Administrative Rules of Montana
Department 37 - PUBLIC HEALTH AND HUMAN SERVICES
Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES
Subchapter 37.86.29 - Inpatient Hospital Services
Rule 37.86.2920 - INPATIENT HOSPITAL PROSPECTIVE REIMBURSEMENT, HOSPITAL RESIDENTS
Universal Citation: MT Admin Rules 37.86.2920
Current through Register Vol. 18, September 20, 2024
(1) Payment for hospital residents will be made as follows:
(a) the hospital must request residency
status from the department prior to submission of the first claim;
(b) prior to obtaining hospital residency
status, claims for that recipient may be billed on an interim basis as provided
in ARM 37.86.2905(4);
(c) final payment for the first hospital stay
will be paid the APR-DRG payment for the case as computed in ARM
37.86.2907 plus any appropriate
outlier and add-on payments:
(i) the hospital
stay is from admit through the request for residency, if approved by the
department; and
(ii) the length of
stay must be greater than or equal to 180 days of inpatient care at the same
facility.
(d) final
payment for all client care subsequent to the request date, which must be
greater than 180 days will be reimbursed at 80% of the hospital specific
estimated cost-to-charge ratio as computed by the department without cost
settlement; and
(e) the hospital
must provide medical records upon request of the department or the department's
designated review organization for continued stay reviews.
2-4-201, 53-2-201, 53-6-113, MCA; IMP, 2-4-201, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA;
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