Ind. Code ch. 12-15-16

Ind. Code ch. 12-15-16
in effect

Ind. Code § 12-15-16-1 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 IC 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: (1) that is identified in IC 12-29-2-1; (2) for which a county provides funds under: (A) IC 12-29-1-7(b) before January 1, 2004; or (B) IC 12-29-2 after December 31, 2018; or from other county sources; and (3) that 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. (f) Except as provided in section 7.3 of this chapter, no payments shall be made to disproportionate share hospitals for any state fiscal year for which the state directed payment program under IC 16-21-10-8.5 is in effect. [Pre-1992 Revision Citation: 12-1-7-60(a).] As added by P.L.2-1992, SEC.9. Amended by P.L.27-1992, SEC.12; 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; P.L.123-2008, SEC.1; P.L.76-2018, SEC.2; P.L.216-2025, SEC.3.

Ind. Code § 12-15-16-2 Inpatient utilization rate

Sec. 2. (a) For purposes of disproportionate share eligibility, a provider's Medicaid inpatient utilization rate is a fraction (expressed as a percentage) where: (1) the numerator is the provider's total number of Medicaid inpatient days in the most recent year for which an audited cost report is on file with the office; and (2) the denominator is the total number of the provider's inpatient days in the most recent year for which an audited cost report is on file with the office. (b) For purposes of this section, "Medicaid inpatient days" includes all acute care days attributable to individuals eligible for Medicaid benefits under a state plan approved under 42 U.S.C. 1396a on the days of service: (1) whether attributable to individuals eligible for Medicaid in Indiana or any other state; (2) even if the office did not make payment for any services, including inpatient days that are determined to be medically necessary but for which payment is denied by the office for other reasons; and (3) including days attributable to Medicaid beneficiaries receiving services through a managed care organization or health maintenance organization. [Pre-1992 Revision Citation: 12-1-7-60(b).] As added by P.L.2-1992, SEC.9. Amended by P.L.277-1993(ss), SEC.72; P.L.156-1995, SEC.2; P.L.126-1998, SEC.7; P.L.113-2000, SEC.6; P.L.283-2001, SEC.22; P.L.153-2011, SEC.18.

Ind. Code § 12-15-16-3 Low income utilization rate; contractual allowances and discounts

Sec. 3. (a) For purposes of disproportionate share eligibility, a provider's low income utilization rate is the sum of the following, based on the most recent year for which an audited cost report is on file with the office: (1) A fraction (expressed as a percentage) for which: (A) the numerator is the sum of: (i) the total Medicaid patient revenues paid to the provider; plus (ii) the amount of the cash subsidies received directly from state and local governments, including payments made under the hospital care for the indigent program (IC 12-16-2) (before its repeal) and IC 12-16-2.5; and (B) the denominator is the total amount of the provider's patient revenues paid to the provider, including cash subsidies; and (2) A fraction (expressed as a percentage) for which: (A) the numerator is the total amount of the provider's charges for inpatient services that are attributable to care provided to individuals who have no source of payment; and (B) the denominator is the total amount of charges for inpatient services. (b) The numerator in subsection (a)(1)(A) does not include contractual allowances and discounts other than for indigent patients not eligible for Medicaid. [Pre-1992 Revision Citation: 12-1-7-60(c).] As added by P.L.2-1992, SEC.9. Amended by P.L.277-1993(ss), SEC.73; P.L.113-2000, SEC.7; P.L.283-2001, SEC.23; P.L.120-2002, SEC.16.

Ind. Code § 12-15-16-4 Repealed

[Pre-1992 Revision Citation: 12-1-7-60(d).] As added by P.L.2-1992, SEC.9. Repealed by P.L.156-1995, SEC.9.

Ind. Code § 12-15-16-5 Implementation; federal approval; termination of implementation

Sec. 5. (a) The office may not implement this chapter, IC 12-15-17, IC 12-15-18, IC 12-15-19, or IC 12-15-20 until the federal Centers for Medicare and Medicaid Services has issued its approval of the amended state plan for medical assistance. (b) The office may determine not to continue to implement this chapter, IC 12-15-17, IC 12-15-18, IC 12-15-19, and IC 12-15-20 if federal financial participation is not available. [Pre-1992 Revision Citation: P.L.112-1991, SEC.7(b), (c), (d).] As added by P.L.2-1992, SEC.9. Amended by P.L.277-1993(ss), SEC.74; P.L.156-1995, SEC.3; P.L.126-1998, SEC.8; P.L.66-2002, SEC.7; P.L.216-2025, SEC.4.

Ind. Code § 12-15-16-6 Basic disproportionate payments to hospitals; amount

Sec. 6. (a) As used in this section, "low income utilization rate" refers to the low income utilization rate described in section 3 of this chapter. (b) Hospitals that qualify for basic disproportionate share under section 1(a) of this chapter shall receive disproportionate share payments as follows: (1) For the state fiscal year ending June 30, 1999, a pool not exceeding twenty-one million dollars ($21,000,000) shall be distributed to all hospitals licensed under IC 16-21 that qualify under section 1(a)(1) of this chapter. The funds in the pool must be distributed to qualifying hospitals in proportion to each hospital's Medicaid day utilization rate and Medicaid discharges, as determined based on data from the most recent audited cost report on file with the office. Any funds remaining in the pool referred to in this subdivision following distribution to all qualifying hospitals shall be transferred to the pool distributed under subdivision (3). (2) Hospitals licensed under IC 16-21 that qualify under both section 1(a)(1) and 1(a)(2) of this chapter shall receive a disproportionate share payment in accordance with subdivision (1). (3) For the state fiscal year ending June 30, 1999, a pool not exceeding five million dollars ($5,000,000), subject to adjustment by the transfer of any funds remaining in the pool referred to in subdivision (1), following distribution to all qualifying hospitals, shall be distributed to all hospitals licensed under IC 16-21 that: (A) qualify under section 1(a)(1) or 1(a)(2) of this chapter; and (B) have at least twenty-five thousand (25,000) Medicaid inpatient days per year, based on data from each hospital's Medicaid cost report for the fiscal year ended during state fiscal year 1996. The funds in the pool must be distributed to qualifying hospitals in proportion to each hospital's Medicaid day utilization rate and total Medicaid patient days, as determined based on data from the most recent audited cost report on file with the office. Payments under this subdivision are in place of the payments made under subdivisions (1) and (2). (c) This subsection does not apply during the period that the office is assessing a hospital fee authorized by IC 16-21-10. Other institutions that qualify as disproportionate share providers under section 1 of this chapter, in each state fiscal year, shall receive disproportionate share payments as follows: (1) For each of the state fiscal years ending after June 30, 1995, a pool not exceeding two million dollars ($2,000,000) shall be distributed to all private psychiatric institutions licensed under IC 12-25 that qualify under section 1(a)(1) or 1(a)(2) of this chapter. The funds in the pool must be distributed to the qualifying institutions in proportion to each institution's Medicaid day utilization rate as determined based on data from the most recent audited cost report on file with the office. (2) A pool not exceeding one hundred ninety-one million dollars ($191,000,000) for all state fiscal years ending after June 30, 1995, shall be distributed to all state mental health institutions under IC 12-24-1-3 that qualify under either section 1(a)(1) or 1(a)(2) of this chapter. The funds in the pool must be distributed to each qualifying institution in proportion to each institution's low income utilization rate, as determined based on the most recent data on file with the office. (d) This subsection does not apply during the period that the office is assessing a hospital fee authorized by IC 16-21-10. Disproportionate share payments described in this section shall be made on an interim basis throughout the year, as provided by the office. As added by P.L.277-1993(ss), SEC.75. Amended by P.L.156-1995, SEC.4; P.L.24-1997, SEC.49; P.L.126-1998, SEC.9; P.L.113-2000, SEC.8; P.L.229-2011, SEC.134; P.L.205-2013, SEC.196.

Ind. Code § 12-15-16-7 Disproportionate share payments when hospital assessment fees are authorized; not applicable when state directed payment program in effect

Sec. 7. (a) Except as provided in subsection (j) and section 7.7 of this chapter, this section applies to Medicaid disproportionate share payments for the state fiscal year beginning: (1) July 1, 2012, if hospital fees authorized under P.L.229-2011, SECTION 281 or authorized to be transferred and used for payments are used as state share dollars for the payments; and (2) July 1, 2013, and for each state fiscal year after, for which hospital fees authorized under IC 16-21-10 are used as state share dollars for the payments. (b) As used in this section, "hospital specific limit" refers to the hospital specific limit provided under 42 U.S.C. 1396r-4(g). (c) As used in this section, "municipal hospital payment amount" means, concerning a hospital established and operated under IC 16-22-2 or IC 16-23, an amount equal to the lesser of: (1) the hospital specific limit for the hospital for the state fiscal year; or (2) the hospital's net 2009 supplemental payment amount. (d) As used in this section, "nongovernmental hospital" refers to a hospital that is licensed under IC 16-21-2, that is not a unit of state or local government, and is not owned or operated by a unit of state or local government. (e) Subject to subsection (j), the following providers are eligible for Medicaid disproportionate share payments under this section: (1) A hospital or psychiatric institution described in Attachment 4.19-A, Section III, page 6.1(a) of the Medicaid state plan in effect July 1, 2011. (2) A hospital that satisfies the following for the state fiscal year for which Medicaid disproportionate share payments are made under this section: (A) A nongovernmental hospital that: (i) has a Medicaid inpatient utilization rate for the state fiscal year that is at least equal to the mean Medicaid inpatient utilization rate as calculated for purposes of determining Medicaid disproportionate share eligibility, but does not equal or exceed one (1) standard deviation above the mean Medicaid inpatient utilization rate; and (ii) satisfies the obstetric service provisions of 42 U.S.C. 1396r-4(d). (B) A hospital established and operated under IC 16-22-2 or IC 16-23 that: (i) has a Medicaid inpatient utilization rate for the state fiscal year greater than one percent (1%); and (ii) satisfies the obstetric service provisions of 42 U.S.C. 1396r-4(d). (3) A nongovernmental hospital that satisfies the following for the state fiscal year for which Medicaid disproportionate share payments are made under this section: (A) The hospital has a Medicaid inpatient utilization rate for the state fiscal year that is less than the mean Medicaid inpatient utilization rate, as calculated for purposes of determining Medicaid disproportionate share eligibility, but is at least greater than one percent (1%). (B) The hospital satisfies the obstetric service provisions of 42 U.S.C. 1396r-4(d). (f) This subsection applies to a payment of Medicaid disproportionate share payments, if any, to hospitals described in subsection (e)(2) and (e)(3). For Medicaid disproportionate share payments for the state fiscal year beginning July 1, 2012, the office may develop and implement a Medicaid state plan amendment that provides Medicaid disproportionate share payments for the hospitals described in: (1) subsection (e)(2), as long as each hospital and psychiatric institution described in subsection (e)(1) has received a Medicaid disproportionate share payment for the state fiscal year in an amount equal to either: (A) the hospital specific limit; or (B) the municipal hospital payment amount; for the hospital or psychiatric institution for the state fiscal year; and (2) subsection (e)(3), as long as each hospital described in subsection (e)(2) has received a Medicaid disproportionate share payment for the state fiscal year in an amount equal to the hospital specific limit for the hospital for the state fiscal year. (g) This subsection applies to a payment of Medicaid disproportionate share payments, if any, to hospitals described in subsection (e)(2) and (e)(3). For Medicaid disproportionate share payments for the state fiscal year beginning July 1, 2013, and each state fiscal year thereafter under this section, the office may develop and implement a Medicaid state plan amendment that: (1) renews, for state fiscal year beginning July 1, 2013, and each state fiscal year thereafter under this section, the Medicaid disproportionate share provisions of Attachment 4.19-A, Section III, page 6.1(a) of the Medicaid state plan in effect on July 1, 2011; (2) provides Medicaid disproportionate share payments for the hospitals described in subsection (e)(2), as long as each hospital and psychiatric institution described in subsection (e)(1) has received a Medicaid disproportionate share payment for the state fiscal year in an amount equal to the: (A) hospital specific limit; or (B) municipal hospital payment amount; for the hospital or psychiatric institution for the state fiscal year; and (3) provides Medicaid disproportionate share payments for the hospitals described in subsection (e)(3), as long as each hospital described in subsection (e)(2) has received a Medicaid disproportionate share payment for the state fiscal year in an amount equal to the hospital specific limit of the hospital for the state fiscal year. (h) This subsection does not apply to Medicaid disproportionate share payments made to hospitals described in subsection (e)(2)(B) under Attachment 4.19-A, Section III, page 6.1(a) of the Medicaid state plan in effect on July 1, 2011, or any renewal. Nothing in this section: (1) requires that the hospitals described in subsection (e)(2) or (e)(3) receive Medicaid disproportionate share payments for a state fiscal year; (2) requires that the hospitals described in subsection (e)(2) or (e)(3) receive Medicaid disproportionate share payments for a state fiscal year in an amount equal to the respective hospital specific limits for the state fiscal year; or (3) prescribes how Medicaid disproportionate share payments are to be distributed among the hospitals described in: (A) subsection (e)(2); or (B) subsection (e)(3). (i) Nothing in this section prohibits the use of unexpended federal Medicaid disproportionate share allotments for a state fiscal year under a program, as long as each hospital listed in subsection (e)(1), (e)(2), and (e)(3) has received Medicaid disproportionate share payments for the state fiscal year equal to the hospital specific limit for the hospital for the state fiscal year. (j) This section does not apply for a state fiscal year for which the state directed payment program under IC 16-21-10-8.5 is in effect. As added by P.L.205-2013, SEC.197. Amended by P.L.2-2014, SEC.64; P.L.108-2019, SEC.195; P.L.216-2025, SEC.5.

Ind. Code § 12-15-16-7.3 Disproportionate share payments during state directed payment program in effect; state plan amendment for payments; state mental health institutions

Sec. 7.3. (a) This section applies to disproportionate share payments for any state fiscal year during which the state directed payment program under IC 16-21-10-8.5 is in effect. (b) The office may develop and implement a Medicaid state plan amendment that provides Medicaid disproportionate share payments for state mental health institutions under IC 12-24-1-3 that qualify as a disproportionate share provider under section 1(a) of this chapter. (c) The office shall develop and implement a Medicaid state plan amendment that provides Medicaid disproportionate share payments for hospitals pursuant to the following STEPS: STEP ONE: Each acute care hospital licensed under IC 16-21 that qualifies as a disproportionate share provider under section 1(a) of this chapter, including acute care hospitals licensed under IC 16-21 and established and operated under IC 16-22-2, IC 16-22-8, or IC 16-23 that qualify as a disproportionate share provider under section 1(a) of this chapter, shall be paid a disproportionate share payment for the state fiscal year in the amount of one thousand dollars ($1,000). STEP TWO: Of the state's disproportionate share payment allotment under 42 CFR 447.297 that remains for the state fiscal year following STEP ONE, and any applicable payments under subsection (b), disproportionate share payments shall be paid to municipal disproportionate share providers described in section 1(b) of this chapter, and to acute care hospitals licensed under IC 16-21 and established and operated under IC 16-22-8 that qualify as a disproportionate share provider under section 1(a) of this chapter, that fund the state's share of their disproportionate share payment for the state fiscal year through an intergovernmental transfer. Subject to subsection (d), each hospital's payment shall be an amount equal to its hospital specific limit for the state fiscal year calculated pursuant to 42 U.S.C. 1396r-4(g). (d) If the total disproportionate share payments under STEP TWO of subsection (c) for a state fiscal year would be greater than the state's disproportionate share payment allotment under 42 CFR 447.297 that remains following STEP ONE of subsection (c), and any applicable payments under subsection (b), the disproportionate share payments to each hospital eligible under STEP TWO shall be made on a pro rata basis, based on each hospital's hospital specific limit in relation to the remaining disproportionate share payment allotment. As added by P.L.216-2025, SEC.6.

Ind. Code § 12-15-16-7.7 Disproportionate share payment plan; requirements; state plan amendment for plan

Sec. 7.7. (a) As used in this section, "CMS" refers to the federal Centers for Medicare and Medicaid Services. (b) As used in this section, "disproportionate share payment plan" refers to a plan for distributing disproportionate share payments for the state fiscal year beginning July 1, 2020, for any state fiscal year beginning after July 1, 2020, and that meets the requirements set forth in this section. (c) As used in this section, "federal DSH allotment" refers to the allotment of federal disproportionate share funds calculated for the state under 42 U.S.C. 1396r-4. (d) As used in this section, "reduced federal DSH allotment" refers to a federal DSH allotment for the state for the federal fiscal year beginning October 1, 2020, that, by operation of 42 U.S.C. 1396r-4(f)(7), is less than the federal DSH allotment for the state for the federal fiscal year beginning October 1, 2018. (e) As used in this section, "terminating event" refers to federal legislation (including an amendment to 42 U.S.C. 1396r-4), a regulation or sub-regulatory policy or directive issued by CMS, or a judicial ruling, that is enacted or issued on or before March 30, 2021, that: (1) cancels, or postpones to a subsequent federal fiscal year, a reduced federal DSH allotment; and (2) does not cause the state to incur a reduced federal DSH allotment. (f) The office shall develop a disproportionate share payment plan. The following apply to the disproportionate share payment plan developed under this subsection: (1) The disproportionate share payment plan must: (A) specify the amount or amounts of disproportionate share payment adjustments to be paid to acute care hospitals licensed under IC 16-21-2 and private mental health institutions licensed under IC 12-25 for the state fiscal year beginning on or after July 1, 2020; or (B) specify the formula to be used by the office for purposes of determining the amount or amounts of disproportionate share payment adjustments to be paid to acute care hospitals licensed under IC 16-21-2 and private mental health institutions licensed under IC 12-25 for the state fiscal year beginning on or after July 1, 2020. (2) In developing the disproportionate share payment plan, the office is not required to: (A) follow paragraphs 1 through 7 of Subsection A of Section III of Attachment 4.19-A of the Indiana Medicaid state plan in effect on January 1, 2019; (B) provide for disproportionate share payment adjustments to be paid to acute care hospitals licensed under IC 16-21-2 or private mental health institutions licensed under IC 12-25 that, for purposes of the state fiscal year beginning on or after July 1, 2020, do not meet the definition of a "disproportionate share hospital" as set forth in Section II(E) of Attachment 4.19-A of the Indiana Medicaid state plan in effect on January 1, 2019; or (C) follow the provisions set forth in section 7.5 of this chapter. (3) In developing the disproportionate share payment plan, the office shall take into consideration the percentage of a hospital's patients whose health care coverage is provided by a governmental health care program. (g) After the office submits the state plan amendment described in section 7.5 of this chapter, but before October 1, 2020, the office shall file with CMS and, if approved by CMS, the office shall implement, a proposed Medicaid state plan amendment that is based upon the disproportionate share payment plan developed by the office, subject to the following: (1) The proposed Medicaid state plan amendment referred to in this subsection shall include language that, in the event a terminating event occurs after the Medicaid state plan amendment is approved by the CMS but before March 30, 2021, would operate to cause the state plan amendment to be immediately and automatically void and without effect, and to cause Subsection A of Section III of Attachment 4.19-A of the state's Medicaid state plan, in effect on January 1, 2019, to be immediately and automatically reinstated and effective. (2) Subdivision (1) does not prevent the office from submitting a subsequent Medicaid state plan amendment for approval by CMS after CMS's approval of the state plan amendment referenced in subdivision (1) and that applies to a state fiscal year beginning on or after July 1, 2021, and that amends or replaces the state plan amendment described in this subsection. As added by P.L.108-2019, SEC.197. Amended by P.L.156-2020, SEC.55; P.L.216-2025, SEC.7.
Source: Open US Law by Vaquill AI (CC BY 4.0)URL: https://iga.in.gov/laws/2026/ic/titles/12Fetched: 10/17/2026

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