Administrative Rules of Montana
Department 37 - PUBLIC HEALTH AND HUMAN SERVICES
Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES
Subchapter 37.86.30 - Outpatient Hospital Services
Rule 37.86.3005 - OUTPATIENT HOSPITAL SERVICES, REIMBURSEMENT
Current through Register Vol. 18, September 20, 2024
(1) The department will reimburse for outpatient hospital services and birthing center services compensable under the Montana Medicaid program as provided in this rule.
(2) Outpatient hospital services that are not provided by critical access hospitals as defined in ARM 37.86.2901 will be reimbursed under ARM 37.86.3007, 37.86.3009, 37.86.3016, 37.86.3018, 37.86.3020, 37.86.3025, 37.86.3109, and 37.86.3037 for medically necessary services.
(3) Birthing center services as defined in ARM 37.86.3001 will be reimbursed under ARM 37.86.3007, 37.86.3016, 37.86.3018, and 37.86.3020, for medically necessary services.
(4) For critical access hospitals, interim reimbursement for outpatient hospital services is based on hospital-specific Medicaid outpatient cost-to-charge ratio, not to exceed 100%. Critical access hospitals will be reimbursed their actual allowable costs determined according to ARM 37.86.2803.
53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-141, MCA;
