Authority: IC 12-15-21-2; IC 12-15-21-3; IC
16-21-10-16
Affected: IC 4-21.5-3; IC 12-15-15-1; IC 12-15-21-3; IC
12-25; IC 16-18-2-179; IC 16-21-2; IC 16-21-10
Sec. 5.
(a)
Effective through June 30, 2019, the office shall collect an outpatient
hospital assessment fee (HAF) from each outpatient hospital that:
(1) meets the definition set forth in IC
16-18-2-179(b); and
(2) is licensed
under either:
(A) IC 16-21-2 as an acute care
hospital; or
(B) IC 12-25 as a
private psychiatric hospital.
(b) The outpatient hospital assessment fee
applies to equivalent outpatient days. Equivalent outpatient days are derived
by dividing each hospital's outpatient revenue by its inpatient revenue per
day. Each hospital's equivalent outpatient days will be reduced to account for
services provided to patients residing outside of Indiana. Cost report data
shall be obtained from each eligible hospital's most recent cost report on file
with the office, as of the last day of February preceding the HAF period,
defined in subsection (c). Cost report data will be adjusted to account for
fiscal years other than twelve (12) months and to exclude hospitals that have
closed. Hospitals that are newly licensed in the HAF period that do not have a
cost report on file with the office as of the last day of February preceding
the HAF period defined in subsection (c) will be excluded from the assessment
fee. For hospitals that are not certified for participation in the Medicaid
program under Title XIX of the federal Social Security Act (
42 U.S.C.
1396 et seq.) and that do not have a cost
report on file, information for computing the assessment fee will be obtained
from the hospital by the office or its designee.
(c) The HAF period is defined as separate two
(2) year periods during the fee period, defined at IC 16-21-10-3.
(d) The following hospitals are excluded from
the assessment fee:
(1) Long term care
hospitals.
(2) State-owned
hospitals.
(3) Hospitals operated
by the federal government.
(4)
Freestanding rehabilitation hospitals.
(5) Freestanding psychiatric hospitals with:
(A) greater than forty percent (40%) of
admissions having a primary diagnosis of chemical dependency; or
(B) greater than ninety percent (90%) of
admissions comprised of individuals at least fifty-five (55) years of age
having a primary diagnosis of Alzheimer's disease, early onset Alzheimer's
disease, dementia, mood disorders, anxiety, psychotic disorders, other
behavioral health illnesses or disorders, or neurologic disorders related to
trauma or aging.
A freestanding psychiatric hospital that was certified as
part of a community mental health center at any time during the HAF period is
subject to the assessment fee.
(6) Out-of-state hospitals.
(e) The assessment fee rate for
the following hospitals shall be reduced by the following percentages:
(1) Seventy-five percent (75%) of the full
rate for:
(A) hospitals qualifying for
disproportionate share hospital (DSH) payments during each HAF period through
meeting Medicaid inpatient utilization rate (MIUR) criteria; or
(B) acute care hospitals that:
(i) qualify for DSH payments during each HAF
period through meeting low income utilization rate (LIUR) criteria; and
(ii) did not have LIUR status in
2010.
(2)
Fifty percent (50%) of the full rate for acute hospitals that:
(A) qualify for DSH payments during each HAF
period through meeting LIUR criteria; and
(B) met LIUR status in 2010.
(3) Fifty percent (50%) of the
full rate for psychiatric hospitals qualifying for DSH payments during each HAF
period through meeting LIUR criteria.
(4) Fifty percent (50%) of the full rate for
all hospitals qualifying for DSH payments during each HAF period when more than
twenty-five percent (25%) of the hospital's Medicaid days are provided to
patients residing outside Indiana.
(f) The office or its contractor shall notify
each hospital of the amount of the hospital's assessment after the amount of
the assessment has been computed. If the hospital disagrees with either the
computation or the amount of the assessment, the hospital may request an
administrative reconsideration by the Medicaid rate-setting contractor. A
reconsideration request shall meet the following requirements:
(1) Be in writing.
(2) Contain the following:
(A) Specific issues to be
reconsidered.
(B) The rationale for
the hospital's position.
(3) Be signed by the authorized
representative of the hospital.
(4)
Be received by the contractor within forty-five (45) days after the notice of
the assessment is mailed.
Upon receipt of the request for reconsideration, the Medicaid
rate-setting contractor shall evaluate the data. After review, the Medicaid
rate-setting contractor may amend the assessment or affirm the original
decision. The Medicaid rate-setting contractor shall thereafter notify the
hospital of its final decision in writing, within forty-five (45) days of the
Medicaid rate-setting contractor's receipt of the request for reconsideration.
If the rate-setting contractor does not make a timely response to the
hospital's reconsideration request, the request shall be deemed denied and the
provider may initiate an appeal under IC 4-21.5-3.
(g) The office shall collect the assessment
fee for a hospital as follows:
(1) Offset the
amount owed against either of the following:
(A) A Medicaid payment to the
hospital.
(B) A Medicaid payment to
another provider that is related to the hospital through common ownership or
control.
(2) In another
manner determined by the office.
(h) A hospital may file a request to pay the
assessment fee on an installment plan. The request shall be:
(1) made in writing setting forth the
hospital's rationale for the request; and
(2) submitted to the office or its designee.
If the office or its designee approves the hospital's
request, the office or its designee and the requesting hospital shall enter
into a written agreement for an installment plan. The installment plan
established under this section shall not exceed a period of six (6) months from
the date of execution of the agreement. The agreement shall set forth the
amount of the assessment that shall be paid in installments and shall include
provisions for the collection of interest. The interest shall not exceed the
percentage determined in IC 12-15-21-3(6)(A).
(i) If a hospital fails to pay the assessment
fee due under this section within ten (10) days after the date the payment is
due, the hospital shall pay interest on the assessment fee at the same rate as
determined under IC 12-15-21-3(6)(A).
(j) For hospitals that are not certified for
participation in the Medicaid program under Title XIX of the federal Social
Security Act (
42 U.S.C.
1396 et seq.), the hospital shall remit the
assessment fee to the state of Indiana within ten (10) days after the due date.
If a hospital fails to pay the hospital assessment under this subsection within
ten (10) days after the due date, the hospital shall pay interest on the
assessment fee at the rate as determined under IC 12-15-21-3(6)(A).
(k) If a hospital fails to pay the assessment
fee within one hundred twenty (120) days after the payment is due, the office
shall report the hospital to the Indiana state department of health to initiate
license revocation proceedings.
(l)
For hospitals certified for participation in the Medicaid program under Title
XIX of the federal Social Security Act (
42 U.S.C.
1396 et seq.), the hospital assessment fee
shall be an allowable cost for cost reporting and auditing purposes.
(m) The office may adjust the assessment fee
to incorporate DSH eligibility information for each HAF period and to make
changes as necessary to the assessment fee because of administrative
reconsideration requests and appeals. Adjustments of the assessment fee as a
result of administrative reconsideration requests or appeals are available only
for reconsideration requests and appeals filed timely in accordance with
subsection (f). If the assessment fee is adjusted as described in this
subsection, the determination of the assessment fee as adjusted for each HAF
period will be final and shall not be subject to additional reconsideration
requests or appeals.
(n) For the
fee period, as defined at IC 16-21-10-3, outpatient hospital rates are subject
to an outpatient hospital adjustment factor. The outpatient hospital adjustment
factors shall result in aggregate payments that reasonably approximate the
federal Medicare upper payment limit under
42
CFR
447.321, but shall not result in payments
in excess of the federal Medicare upper payment limit. The outpatient hospital
adjustment factors are published in provider bulletins.
(o) For the period through June 30, 2019, the
limitation on payments for an individual claim to the lesser of the amount
computed or billed charges shall not apply.
