205.640 Medical Assistance Revolving Trust Fund (MART) -- Distribution of disproportionate share funds -- Authority for administrative regulations -- Duties of hospitals receiving funds from MART. - Kentucky Statutes

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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) 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. (2) 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. (3) (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) 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. (c) An individual hospital shall receive distributions for indigent care provided by that hospital if the hospital meets the requirements of the disproportionate
share program. (d) 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
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. (4) 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. (5) 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. (6) 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) 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." (8) 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.