2013 Indiana Code
TITLE 12. HUMAN SERVICES
ARTICLE 15. MEDICAID
CHAPTER 19. DISPROPORTIONATE SHARE PROVIDERS; ENHANCED DISPROPORTIONATE SHARE PAYMENTS
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IC 12-15-19
Chapter 19. Disproportionate Share Providers; Enhanced
Disproportionate Share Payments
IC 12-15-19-1
Enhanced disproportionate share payment methodology for state
fiscal years ending June 30, 1998, and June 30, 1999; limits on
basic and enhanced disproportionate share payments to hospitals
Sec. 1. (a) For the state fiscal years ending on June 30, 1998, and
June 30, 1999, the office shall develop an enhanced disproportionate
share payment methodology that ensures that each enhanced
disproportionate share provider receives total disproportionate share
payments that do not exceed its hospital specific limit specified in
subsection (c). The methodology developed by the office shall ensure
that hospitals operated by or affiliated with the governmental entities
described in IC 12-15-18-5.1(a) receive, to the extent practicable,
disproportionate share payments equal to their hospital specific
limits. The funds shall be distributed to qualifying hospitals in
proportion to each qualifying hospital's percentage of the total net
hospital specific limits of all qualifying hospitals. A hospital's net
hospital specific limit for state fiscal years ending on or before June
30, 1999, is determined under STEP THREE of the following
formula:
STEP ONE: Determine the hospital's hospital specific limit
under subsection (c).
STEP TWO: Subtract basic disproportionate share payments
received by the hospital under IC 12-15-16-6 from the amount
determined under STEP ONE.
STEP THREE: Subtract intergovernmental transfers paid by or
on behalf of the hospital from the amount determined under
STEP TWO.
(b) The office shall include a provision in each amendment to the
state plan regarding disproportionate share payments, municipal
disproportionate share payments, and community mental health
center disproportionate share payments that the office submits to the
federal Centers for Medicare and Medicaid Services that, as provided
in 42 CFR 447.297(d)(3), allows the state to make additional
disproportionate share expenditures, municipal disproportionate
share expenditures, and community mental health center
disproportionate share expenditures after the end of each federal
fiscal year that relate back to a prior federal fiscal year. Each eligible
hospital or community mental health center may receive an
additional disproportionate share adjustment if:
(1) additional intergovernmental transfers or certifications are
made as authorized under IC 12-15-18-5.1; and
(2) the total disproportionate share payments to:
(A) each individual hospital; and
(B) all qualifying hospitals in the aggregate;
do not exceed the limits provided by federal law and regulation.
(c) For state fiscal years ending on or before June 30, 1999, total
basic and enhanced disproportionate share payments to a hospital
under this chapter and IC 12-15-16 shall not exceed the hospital
specific limit provided under 42 U.S.C. 1396r-4(g). The hospital
specific limit for state fiscal years ending on or before June 30, 1999,
shall be determined by the office taking into account any data
provided by each hospital for each hospital's most recent fiscal year
(or in cases where a change in fiscal year causes the most recent
fiscal period to be less than twelve (12) months, twelve (12) months
of data ending at the end of the most recent fiscal year) as certified
to the office by:
(1) an independent certified public accounting firm if the
hospital is a hospital licensed under IC 16-21 that qualifies
under IC 12-15-16-1(a); or
(2) the budget agency if the hospital is a state mental health
institution listed under IC 12-24-1-3 that qualifies under either
IC 12-15-16-1(a)(1) or IC 12-15-16-1(a)(2);
in accordance with this subsection and federal laws, regulations, and
guidelines. The hospital specific limit for state fiscal years ending
after June 30, 1999, shall be determined by the office using the
methodology described in section 2.1(b) of this chapter.
As added by P.L.2-1992, SEC.9. Amended by P.L.27-1992, SEC.18;
P.L.2-1993, SEC.101; P.L.277-1993(ss), SEC.79; P.L.1-1994,
SEC.63; P.L.156-1995, SEC.7; P.L.115-1996, SEC.2; P.L.24-1997,
SEC.52; P.L.126-1998, SEC.11; P.L.113-2000, SEC.11;
P.L.66-2002, SEC.9.
IC 12-15-19-2
Repealed
(Repealed by P.L.126-1998, SEC.21.)
IC 12-15-19-2.1
Disproportionate share payment methodology for state fiscal years
ending on or after June 30, 2000; limits on total disproportionate
share payments to hospitals
Sec. 2.1. (a) This section does not apply during the period that the
office is assessing a hospital fee authorized by IC 16-21-10. For each
state fiscal year ending on or after June 30, 2000, the office shall
develop a disproportionate share payment methodology that ensures
that each hospital qualifying for disproportionate share payments
under IC 12-15-16-1(a) timely receives total disproportionate share
payments that do not exceed the hospital's hospital specific limit
provided under 42 U.S.C. 1396r-4(g). The payment methodology as
developed by the office must:
(1) maximize disproportionate share hospital payments to
qualifying hospitals to the extent practicable;
(2) take into account the situation of those qualifying hospitals
that have historically qualified for Medicaid disproportionate
share payments; and
(3) ensure that payments for qualifying hospitals are equitable.
(b) Total disproportionate share payments to a hospital under this
chapter shall not exceed the hospital specific limit provided under 42
U.S.C. 1396r-4(g). The hospital specific limit for a state fiscal year
shall be determined by the office taking into account data provided
by each hospital that is considered reliable by the office based on a
system of periodic audits, the use of trending factors, and an
appropriate base year determined by the office. The office may
require independent certification of data provided by a hospital to
determine the hospital's hospital specific limit.
(c) The office shall include a provision in each amendment to the
state plan regarding Medicaid disproportionate share payments that
the office submits to the federal Centers for Medicare and Medicaid
Services that, as provided in 42 CFR 447.297(d)(3), allows the state
to make additional disproportionate share expenditures after the end
of each federal fiscal year that relate back to a prior federal fiscal
year. However, the total disproportionate share payments to:
(1) each individual hospital; and
(2) all qualifying hospitals in the aggregate;
may not exceed the limits provided by federal law and regulation.
As added by P.L.113-2000, SEC.12. Amended by P.L.283-2001,
SEC.24; P.L.66-2002, SEC.10; P.L.212-2007, SEC.8; P.L.218-2007,
SEC.18; P.L.229-2011, SEC.136; P.L.205-2013, SEC.199.
IC 12-15-19-3
Repealed
(Repealed by P.L.27-1992, SEC.30.)
IC 12-15-19-4
Repealed
(Repealed by P.L.156-1995, SEC.9.)
IC 12-15-19-5
Federal financial participation unavailable; withholding
disproportionate share payment adjustments
Sec. 5. Except as provided in section 6 of this chapter,
disproportionate share payment adjustments under this chapter may
not be withheld by the office unless federal financial participation
becomes unavailable to match state money for the purpose of
providing disproportionate share payment adjustments.
As added by P.L.2-1992, SEC.9. Amended by P.L.27-1992, SEC.21;
P.L.113-2000, SEC.13.
IC 12-15-19-6
Deposits in fund; insufficiency; suspension or reduction of
payments to eligible institutions
Sec. 6. (a) This section does not apply during the period that the
office is assessing a hospital fee authorized by IC 16-21-10. The
office is not required to make disproportionate share payments under
this chapter from the Medicaid indigent care trust fund established
by IC 12-15-20-1 until the fund has received sufficient deposits,
including intergovernmental transfers of funds and certifications of
expenditures, to permit the office to make the state's share of the
required disproportionate share payments.
(b) For state fiscal years beginning after June 30, 2006, if:
(1) sufficient deposits have not been received; or
(2) the statewide Medicaid disproportionate share allocation is
insufficient to provide federal financial participation for the
entirety of all eligible disproportionate share hospitals'
hospital-specific limits;
the office shall reduce disproportionate share payments made under
IC 12-15-19-2.1 and Medicaid safety-net payments made in
accordance with the Medicaid state plan to eligible institutions using
an equitable methodology consistent with subsection (c).
(c) For state fiscal years beginning after June 30, 2006, payments
reduced under this section shall, in accordance with the Medicaid
state plan, be made:
(1) to best utilize federal matching funds available for hospitals
eligible for Medicaid disproportionate share payments under
IC 12-15-19-2.1; and
(2) by utilizing a methodology that allocates available funding
under this subdivision, and Medicaid supplemental payments as
defined in IC 12-15-15-1.5, in a manner that all hospitals
eligible for Medicaid disproportionate share payments under
IC 12-15-19-2.1 receive payments using a methodology that:
(A) takes into account the situation of the eligible hospitals
that have historically qualified for Medicaid disproportionate
share payments; and
(B) ensures that payments for eligible hospitals are
equitable.
(d) The percentage reduction shall be sufficient to ensure that
payments do not exceed the statewide Medicaid disproportionate
share allocation or the amounts that can be financed with:
(1) the amount transferred from the hospital care for the
indigent trust fund;
(2) other intergovernmental transfers;
(3) certifications of public expenditures; or
(4) any other permissible sources of non-federal match.
As added by P.L.2-1992, SEC.9. Amended by P.L.27-1992, SEC.22;
P.L.113-2000, SEC.14; P.L.212-2007, SEC.9; P.L.218-2007,
SEC.19; P.L.229-2011, SEC.137; P.L.205-2013, SEC.200.
IC 12-15-19-7
Repealed
(Repealed by P.L.27-1992, SEC.30.)
IC 12-15-19-8
Disproportionate share adjustments received by municipal
disproportionate share providers; limits on total disproportionate
share payments
Sec. 8. (a) This section does not apply during the period that the
office is assessing a hospital fee authorized by IC 16-21-10. A
provider that qualifies as a municipal disproportionate share provider
under IC 12-15-16-1 shall receive a disproportionate share
adjustment, subject to the provider's hospital specific limits described
in subsection (b), as follows:
(1) For each state fiscal year ending on or after June 30, 1998,
an amount shall be distributed to each provider qualifying as a
municipal disproportionate share provider under IC 12-15-16-1.
The total amount distributed shall not exceed the sum of all
hospital specific limits for all qualifying providers.
(2) For each municipal disproportionate share provider
qualifying under IC 12-15-16-1 to receive disproportionate
share payments, the amount in subdivision (1) shall be reduced
by the amount of disproportionate share payments received by
the provider under IC 12-15-16-6 or sections 1 or 2.1 of this
chapter. The office shall develop a disproportionate share
provider payment methodology that ensures that each municipal
disproportionate share provider receives disproportionate share
payments that do not exceed the provider's hospital specific
limit specified in subsection (b). The methodology developed
by the office shall ensure that a municipal disproportionate
share provider receives, to the extent possible, disproportionate
share payments that, when combined with any other
disproportionate share payments owed to the provider, equals
the provider's hospital specific limits.
(b) Total disproportionate share payments to a provider under this
chapter and IC 12-15-16 shall not exceed the hospital specific limit
provided under 42 U.S.C. 1396r-4(g). The hospital specific limit for
state fiscal years ending on or before June 30, 1999, shall be
determined by the office taking into account data provided by each
hospital for the hospital's most recent fiscal year or, if a change in
fiscal year causes the most recent fiscal period to be less than twelve
(12) months, twelve (12) months of data compiled to the end of the
provider's fiscal year that ends within the most recent state fiscal
year, as certified to the office by an independent certified public
accounting firm. The hospital specific limit for all state fiscal years
ending on or after June 30, 2000, shall be determined by the office
taking into account data provided by each hospital that is deemed
reliable by the office based on a system of periodic audits, the use of
trending factors, and an appropriate base year determined by the
office. The office may require independent certification of data
provided by a hospital to determine the hospital's hospital specific
limit.
(c) For each of the state fiscal years:
(1) beginning July 1, 1998, and ending June 30, 1999; and
(2) beginning July 1, 1999, and ending June 30, 2000;
the total municipal disproportionate share payments available under
this section to qualifying municipal disproportionate share providers
is twenty-two million dollars ($22,000,000).
As added by P.L.126-1998, SEC.12. Amended by P.L.113-2000,
SEC.15; P.L.229-2011, SEC.138; P.L.205-2013, SEC.201.
IC 12-15-19-9
Repealed
(Repealed by P.L.2-2005, SEC.131.)
IC 12-15-19-10
Priorities of payments
Sec. 10. This section does not apply during the period that the
office is assessing a hospital fee authorized by IC 16-21-10. For state
fiscal years beginning after June 30, 2000, the state shall pay
providers as follows:
(1) The state shall make municipal disproportionate share
provider payments to providers qualifying under
IC 12-15-16-1(b) until the state exceeds the state
disproportionate share allocation (as defined in 42 U.S.C.
1396r-4(f)(2)).
(2) After the state makes all payments under subdivision (1), if
the state fails to exceed the state disproportionate share
allocation (as defined in 42 U.S.C. 1396r-4(f)(2)), the state shall
make disproportionate share provider payments to providers
qualifying under IC 12-15-16-1(a).
(3) After the state makes all payments under subdivision (2), if
the state fails to exceed the state disproportionate share
allocation (as defined in 42 U.S.C. 1396r-4(f)(2)), or the state
limit on disproportionate share expenditures for institutions for
mental diseases (as defined in 42 U.S.C. 1396r-4(h)), the state
shall make community mental health center disproportionate
share provider payments to providers qualifying under
IC 12-15-16-1(c).
As added by P.L.126-1998, SEC.14. Amended by P.L.113-2000,
SEC.17; P.L.283-2001, SEC.25; P.L.2-2005, SEC.49; P.L.229-2011,
SEC.139; P.L.205-2013, SEC.202.
IC 12-15-19-10.1
Repealed
(Repealed by P.L.283-2001, SEC.39.)
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