2014 Kentucky Revised Statutes CHAPTER 205 - PUBLIC ASSISTANCE AND MEDICAL ASSISTANCE 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 -Duties of hospitals receiving funds from MART.
(1)
(2)
(3)
The commissioner of Medicaid services shall adopt a disproportionate share
program consistent with the requirements of Title XIX of the Social Security Act
which shall include to the extent possible, but not limited to, the provisions of
this section.
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 142.363 shall be deposited in the State Treasury and transferred on
a quarterly basis to the Department for Medicaid Services for use as specified
in this section. All investment earnings of the fund shall be credited to the fund.
Provider tax revenues collected in accordance with KRS 142.301 to 142.363
may be used to fund the provisions of KRS 216.2920 to 216.2929 and to
supplement the medical assistance-related general fund appropriations for
fiscal year 1994 and subsequent fiscal years. Notwithstanding the provisions of
KRS 48.500 and 48.600, the MART fund shall be exempt from any state
budget reduction acts.
(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 fund the disproportionate share program established by
administrative regulations promulgated by the Cabinet for Health and
Family Services. Disproportionate share funds shall be divided into three
(3) pools for distribution as follows:
1.
Forty-three and ninety-two hundredths percent (43.92%) of the total
disproportionate share funds shall be allocated to acute care
hospitals;
2.
Thirty-seven percent (37%) of the total disproportionate share funds
shall be allocated to university hospitals;
3.
The percentage allowable by federal law pursuant to 42 U.S.C. sec.
1396r-4(h), up to nineteen and eight hundredths percent (19.08%) of
the total disproportionate share funds shall be allocated to private
psychiatric hospitals and state mental hospitals, with the allocation
to each respective group of hospitals established by the biennial
budget;
4.
If there are any remaining disproportionate share funds from private
psychiatric hospitals and state mental hospitals, fifty-four percent
(54%) of those funds shall be distributed to the acute care hospitals
and forty-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 matching funds necessary to secure federal financial
participation for the funds allocated to university hospitals under this
subsection, the portion of the funding allocation applicable to the
hospital or hospitals that fail to provide state matching funds shall be
made available to acute care hospitals.
(b)
(c)
(d)
The MART fund shall be used to compensate acute care hospitals,
private psychiatric hospitals, state mental hospitals, and university
hospitals participating in the disproportionate share program for
uncompensated service provided by the hospitals to individuals and
families with total annual incomes and resources up to one hundred
percent (100%) of the federal poverty level, as determined by the hospital
pursuant to administrative regulations promulgated by the Cabinet for
Health and Family Services in accordance with this section.
An individual hospital shall receive distributions for indigent care provided
by that hospital if the hospital meets the requirements of the
disproportionate share program.
Distributions to acute care and private psychiatric hospitals shall be made
as follows:
1.
The department shall calculate an indigent care factor for each
hospital annually. The indigent care factor shall be determined by
calculating the percentage of each hospital's annual indigent care
costs toward the sum of the total annual indigent care costs for all
hospitals within each respective pool. For purposes of this
paragraph, "indigent care costs" means the hospital's inpatient and
outpatient care as reported to the department multiplied by the
hospital's Medicaid rate, or at a rate determined by the department
in administrative regulation that, when multiplied by the hospital's
reported indigent care, is equivalent to the amount that would be
payable by the department under the fee-for-service Medicaid
program for the hospital's total reported indigent care.
2.
Each hospital's annual distribution shall be calculated by multiplying
the hospital's indigent care factor by the total fund allocated to all
hospitals within the respective pool under paragraph (a) of this
subsection.
a.
Hospitals shall report uncompensated care provided to
qualified individuals and families with total annual incomes and
resources up to one hundred percent (100%) of the federal
poverty level, including care rendered to indigent persons age
twenty-two (22) to sixty-four (64) in a psychiatric hospital to the
Cabinet for Health and Family Services on a quarterly basis.
However, all data for care provided during the state fiscal year
shall be submitted no later than August 15 of each year.
b.
For state fiscal year 2001-2002 and each year thereafter, the
department shall use data reported by the hospitals for indigent
care services rendered for the twelve (12) month period ending
June 30 of each year as reported by the hospital to the
department by August 15 in calculating each hospital's indigent
care factor. The hospital shall, upon request by the Cabinet for
Health and Family Services, submit any supporting
documentation to verify the indigent care data submitted for the
calculation of an indigent care factor and annual payment.
c.
By September 1 of each year, the department shall calculate a
(4)
(5)
(6)
preliminary indigent care factor and preliminary annual
payment amount for each hospital, and shall notify each
hospital of their calculation. The notice shall contain a listing of
each hospital's indigent care costs, their indigent care factor,
and the estimated annual payment amount. Hospitals shall
notify the department by September 15 of any adjustments in
the department's preliminary calculations. The department
shall make adjustments identified by hospitals and shall make
a final determination of each hospital's indigent care factor and
annual payment amount by October 1. The department shall
make a final determination of each hospital's annual payment
amount upon notification through the Federal Register of the
annual federal disproportionate share hospital 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 available through notification by publication of
the Federal Register, for the disproportionate share funds available
during the corresponding federal fiscal year. The department may
pay a portion of the expected annual payment prior to the
publication of the annual federal allotment.
Notwithstanding any other provision to contrary, total annual disproportionate
share payments made to state mental hospitals, university hospitals, acute
care hospitals, and private psychiatric hospitals in each state fiscal year shall
be equal to the maximum amount of disproportionate share payments
established under the Federal Balanced Budget Act of 1997 and any
amendments thereto. Disproportionate share payments shall be subject to the
availability of adequate state matching funds and shall not exceed total
uncompensated costs.
Hospitals receiving reimbursement shall not bill patients for services submitted
for reimbursement under this section and KRS 205.641. Services provided to
individuals who are eligible for medical assistance or the Kentucky Children's
Health Insurance Program do not qualify for reimbursement under this section
and KRS 205.641. Hospitals shall make a reasonable determination that an
individual does not qualify for these programs and shall request the individual
to apply, if appropriate, for medical assistance or Kentucky Children's Health
Insurance on forms supplied by and in accordance with procedures established
by the Department for Medicaid Services. The hospital shall document any
refusal to apply and shall inform the patient that the refusal may result in the
patient being billed for any services performed. The hospital shall not be
eligible for reimbursement if the patient was eligible for medical assistance or
Kentucky Children's Health Insurance and did not apply. Hospitals receiving
reimbursement under this section and KRS 205.641 shall not bill patients for
services provided to patients not eligible for medical assistance with family
incomes up to one hundred percent (100%) of the federal poverty level.
The secretary of the Cabinet for Health and Family Services shall promulgate
administrative regulations, pursuant to KRS Chapter 13A, for the administration
and implementation of this section.
(7)
(8)
All hospitals receiving reimbursement under this section and KRS 205.641
shall display prominently a sign which reads as follows: "This hospital will
accept patients regardless of race, creed, ethnic background, or ability to pay."
The hospital shall, upon request by the Cabinet for Health and Family
Services, submit any supporting documentation to substantiate compliance
with the audit requirements established by 42 C.F.R. sec. 455.
Effective:July 15, 2010
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, effective June 20, 2005. -- Amended 2001 Ky. Acts ch. 164, sec. 9,
effective June 21, 2001. -- Amended 2000 Ky. Acts ch. 310, sec. 2, effective
April 4, 2000. -- Amended 1998 Ky. Acts ch. 82, sec. 21, effective July 15, 1998;
ch. 426, sec. 217, effective July 15, 1998; and ch. 545, sec. 1, effective July 15,
1998. -- Amended 1994 Ky. Acts ch. 512, sec. 85, effective July 15, 1994.
Created 1993 (2d Extra. Sess.) Ky. Acts ch. 2, sec. 20, effective June 8, 1993.
Legislative Research Commission Note (7/1/2006). The amendments to this
statute made in 2005 Ky. Acts ch. 107, sec. 1, have not taken effect. Section 2
of 2005 Ky. Acts ch. 107 states: "This Act shall become effective upon
certification to the Reviser of Statutes from the secretary of the Cabinet for
Health Services that necessary federal approval of the proposed distribution of
disproportionate share funds outlined in subsection (3) of Section 1 has been
obtained. This Act shall not become effective if certification is not received prior
to July 1, 2006." The Reviser of Statutes did not receive certification by that
date.
Legislative Research Commission Note (7/15/98). This section was amended by
1998 Ky. Acts chs. 82, 426, and 545. Where these Acts are not in conflict, they
have been codified together. Where a conflict exists between ch. 426 and
ch. 545, Acts ch. 545, which was a nonrevisory Act, prevails under KRS
7.136(3).
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