Current through Register Vol. 6, March 22, 2024
(1) Routine
disproportionate share hospitals (RDSH) will receive an additional payment
amount equal to the product of the hospital's prospective base rate times the
adjustment percentage of:
(a) 4% for rural
hospitals; or
(b) 10% for urban
hospitals.
(2) DSH
payments will be limited to the cap established by CMS for the state of
Montana. The adjustment percentages specified in (1) will be ratably reduced as
determined necessary by the department to avoid exceeding the cap.
(a) The department will submit an independent
certified audit to CMS for each completed Medicaid state plan rate year,
consistent with 42 CFR Part 455, Subpart D.
(b) To the extent that audit findings
demonstrate that DSH payments exceed the documented hospital-specific limits,
the department will collect overpayments and redistribute DSH
payments.
(c) Beginning with state
fiscal year (SFY) 2011, based on audit findings, should the department
determine that there is an overpayment to a provider, the department will:
(i) recover the overpayment from the
provider;
(ii) redistribute the
amount in overpayment to providers that had not exceeded the hospital-specific
limit during the period in which the DSH payments were determined utilizing the
methodology used in the payment of the original allocation; and
(iii) ensure all payments will be subject to
hospital-specific limits. (d) Should the DSH overpayment exceed the aggregate
hospital-specific limit, the federal amount of overpayment will be returned to
CMS.
(e) Beginning with
SFY 2011, facilities choosing not to participate in the annual DSH audit will
forfeit 100% of their DSH payment allocated for that year. This allocation will
be deemed an overpayment and will be recovered from the provider.
(f) Disproportionate share payments must not
exceed the DSH state allotment, except as otherwise required by the Social
Security Act. In no event is the department obligated to use state Medicaid
funds to pay more than the state Medicaid allotment of DSH payments due a
provider.
(3)
Eligibility for RDSH payments will be determined based on a provider's year-end
reimbursement status.
AUTH:
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
