Current through Register Vol. 18, September 20, 2024
(1) Eligible
Montana ambulance providers may receive a qualified rate adjustment (QRA) from
the department for ambulance services. Eligible providers are ambulance service
providers that are either owned or operated by a local government
unit.
(2) For an eligible provider
to receive a QRA payment, the following conditions must be met:
(a) local government funds must be
transferred in accordance with the contract required by (2)(d);
(b) the funds must be certified by the city
or county treasurer, or an authorized local government official, as an
intergovernmental transfer of public funds that qualifies as a payment of
services eligible for federal financial participation (FFP, the federal
government's share of a state's expenditures under the Medicaid program) in
accordance with
42 CFR
433.51(2004);
(c) the provider must be in compliance with a
signed, written contract with the department; and
(d) the written contract covering the
requirements for the QRA payment must be executed prior to the issuance of the
QRA payment. A retroactive effective date on the written agreement will not be
allowed.
(3) To be
eligible for FFP, the local government funds cannot be federal funds unless the
federal funds are authorized by federal law to be used to match other federal
funds.
(4) The QRA payment will be
computed separately for all eligible ambulance providers on or before December
31, annually, using the following formula:
QRA payment = C x D x FMAP
(a) For the purposes of calculating the QRA
payment amount, the following definitions apply:
(i) "C" represents the number of the
provider's complete set of Medicaid paid claims for dates of service for the
most recent state fiscal year filed in accordance with ARM
37.85.406;
(ii) "D" represents the difference between
the Medicare and Medicaid allowed amount per the Healthcare Common Procedure
Coding System (HCPCS); and
(iii)
"FMAP" represents the Federal Medical Assistance Percentage (FMAP) in effect at
the time of department payment. This percentage is the amount of federal
participating matching funds for payment of Montana Medicaid program services.
The methodology for determining this percentage is set forth in
42 USC
1396 b(a) (2004). The department adopts and
incorporates by reference the methodology set out in
42 USC
1396 b(a) (2004). A copy of that statute may
be obtained from the Department of Public Health and Human Services, Health
Resources Division, P.O. Box 202951, Helena, MT 59620-2951.
(5) The QRA is subject
to the following conditions:
(a) the eligible
ambulance provider's local government funds must be received by the department
before it will disburse the QRA payment to the provider;
(b) information submitted from the eligible
ambulance provider, the local Medicare fiscal intermediary, and the Montana
Medicaid Paid Claims Database will be used for calculations, utilizing data
from the most recent state fiscal year with completed Medicaid paid claims data
filed in accordance with ARM 37.85.406;
(c) the limited situations where there is no
Medicare HCPCS code or fee schedule for the ambulance service, the billed
charges from the provider will be used in the computation; and
(d) the ambulance provider is not allowed to
bill Medicaid more than it bills private payers and other insurers.
(6) The QRA payment is subject to
the restrictions imposed by federal law and to the availability of sufficient
local government, state and federal funding.
AUTH:
53-6-113,
MCA; IMP:
53-6-113,
MCA
