the hospital pursuant to administrative \u003cbr\u003eregulations promulgated by the Cabinet for Health and Family Services in \u003cbr\u003eaccordance with this section. (c) An individual hospital shall receive distributions for indigent care provided by that hospital if the hospital meets the requirements of the disproportionate \u003cbr\u003eshare program. (d) Distributions to acute care and private psychiatric hospitals shall be made as follows: \u003cbr\u003e1. The department shall calculate an indigent care factor for each hospital \u003cbr\u003eannually. The indigent care factor shall be determined by calculating the \u003cbr\u003epercentage of each hospital's annual indigent care costs toward the sum \u003cbr\u003eof the total annual indigent care costs for all hospitals within each \u003cbr\u003erespective pool. For purposes of this paragraph, \u0026quot;indigent care costs\u0026quot; \u003cbr\u003emeans the hospital's inpatient and outpatient care as reported to the \u003cbr\u003edepartment multiplied by the hospital's Medicaid rate, or at a rate \u003cbr\u003edetermined by the department in administrative regulation that, when \u003cbr\u003emultiplied by the hospital's reported indigent care, is equivalent to the \u003cbr\u003eamount that would be payable by the department under the fee-for-\u003cbr\u003eservice Medicaid program for the hospital's total reported indigent care. 2. Each hospital's annual distribution shall be calculated by multiplying the \u003cbr\u003ehospital's indigent care factor by the total fund allocated to all hospitals \u003cbr\u003ewithin the respective pool under paragraph (a) of this subsection. \u003cbr\u003ea. Hospitals shall report uncompensated care provided to qualified \u003cbr\u003eindividuals and families with total annual incomes and resources \u003cbr\u003eup to one hundred percent (100%) of the federal poverty level, \u003cbr\u003eincluding care rendered to indigent persons age twenty-two (22) to \u003cbr\u003esixty-four (64) in a psychiatric hospital to the Cabinet for Health \u003cbr\u003eand Family Services on a quarterly basis. However, all data for \u003cbr\u003ecare provided during the state fiscal year shall be submitted no \u003cbr\u003elater than August 15 of each year. b. For state fiscal year 2001-2002 and each year thereafter, the \u003cbr\u003edepartment shall use data reported by the hospitals for indigent \u003cbr\u003ecare services rendered for the twelve (12) month period ending \u003cbr\u003eJune 30 of each year as reported by the hospital to the department \u003cbr\u003eby August 15 in calculating each hospital's indigent care factor. \u003cbr\u003eThe hospital shall, upon request by the Cabinet for Health and \u003cbr\u003eFamily Services, submit any supporting documentation to verify \u003cbr\u003ethe indigent care data submitted for the calculation of an indigent \u003cbr\u003ecare factor and annual payment. c. By September 1 of each year, the department shall calculate a \u003cbr\u003epreliminary indigent care factor and preliminary annual payment \u003cbr\u003eamount for each hospital, and shall notify each hospital of their \u003cbr\u003ecalculation. The notice shall contain a listing of each hospital's \u003cbr\u003eindigent care costs, their indigent care factor, and the estimated \u003cbr\u003eannual payment amount. Hospitals shall notify the department by \u003cbr\u003eSeptember 15 of any adjustments in the department's preliminary \u003cbr\u003ecalculations. The department shall make adjustments identified by \u003cbr\u003ehospitals and shall make a final determination of each hospital's \u003cbr\u003eindigent care factor and annual payment amount by October 1. The \u003cbr\u003edepartment shall make a final determination of each hospital's \u003cbr\u003eannual payment amount upon notification through the Federal \u003cbr\u003eRegister of the annual federal disproportionate share hospital \u003cbr\u003eallotment for the Commonwealth. (e) The department shall issue to each hospital one (1) lump-sum payment on October 15, or later as soon as federal financial participation becomes \u003cbr\u003eavailable through notification by publication of the Federal Register, for \u003cbr\u003ethe disproportionate share funds available during the corresponding \u003cbr\u003efederal fiscal year. The department may pay a portion of the expected \u003cbr\u003eannual payment prior to the publication of the annual federal allotment. (4) Notwithstanding any other provision to contrary, total annual disproportionate share payments made to state mental hospitals, university hospitals, acute care hospitals, \u003cbr\u003eand private psychiatric hospitals in each state fiscal year shall be equal to the \u003cbr\u003emaximum amount of disproportionate share payments established under the Federal \u003cbr\u003eBalanced Budget Act of 1997 and any amendments thereto. Disproportionate share \u003cbr\u003epayments shall be subject to the availability of adequate state matching funds and \u003cbr\u003eshall not exceed total uncompensated costs. (5) Hospitals receiving reimbursement shall not bill patients for services submitted for reimbursement under this section and KRS 205.641. Services provided to \u003cbr\u003eindividuals who are eligible for medical assistance or the Kentucky Children's \u003cbr\u003eHealth Insurance Program do not qualify for reimbursement under this section and \u003cbr\u003eKRS 205.641. Hospitals shall make a reasonable determination that an individual \u003cbr\u003edoes not qualify for these programs and shall request the individual to apply, if \u003cbr\u003eappropriate, for medical assistance or Kentucky Children's Health Insurance on \u003cbr\u003eforms supplied by and in accordance with procedures established by the Department \u003cbr\u003efor Medicaid Services. The hospital shall document any refusal to apply and shall \u003cbr\u003einform the patient that the refusal may result in the patient being billed for any \u003cbr\u003eservices performed. The hospital shall not be eligible for reimbursement if the \u003cbr\u003epatient was eligible for medical assistance or Kentucky Children's Health Insurance \u003cbr\u003eand did not apply. Hospitals receiving reimbursement under this section and KRS \u003cbr\u003e205.641 shall not bill patients for services provided to patients not eligible for \u003cbr\u003emedical assistance with family incomes up to one hundred percent (100%) of the \u003cbr\u003efederal poverty level. (6) The secretary of the Cabinet for Health and Family Services shall promulgate administrative regulations, pursuant to KRS Chapter 13A, for the administration \u003cbr\u003eand implementation of this section. (7) All hospitals receiving reimbursement under this section and KRS 205.641 shall display prominently a sign which reads as follows: \u0026quot;This hospital will accept \u003cbr\u003epatients regardless of race, creed, ethnic background, or ability to pay.\u0026quot; (8) The hospital shall, upon request by the Cabinet for Health and Family Services, submit any supporting documentation to substantiate compliance with the audit \u003cbr\u003erequirements established by 42 C.F.R. sec. 455. Effective: July 15, 2010 \u003cbr\u003eHistory: Amended 2010 Ky. Acts ch. 142, sec. 1, effective July 15, 2010. -- Amended 2005 Ky. Acts ch. 99, sec. 258, effective June 20, 2005; and ch. 120, sec. 14, \u003cbr\u003eeffective June 20, 2005. -- Amended 2001 Ky. Acts ch. 164, sec. 9, effective June 21, \u003cbr\u003e2001. -- Amended 2000 Ky. Acts ch. 310, sec. 2, effective April 4, 2000. -- Amended \u003cbr\u003e1998 Ky. Acts ch. 82, sec. 21, effective July 15, 1998; ch. 426, sec. 217, effective \u003cbr\u003eJuly 15, 1998; and ch. 545, sec. 1, effective July 15, 1998. -- Amended 1994 Ky. \u003cbr\u003eActs ch. 512, sec. 85, effective July 15, 1994."])</script><script>self.__next_f.push([1,"132:[\"$\",\"article\",null,{\"className\":\"article-content\",\"children\":[[\"$\",\"header\",null,{\"className\":\"article-header\",\"children\":[[\"$\",\"$Le\",null,{\"href\":\"/kentucky/\",\"className\":\"article-category\",\"children\":[\"Kentucky\",\" Statutes\"]}],[\"$\",\"h1\",null,{\"className\":\"article-title\",\"children\":\"205.640 Medical Assistance Revolving Trust Fund (MART) -- Distribution of disproportionate share funds -- Authority for administrative regulations -- Duties of hospitals receiving funds from MART.\"}]]}],[\"$\",\"div\",null,{\"className\":\"article-body 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