907 KAR 10:017. Hospital Indigent Care Assurance Program (HICAP).
RELATES TO: KRS 205.520
STATUTORY AUTHORITY: KRS 194A.030(2), 194A.050(1), 205.575, EO 2004-726
NECESSITY, FUNCTION, AND CONFORMITY: EO 2004-726, effective July 9, 2004, reorganized the Cabinet for Health Services and placed the Department for Medicaid Services and the Medicaid Program under the Cabinet for Health and Family Services. The Cabinet for Health and Family Services has responsibility to administer the Medicaid program and the Hospital Indigent Care Assurance Program (HICAP). This administrative regulation sets forth provisions relating to implementation of HICAP.
Section 1. Definition. "Nonparticipant" means a hospital not complying with the conditions of participation for the Hospital Indigent Care Assurance Program (HICAP).
Section 2. Conditions of Participation. A hospital participating in HICAP shall submit to the cabinet any requested information to show the required sign has been posted.
Section 3. Departmental Actions Based on Noncompliance with Participation Requirements. (1) A hospital shall be considered a nonparticipant when it fails to meet one (1) or more of the requirements shown in KRS 205.575 and Section 2 of this administrative regulation. A hospital shall be notified in writing when the department determines the facility to be a nonparticipant. Prior to written notification, the department shall provide the hospital an opportunity to:
(a) Discuss the department's determination; and
(b) Present evidence of its compliance with participation requirements.
(2) A hospital which is a nonparticipant shall not be paid HICAP benefits until all participation requirements are met.
Section 4. Assessments. The assessment percentage for annual periods beginning January 1, 1991 (except for the quarter beginning on April 1, 1993 and ending June 30, 1993), shall be five (5) percent utilizing hospital cost reports used in setting the year's Medicaid hospital rates. The assessment percentage for the quarter beginning April 1, 1993 and ending June 30, 1993 shall be 3.7312 percent utilizing hospital cost reports used in setting the year's Medicaid hospital rates. The department shall reserve $1,000,000 as a contingency reserve and shall reserve two (2) percent of the assessments for necessary administrative expenditures as provided for in KRS 205.575.
Section 5. HICAP Benefit Payments. If a hospital appeals a departmental decision with regard to its assessment payment amount or its HICAP benefit amount to Franklin Circuit Court, it may nevertheless pay to the department the assessment payment amount computed by the department with the understanding that the payment shall not compromise its right of action in court and that its final assessment payment amount or HICAP benefit payment amount shall be contingent on expiration of the time of judicial appeals or on court determination.
Section 6. Assessment Schedules. (1) The assessment payment due date for each calendar quarter shall be on the last day of the second month of each quarter, except that the department may establish administratively different assessment schedules for the calendar quarters ending March 31, 1991 and June 30, 1991 to accommodate assessment and payment requirements mandated by KRS 205.575.
(2) A hospital may request a delay in its assessment payment due date based on unforeseeable circumstances affecting the hospital's ability to pay in a timely manner. Unforeseeable circumstances may include, but are not limited to, substantial disruptions of management or operations from occurrences such as fire, flood, storm, bankruptcy or other demonstrated financial hardship. Simple inability to pay, if combined with a filing of bankruptcy or other demonstrated financial hardship by the hospital, shall constitute justification for a delayed payment schedule. If a delay is granted, the delay shall not exceed sixty (60) days. An appeal to the Franklin Circuit Court (or a higher court as appropriate) with regard to the assessment payment amount or the HICAP benefit amount shall be justification for a delay in payment of the assessment until the court case is resolved.
Section 7. Waiver of Late Payment Penalties. The commissioner of the department shall waive the late payment penalty specified in KRS 205.575 ($20,000 per incident of late payment) only when good cause exists. Good cause shall be determined to exist only when an unforeseeable circumstance occurs affecting timely payment. Unforeseeable circumstances may include substantial disruptions of management or operations from occurrences such as fire, flood, storm or similar events. Good cause may also exist when the responsible official of the hospital reasonably anticipated that payment was or should have been made (e.g., payment was mailed timely but lost in the mail). Failure to pay due to insufficient funds shall not be good cause for a waiver of the penalty unless combined with a bankruptcy filing of the hospital. An appeal to the Franklin Circuit Court (or a higher court as appropriate) with regard to the assessment payment amount or the HICAP benefit payment amount shall be considered to meet the criteria for good cause.
Section 8. Termination of HICAP. HICAP shall terminate, except for activities required to resolve outstanding issues, effective July 1, 1993. (17 Ky.R. 1295; eff. 12-7-90; Am. 3285; 18 Ky.R. 306; eff. 7-17-91; 20 Ky.R. 161; eff. 9-3-93; Recodified from 907 KAR 1:017; eff. 5-3-2011.)