First Regular Session of the 124th General Assembly (2025)
PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
Constitution) is being amended, the text of the existing provision will appear in this style type,
additions will appear in this style type, and deletions will appear in this style type.
Additions: Whenever a new statutory provision is being enacted (or a new constitutional
provision adopted), the text of the new provision will appear in this style type. Also, the
word NEW will appear in that style type in the introductory clause of each SECTION that adds
a new provision to the Indiana Code or the Indiana Constitution.
Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts
between statutes enacted by the 2024 Regular Session of the General Assembly.
HOUSE ENROLLED ACT No. 1024
AN ACT to amend the Indiana Code concerning Medicaid.
Be it enacted by the General Assembly of the State of Indiana:
SECTION 1. IC 12-15-15-1.2, AS AMENDED BY P.L.76-2023,
SECTION 2, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
UPON PASSAGE]: Sec. 1.2. (a) As used in this section, "children's
hospital" means:
(1) a freestanding general acute care hospital that:
(A) is designated by the Medicare program as a children's
hospital; or
(B) furnishes inpatient and outpatient health care services to
patients who are predominantly individuals less than nineteen
(19) years of age; or
(2) a facility located within a freestanding general acute care
hospital that:
(A) is designated by the Medicare program as a children's
hospital; or
(B) furnishes inpatient and outpatient health care services to
patients who are predominately individuals less than nineteen
(19) years of age.
(b) This section applies to reimbursement for inpatient Medicaid
services and outpatient Medicaid services provided to a Medicaid
recipient who is less than nineteen (19) years of age at a children's
hospital that is located in a state bordering Indiana. This section does
not apply to reimbursement for non-emergency medical transportation.
HEA 1024 — Concur 2
(c) As used in this subsection, "cost outlier case" means a Medicaid
stay that exceeds a predetermined threshold, defined as the greater of
twice the diagnosis-related group (DRG) rate or a fixed dollar amount
that has been established by the office. The office shall reimburse a
children's hospital for covered services provided to a Medicaid
recipient that is described in subsection (b) at a rate set by the secretary
that is based on a reimbursement formula that is:
(1) comparable to the current federal Medicare reimbursement
rate for the service provided by the children's hospital; or
(2) one hundred thirty percent (130%) of the Medicaid
reimbursement rate for a service that does not have a Medicare
reimbursement rate.
The reimbursement methodology under this subsection must factor in
any cost outlier case in a manner that results in the final reimbursement
rate made to a hospital meeting the reimbursement requirements
specified in this subsection. The office may, upon factoring in the cost
outlier case in determining the final reimbursement rate, make
retroactive reimbursements to an out of state children's hospital to the
date of the initial Medicaid waiver application.
(d) Before September 1, 2021, the office shall apply to the United
States Department of Health and Human Services for any state plan
amendment or Medicaid waiver necessary to implement and administer
this section. Before June 1, 2022, the office shall apply for an
amendment to the Medicaid waiver concerning reimbursement under
this section that is necessary to implement the changes required by
amendments made to this section concerning factoring in any cost
outlier case.
(e) The office may adopt rules under IC 4-22-2 necessary for the
implementation of this section.
(f) This section expires July 1, 2025. 2027.
SECTION 2. An emergency is declared for this act.
HEA 1024 — Concur Speaker of the House of Representatives
President of the Senate
President Pro Tempore
Governor of the State of Indiana
Date: Time:
HEA 1024 — Concur