in-20250611-IR-405240493FRA: DIGEST HOSPITAL ASSESSMENT FEES

Final Rule LSA Document #24-493 DIGEST Sec. 1. This rule applies to the calculation of hospital assessment fees under IC 16-21-10. Sec. 2. (a) The definition in this section applies throughout this rule. (b) "Disproportionate share hospital" or "DSH" means the federal program in which payments are paid to qualifying hospitals that serve a significantly high number of low income and uninsured patients compared to other hospitals, as determined under IC 12-15-16-1, and have a Medicaid inpatient utilization rate, as defined in 42 U.S.C. 1396r-4(b)(2), of at least one percent (1%). Sec. 3. The hospital assessment fee (HAF) is calculated and paid on a fiscal year basis. Hospitals are first assessed an anticipated HAF amount for the fiscal year, as calculated in sections 5 through 9 of this rule, based on projections using the most current historical claims data and forecasted changes. After the end of the fiscal year, hospitals will be assessed a final HAF amount or receive a refund based on actual costs as calculated in section 10 of this rule. Sec. 4. As used in this rule, the state share of a cost is determined by multiplying the cost by one (1) minus the current applicable Federal Medical Assistance Percentage as defined in 42 U.S.C. 1396d(b). Sec. 5. The base hospital assessment fee (HAF) is calculated as follows: Sec. 6. The incremental hospital assessment fee (HAF) is calculated as follows: Sec. 7. (a) The total amounts calculated for the base hospital assessment fee (HAF) in section 5 of this rule and incremental HAF in section 6 of this rule are allocated between inpatient and outpatient HAF as follows: (b) The inpatient HAF calculated under STEP ONE (A) of subsection (a) is added to the inpatient HAF calculated under STEP TWO (A) of subsection (a) for a total inpatient HAF. (c) The outpatient HAF calculated under STEP TWO (B) of subsection (a) is added to the inpatient HAF calculated under STEP TWO (B) of subsection (a) for a total outpatient HAF. Sec. 8. (a) The inpatient hospital assessment fee (HAF) rate for the upcoming fiscal year is determined by taking the inpatient HAF calculated under section 7(b) of this rule divided by the total equivalent inpatient days calculated under 405 IAC 1-10.5-7. (b) A hospital's total inpatient HAF for the upcoming fiscal year is calculated by multiplying the inpatient HAF rate calculated in subsection (a) by the hospital's equivalent inpatient days calculated under 405 IAC 1-10.5-7. Sec. 9. (a) The outpatient hospital assessment fee (HAF) for the upcoming fiscal year is determined by taking the outpatient HAF calculated under section 7(c) of this rule divided by the total equivalent outpatient days calculated under 405 IAC 1-8-5. (b) A hospital's total outpatient HAF for the upcoming fiscal year is calculated by multiplying the outpatient HAF rate calculated in subsection (a) by the hospital's equivalent outpatient days calculated under 405 IAC 1-8-5. Sec. 10. (a) After the end of each fiscal year, the fee amounts calculated under sections 5 through 9 of this rule, which are based on the projected Medicaid costs are adjusted based on actual costs incurred during the fiscal year to come up with the final hospital assessment fee (HAF) amounts for each hospital. If actual costs are higher than the projected amounts, an additional fee will be assessed to hospitals for the state share of the cost over the projections. If actual costs are less than the projected amounts, a refund will be issued to the hospitals based on the state share of the difference between the forecasts and actual costs incurred during the fiscal year. (b) Final adjustments to HAFs are made after claims runoff for the fiscal year, which is typically six (6) months after the end of the fiscal year. (c) Once actual costs for the fiscal year end are determined under subsection (a), additional HAF fees or refunds are allocated to a hospital based on the hospital's inpatient and outpatient equivalent days during the fiscal year end under sections 8 and 9 of this rule. A refund will be issued to the hospital within thirty (30) calendar days, and an additional HAF fee shall be paid under 405 IAC 1-8-5(h) for outpatient HAF, and 405 IAC 1-10.5-7(i) for inpatient HAF, as applicable. Sec. 11. (a) The hospital assessment fee (HAF) calculated under section 8 or 9 of this rule will be communicated to a hospital in writing and include a calculation of how the HAF was determined. (b) The final HAF calculated under section 10 of this rule will be communicated to a hospital in writing and include a calculation of any additional amounts that need to be paid or paid back to the hospital based on the comparison to the projected assessment. Sec. 12. (a) A hospital may request administrative reconsideration of a calculated hospital assessment fee (HAF). To request administrative reconsideration, requests must: (b) If the office determines, after reviewing a hospital's timely request for reconsideration, the HAF requires adjustment, the office shall notify the hospital in writing of the final calculated HAF. A hospital may contest the office's determination by filing an appeal under IC 4-21.5-3.