CHAPTER 7.5. HOSPITAL CARE FOR THE INDIGENT; COST OF CARE AND PAYMENT - Indiana Statutes

IC 12-16-7.5
     Chapter 7.5. Hospital Care for the Indigent; Cost of Care and Payment

IC 12-16-7.5-1
Repealed
    (Repealed by P.L.145-2005, SEC.31.)

IC 12-16-7.5-1.2
Eligible patient not financially obligated; payment
     Sec. 1.2. (a) A person determined to be eligible under the hospital care for the indigent program is not financially obligated for services provided to the person during the person's eligibility under the program, if the items or services were:
        (1) identified in a claim filed with the division under IC 12-16-4.5; and
        (2) determined:
            (A) to have been necessitated by one (1) or more of the medical conditions listed in IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3) or IC 12-16-3.5-2(a)(1) through IC 12-16-3.5-2(a)(3); or
            (B) to be a direct consequence of one (1) or more of the medical conditions listed in IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3).
    (b) Hospitals may receive a payment from the office calculated and made under IC 12-15-15-9 and, if applicable, IC 12-15-15-9.5. Hospitals shall not file claims for payments under IC 12-15-15-9 and IC 12-15-15-9.5 for payments attributable to state fiscal years beginning after June 30, 2007.
    (c) Based on a physician's services identified in a claim under subsection (a), the physician may receive a payment from the division calculated and made under section 5 of this chapter.
    (d) Based on the transportation services identified in a claim under subsection (a), the transportation provider may receive a payment from the division calculated and made under section 5 of this chapter.
As added by P.L.145-2005, SEC.23. Amended by P.L.212-2007, SEC.25; P.L.218-2007, SEC.36.

IC 12-16-7.5-2
Repealed
     (Repealed by P.L.255-2003, SEC.55.)

IC 12-16-7.5-2.5
Segregation of payable claims by fiscal year; division determination of amount of payment
     Sec. 2.5. (a) Payable claims shall be segregated by state fiscal year.
    (b) For purposes of this chapter, IC 12-15-15-9, IC 12-15-15-9.5, and IC 12-16-14, "payable claim" refers to the following:         (1) Subject to subdivision (2), a claim for payment for physician care, hospital care, or transportation services under this chapter:
            (A) that includes, on forms prescribed by the division, all the information required for timely payment;
            (B) that is for a period during which the person is determined to be financially and medically eligible for the hospital care for the indigent program; and
            (C) for which the payment amounts for the care and services are determined by the division.
        This subdivision applies for the state fiscal year ending June 30, 2004.
        (2) For state fiscal years ending after June 30, 2004, and before July 1, 2007, a claim for payment for physician care, hospital care, or transportation services under this chapter:
            (A) provided to a person under the hospital care for the indigent program under this article during the person's eligibility under the program;
            (B) identified in a claim filed with the division; and
            (C) determined to:
                (i) have been necessitated by one (1) or more of the medical conditions listed in IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3) or IC 12-16-3.5-2(a)(1) through IC 12-16-3.5-2(a)(3); or
                (ii) be a direct consequence of one (1) or more of the medical conditions listed in IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3).
        (3) For state fiscal years beginning after June 30, 2007, a claim for payment for physician care or transportation services under this chapter:
            (A) provided to a person under the hospital care for the indigent program under this article during the person's eligibility under the program;
            (B) identified in a claim filed with the division; and
            (C) determined to:
                (i) be necessary after the onset of a medical condition that was manifested by symptoms of sufficient severity that the absence of immediate medical attention would probably result in any of the outcomes described in IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3) or IC 12-16-3.5-2(a)(1) through IC 12-16-3.5-2(a)(3); or
                (ii) be a direct consequence of the onset of a medical condition that was manifested by symptoms of sufficient severity that the absence of immediate medical attention would probably result in any of the outcomes listed in IC 12-16-3.5-1(a)(1) through IC 12-16-3.5-1(a)(3).
    (c) For purposes of this chapter, IC 12-15-15-9, IC 12-15-15-9.5, and IC 12-16-14, "amount" when used in regard to a claim or payable claim means an amount calculated under STEP THREE of the following formula:
            STEP ONE: Identify the items and services identified in a

claim or payable claim.
            STEP TWO: Using the applicable Medicaid fee for service reimbursement rates, calculate the reimbursement amounts for each of the items and services identified in STEP ONE.
            STEP THREE: Calculate the sum of the amounts identified in STEP TWO.
    (d) For purposes of this chapter, IC 12-15-15-9, IC 12-15-15-9.5, and IC 12-16-14, a provider that submits a claim to the division is considered to have submitted the claim during the state fiscal year during which the amount of the claim was determined under IC 12-16-5.5-1.2(b) or, if successfully appealed by a provider, the state fiscal year in which the appeal was decided.
    (e) The division shall determine the amount of a claim under IC 12-16-5.5-1.2(b).
As added by P.L.255-2003, SEC.36. Amended by P.L.145-2005, SEC.24; P.L.1-2006, SEC.189; P.L.212-2007, SEC.26; P.L.218-2007, SEC.37.

IC 12-16-7.5-3
Warrant on fund; payment
     Sec. 3. (a) A payment made to a physician or a transportation provider under this chapter must be on a warrant drawn on the state hospital care for the indigent fund established by IC 12-16-14.
    (b) A payment made to a hospital under this chapter shall be made under IC 12-15-15-9 and IC 12-15-15-9.5.
As added by P.L.120-2002, SEC.23. Amended by P.L.255-2003, SEC.37.

IC 12-16-7.5-4
Repealed
     (Repealed by P.L.255-2003, SEC.55.)

IC 12-16-7.5-4.5
Calculation and allocation of funds available for payments from the state hospital care for the indigent fund
     Sec. 4.5. (a) Not later than October 31 following the end of each state fiscal year, the division shall:
        (1) calculate for each county the total amount of payable claims submitted to the division during the state fiscal year attributed to:
            (A) patients who were residents of the county; and
            (B) patients:
                (i) who were not residents of Indiana;
                (ii) whose state of residence could not be determined by the division; and
                (iii) who were residents of Indiana but whose county of residence in Indiana could not be determined by the division;
            and whose medical condition that necessitated the care or service occurred in the county;         (2) notify each county of the amount of payable claims attributed to the county under the calculation made under subdivision (1); and
        (3) with respect to payable claims attributed to a county under subdivision (1):
            (A) calculate the total amount of payable claims submitted during the state fiscal year for:
                (i) each hospital;
                (ii) each physician; and
                (iii) each transportation provider; and
            (B) determine the amount of each payable claim for each hospital, physician, and transportation provider listed in clause (A).
    (b) For the state fiscal years beginning after June 30, 2005, but before July 1, 2007, and before November 1 following the end of a state fiscal year, the division shall allocate the funds transferred from a county's hospital care for the indigent fund to the state hospital care for the indigent fund under IC 12-16-14 during or for the following state fiscal years:
        (1) For the state fiscal year ending June 30, 2006, as required under the following STEPS:
            STEP ONE: Determine the total amount of funds transferred from all counties' hospital care for the indigent funds by the counties to the state hospital care for the indigent fund under IC 12-16-14 during or for the state fiscal year.
            STEP TWO: Of the total amount of payable claims submitted to the division during the state fiscal year from all counties under subsection (a), determine the amount that is the lesser of:
                (A) the amount of total physician payable claims and total transportation provider payable claims; or
                (B) three million dollars ($3,000,000).
            The amount determined under this STEP shall be used by the division to make payments under section 5 of this chapter.
            STEP THREE: Transfer an amount equal to the sum of:
                (A) the non-federal share of the payments made under clause (A) of STEP FIVE of IC 12-15-15-1.5(b);
                (B) the amount transferred under IC 12-15-20-2(8)(F); and
                (C) the non-federal share of the payments made under IC 12-15-15-9 and IC 12-15-15-9.5;
            to the Medicaid indigent care trust fund for funding the transfer to the office and the non-federal share of the payments identified in this STEP.
            STEP FOUR: Transfer an amount equal to sixty-one million dollars ($61,000,000) less the sum of:
                (A) the amount determined in STEP TWO; and
                (B) the amount transferred under STEP THREE;
            to the Medicaid indigent care trust fund for funding the non-federal share of payments under clause (B) of STEP FIVE of IC 12-15-15-1.5(b).             STEP FIVE: Transfer to the Medicaid indigent care trust fund for the programs referenced at IC 12-15-20-2(8)(D)(vi) and funded in accordance with IC 12-15-20-2(8)(H) the amount determined under STEP ONE, less the sum of the amount:
                (A) determined in STEP TWO;
                (B) transferred in STEP THREE; and
                (C) transferred in STEP FOUR.
        (2) For the state fiscal year ending June 30, 2007, as required under the following steps:
            STEP ONE: Determine the total amount of funds transferred from all counties' hospital care for the indigent funds by the counties to the state hospital care for the indigent fund under IC 12-16-14 during or for the state fiscal year.
            STEP TWO: Of the total amount of payable claims submitted to the division during the state fiscal year from all counties under subsection (a), determine the amount that is the lesser of:
                (A) the amount of total physician payable claims and total transportation provider payable claims; or
                (B) three million dollars ($3,000,000).
            The amount determined under this STEP shall be used by the division for making payments under section 5 of this chapter or for the non-federal share of Medicaid payments for physicians and transportation providers, as determined by the office.
            STEP THREE: Transfer an amount equal to the sum of:
                (A) the non-federal share of five million dollars ($5,000,000) for the payment made under clause (A) of STEP FIVE of IC 12-15-15-1.5(b);
                (B) the amount transferred under IC 12-15-20-2(8)(F); and
                (C) the non-federal share of the payments made under IC 12-15-15-9 and IC 12-15-15-9.5;
            to the Medicaid indigent care trust fund for funding the transfer to the office and the non-federal share of the payments identified in this STEP.
            STEP FOUR: Transfer an amount equal to the amount determined under STEP ONE less the sum of:
                (A) the amount determined in STEP TWO; and
                (B) the amount transferred under STEP THREE;
            to the Medicaid indigent care trust fund for funding the non-federal share of payments under clause (B) of STEP FIVE of IC 12-15-15-1.5(b).
    (c) For the state fiscal years beginning after June 30, 2007, before November 1 following the end of the state fiscal year, the division shall allocate the funds transferred to the state hospital care for the indigent fund for the state fiscal year as required under the following STEPS:
        STEP ONE: Determine the total amount of funds transferred to the state hospital care for the indigent fund for the state fiscal

year.
        STEP TWO: Determine the amount specified in STEP THREE.
        STEP THREE: The amount to be used under STEP TWO is three million dollars ($3,000,000).
        STEP FOUR: Transfer to the Medicaid indigent care trust fund for purposes of IC 12-15-20-2(8)(G) an amount equal to the amount calculated under STEP ONE, minus an amount equal to the amount specified under STEP THREE.
        STEP FIVE: The division shall retain an amount equal to the amount remaining in the state hospital care for the indigent fund after the transfer in STEP FOUR for purposes of making payments under section 5 of this chapter or for the non-federal share of Medicaid payments for physicians and transportation providers, as determined by the office.
    (d) The costs of administering the hospital care for the indigent program, including the processing of claims, shall be paid from the funds transferred to the state hospital care for the indigent fund.
As added by P.L.255-2003, SEC.38. Amended by P.L.212-2007, SEC.27; P.L.218-2007, SEC.38; P.L.146-2008, SEC.388.

IC 12-16-7.5-5
Pro rata payments to physicians and transportation providers; limitation
     Sec. 5. Before December 15 following the end of each state fiscal year, the division shall, from the amounts combined from the counties' hospital care for the indigent funds and retained under section 4.5(b) or 4.5(c) of this chapter, pay each physician and transportation provider a pro rata part of that amount. The total payments available under this section may not exceed three million dollars ($3,000,000).
As added by P.L.120-2002, SEC.23. Amended by P.L.255-2003, SEC.39; P.L.212-2007, SEC.28; P.L.218-2007, SEC.39.

IC 12-16-7.5-6
Repealed
     (Repealed by P.L.255-2003, SEC.55.)

IC 12-16-7.5-7
Responsibility for the payment of hospital care; limitations
     Sec. 7. The division is not responsible under the hospital care for the indigent program for the payment of any part of the costs of providing care in a hospital to an individual who is not either of the following:
        (1) A citizen of the United States.
        (2) A lawfully admitted alien.
As added by P.L.120-2002, SEC.23. Amended by P.L.255-2003, SEC.40.

IC 12-16-7.5-8
No liability for cost of care provided to patient described in

specified rules
     Sec. 8. The division is not liable for any part of the cost of care provided to an individual who has been determined to be a patient described in the rules adopted under IC 12-16-10.5.
As added by P.L.120-2002, SEC.23. Amended by P.L.255-2003, SEC.41.

IC 12-16-7.5-9
Repealed
     (Repealed by P.L.146-2008, SEC.819.)

IC 12-16-7.5-10
Repealed
     (Repealed by P.L.146-2008, SEC.819.)

IC 12-16-7.5-11
Repealed
     (Repealed by P.L.255-2003, SEC.55.)

IC 12-16-7.5-12
Agreement to accept payment as payment in full
     Sec. 12. All providers receiving payment under section 1.2 of this chapter agree to accept, as payment in full, the payment referred to in section 1.2 of this chapter for the health care items or services identified in payable claims submitted to the division.
As added by P.L.120-2002, SEC.23. Amended by P.L.145-2005, SEC.25.

IC 12-16-7.5-13
Repealed
     (Repealed by P.L.255-2003, SEC.55.)