2006 Indiana Code - CHAPTER 14.5. SUPPLEMENTAL PAYMENTS TO AMBULANCE TRANSPORTATION SERVICE PROVIDERS

IC 12-15-14.5
     Chapter 14.5. Supplemental Payments to Ambulance Transportation Service Providers

IC 12-15-14.5-1
Application of chapter
     Sec. 1. This chapter applies to a Medicaid provider that receives reimbursement from the office during a state fiscal year for providing ambulance transportation services.
As added by P.L.224-2003, SEC.83.

IC 12-15-14.5-2
Reimbursement of ambulance transportation service provider
     Sec. 2. (a) Subject to section 6 of this chapter, for each state fiscal year beginning July 1, 2003, an ambulance transportation service provider may receive reimbursement under this chapter that is in addition to the following reimbursement:
        (1) Reimbursement under this article.
        (2) The state plan for medical assistance.
        (3) Rules and policies adopted by the office to provide ambulance transportation services.
    (b) Any additional reimbursement allowed under subsection (a) is subject to the approval by the United States Department of Health and Human Services to an amendment of the state Medicaid plan.
As added by P.L.224-2003, SEC.83.

IC 12-15-14.5-3
Schedule of payments
     Sec. 3. The office shall:
        (1) develop a schedule for payments made under this chapter; and
        (2) make a payment under this chapter in accordance with the schedule.
As added by P.L.224-2003, SEC.83.

IC 12-15-14.5-4
Calculation of payment
     Sec. 4. (a) Except as provided in subsection (b), the office shall calculate and make a payment under this chapter in an amount equal to the amount calculated in STEP SIX of the following formula:
        STEP ONE: The office shall identify a Medicaid provider described in section 1 of this chapter that received reimbursement for ambulance transportation services during a time frame determined by the office.
        STEP TWO: For each Medicaid provider described in STEP ONE, the office shall identify the ambulance transportation services for which the Medicaid provider was reimbursed.
        STEP THREE: For each Medicaid provider described in STEP ONE, the office shall calculate the reimbursement paid to the Medicaid provider for the ambulance transportation services

identified under STEP TWO.
        STEP FOUR: For each Medicaid provider described in STEP ONE, the office shall calculate the Medicaid provider's usual and customary charges for each of the Medicaid provider's services identified under STEP TWO.
        STEP FIVE: For each Medicaid provider described in STEP ONE, the office shall subtract an amount equal to the reimbursement calculation for each of the ambulance transportation services under STEP THREE from an amount equal to the amount calculated for each of the ambulance transportation services under STEP FOUR.
        STEP SIX: For each Medicaid provider described in STEP ONE, the office shall calculate the sum of each of the amounts calculated for each ambulance transportation services under STEP FIVE.
    (b) For any Medicaid provider described in STEP ONE of subsection (a), the office may decline to base the calculations under STEP FOUR of subsection (a) on the Medicaid provider's usual and customary charges if the office determines a formula or criteria that will increase the amount calculated for the provider under STEP SIX of subsection (a).
As added by P.L.224-2003, SEC.83.

IC 12-15-14.5-5
Calculation of usual and customary charges
     Sec. 5. The office shall establish a methodology for calculating a provider's usual and customary charges for purpose of STEP FOUR of the formula in section 4(a) of this chapter.
As added by P.L.224-2003, SEC.83.

IC 12-15-14.5-6
Intergovernmental transfer required
     Sec. 6. (a) A Medicaid provider that receives reimbursement from the office during a state fiscal year for ambulance transportation services is eligible for payment under this chapter only if an intergovernmental transfer under this section is made by the provider or on behalf of the provider to the office.
    (b) The amount of the intergovernmental transfer under subsection (a) must be an amount of at least eighty-five percent (85%) of the amount calculated for the provider under STEP SIX of section 4 of this chapter.
As added by P.L.224-2003, SEC.83.

IC 12-15-14.5-7
Appeal by Medicaid provider
     Sec. 7. A Medicaid provider that receives reimbursement from the office during a state fiscal year for ambulance transportation services may appeal under IC 4-21.5 the amount determined by the office to be paid to the Medicaid provider under STEP SIX of section 4 of this chapter. As added by P.L.224-2003, SEC.83.

IC 12-15-14.5-8
Determination of services covered
     Sec. 8. The office shall determine the services to be considered ambulance transportation services under this chapter. The services must at least include the following:
        (1) Air.
        (2) Basic life support services.
        (3) Advanced life support services.
As added by P.L.224-2003, SEC.83.


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