Administrative Rules of Montana
Department 37 - PUBLIC HEALTH AND HUMAN SERVICES
Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES
Subchapter 37.40.4 - Swing-beds
Rule 37.40.406 - SWING-BED HOSPITALS, REIMBURSEMENT

(1) Montana medicaid will reimburse swing-bed hospitals as provided in this rule for swing-bed hospital services provided in accordance with all applicable swing-bed hospital service requirements specified in ARM 37.40.401, 37.40.402, 37.40.405 and this rule and subject to all other applicable laws and regulations.

(2) For swing-bed hospital services, the Montana medicaid program will pay a provider a per diem rate as specified in (2) (a) for each medicaid patient day, plus additional reimbursement for separately billable items as provided in (2) (b) .

(3) For purposes of reporting costs under ARM 37.86.2803, inpatient hospital services providers which also provide swing-bed hospital services shall allocate hospital inpatient general routine service costs associated with swing-bed hospital services on the medicare "carve out" method as specified in 42 CFR 413.53 (a) (2) . The department adopts and incorporates by reference 42 CFR 413.53 (a) (2) (2004) . A copy of 42 CFR 413.53 (a) (2) may be obtained from the Department of Public Health and Human Services, Senior and Long Term Care Division, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210.

(4) Providers must bill for all services and supplies in accordance with the provisions of ARM 37.85.406. The department's fiscal agent will pay a provider the amount determined under these rules upon receipt of an appropriate billing which reports the number of patient days of swing-bed hospital services provided to authorized Medicaid recipients during the billing period.

(5) Swing-bed hospital service providers aggrieved by adverse determinations by the department may request administrative review and fair hearing as provided in ARM 37.5.304, 37.5.305, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334 and 37.5.337.