Current through Register Vol. 24, December 20, 2024
(1) Subject to the availability of funding,
restrictions imposed by federal law, and the approval of the state plan by the
Centers for Medicare and Medicaid Services (CMS), the department will pay, in
addition to the Medicaid payments provided for in ARM
37.86.2806,
37.86.2905,
37.86.2907,
37.86.2912,
37.86.2916,
37.86.2918,
37.86.2920,
37.86.2924,
37.86.2925,
37.86.2928,
37.86.2943,
and
37.86.2947,
a Graduate Medical Education (GME) payment for the purpose of partially funding
primary care and psychiatry residency programs for eligible hospitals located
in Montana.
(2) Revenue for the GME
payment will be generated through a transfer of funds from the Montana
University System to the department through an Intergovernmental Transfer
contract agreement. The transfer of funds from the University System will occur
prior to July 31 of each year.
(3)
The department will make an annual payment to each eligible hospital on or
before August 31 of each year.
(a) The
payment will be calculated based upon the eligible hospital's inpatient
Medicaid utilization per year, as calculated in (4).
(b) If an eligible hospital reports no
primary care or psychiatry resident full time equivalents (FTE) participating
in the GME program for any given program year or portion thereof, the eligible
hospital will not receive payment for those time periods of nonparticipation.
FTE totals include residents conducting rural rotations. For purposes of this
rule, a rural rotation is a period of one month where a primary care or
psychiatry resident is working in a rural location, outside of their primary
facility and urbanized area, with the express purpose of the resident being
available to provide care to the rural area's patient population.
(4) To calculate an eligible
hospital's GME payment, the department will:
(a) divide the total amount of GME funding,
including federal match, by the total number of primary care and psychiatry
resident full-time equivalents (FTE) participating in the program to establish
the per-resident amount (PRA);
(b)
divide the number of FTE residents at each eligible hospital by the total
number of primary care and psychiatry resident FTEs at all eligible hospitals
participating in the program to establish each hospital's resident FTE
percentage;
(c) divide the eligible
hospital's Medicaid inpatient days by its total inpatient days to determine
each eligible hospital's Medicaid utilization percentage;
(d) multiply each eligible hospital's
Medicaid utilization percentage by its resident FTE percentage and then add the
results from all of the eligible hospitals to establish the weighted average
Medicaid utilization percentage for all hospitals;
(e) divide an eligible hospital's Medicaid
utilization percentage from (c) by the weighted Medicaid utilization percentage
for all eligible hospitals to establish each eligible hospital's Medicaid
utilization index;
(f) multiply the
eligible hospital's Medicaid utilization index by the PRA in (a) to establish
each eligible hospital's adjusted PRA; and
(g) multiply the eligible hospital's adjusted
PRA by the number of resident FTEs at the hospital to determine the GME payment
amount.
(5) The GME
payment must comply with the following criteria:
(a) if the eligible hospital's cost of
inpatient hospital services do not exceed the total Montana Medicaid allowed
payments for inpatient care, the eligible hospital will receive a GME payment
as calculated in (4);
(b) as-filed
cost reports from eligible hospitals and information from the Medicaid paid
claims database will be used for calculations;
(c) the GME payment must be for services
derived from Medicaid paid claims. The dates of these services must occur
within the eligible hospital's fiscal year end, and the hospital's fiscal year
must be the year immediately prior to the payment date; and
(d) at the end of the contract period, the
department will reconcile the total Medicaid payments including the Medicaid
GME payments to ensure that the total of these payments do not exceed the
Medicaid Upper Payment Limit (UPL) for the fiscal year.
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
