2006 Indiana Code - CHAPTER 16. DISPROPORTIONATE SHARE PROVIDERS; ELIGIBILITY
IC 12-15-16Chapter 16. Disproportionate Share Providers; Eligibility
IC 12-15-16-1
P.L.277-1993(ss), SEC.71; P.L.126-1998, SEC.6; P.L.113-2000,
SEC.5; P.L.78-2004, SEC.8.
Disproportionate share provider status
Sec. 1. (a) A provider that is an acute care hospital licensed under
IC 16-21, a state mental health institution under IC 12-24-1-3, or a
private psychiatric institution licensed under IC 12-25 is a
disproportionate share provider if the provider meets either of the
following conditions:
(1) The provider's Medicaid inpatient utilization rate is at least
one (1) standard deviation above the mean Medicaid inpatient
utilization rate for providers receiving Medicaid payments in
Indiana. However, the Medicaid inpatient utilization rate of
providers whose low income utilization rate exceeds
twenty-five percent (25%) must be excluded in calculating the
statewide mean Medicaid inpatient utilization rate.
(2) The provider's low income utilization rate exceeds
twenty-five percent (25%).
(b) An acute care hospital licensed under 16-21 is a municipal
disproportionate share provider if the hospital:
(1) has a Medicaid utilization rate greater than one percent
(1%); and
(2) is established and operated under IC 16-22-2 or IC 16-23.
(c) A community mental health center that:
(1) is identified in IC 12-29-2-1;
(2) receives funding under:
(A) IC 12-29-1-7(b) before January 1, 2004; or
(B) IC 12-29-2-20(c) after December 31, 2003;
or from other county sources; and
(3) provides inpatient services to Medicaid patients;
is a community mental health center disproportionate share provider
if the community mental health center's Medicaid inpatient
utilization rate is greater than one percent (1%).
(d) A disproportionate share provider under IC 12-15-17 must
have at least two (2) obstetricians who have staff privileges and who
have agreed to provide obstetric services under the Medicaid
program. For a hospital located in a rural area (as defined in Section
1886 of the Social Security Act), an obstetrician includes a physician
with staff privileges at the hospital who has agreed to perform
nonemergency obstetric procedures. However, this obstetric service
requirement does not apply to a provider whose inpatients are
predominantly individuals less than eighteen (18) years of age or that
did not offer nonemergency obstetric services as of December 21,
1987.
(e) The determination of a provider's status as a disproportionate
share provider under this section shall be based on utilization and
revenue data from the most recent year for which an audited cost
report from the provider is on file with the office.
As added by P.L.2-1992, SEC.9. Amended by P.L.27-1992, SEC.12;
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