Administrative Rules of Montana
Department 37 - PUBLIC HEALTH AND HUMAN SERVICES
Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES
Subchapter 37.86.44 - Rural Health Clinics and Federally Qualified Health Centers
Rule 37.86.4410 - RETROSPECTIVE CHANGE IN SCOPE OF SERVICE

Universal Citation: MT Admin Rules 37.86.4410

Current through Register Vol. 18, September 20, 2024

(1) A retrospective change in scope of service occurs when a change took place in the past and the RHC or FQHC is seeking to adjust its rate based on that change. An approved retrospective change in scope of service request may result in an incremental change to the baseline PPS rate.

(2) An RHC or FQHC may apply for an incremental change to the baseline PPS rate for a retrospective change in scope of service once per calendar year. In order to be deemed timely, the completed application must be received by the department no later than six months after the close of the RHC's or FQHC's fiscal year in which the change in scope of service occurred, or otherwise the application is untimely. A completed application must include the information in (3) and, if applicable, (4).

(3) To apply for an incremental change to the baseline PPS rate for a retrospective change in scope of service, an RHC or FQHC must submit the following application materials:

(a) a narrative description of each change in scope of service, including how services were provided both before and after the change;

(b) the RHC's or FQHC's as-filed Medicare cost reports for the fiscal year prior to the change in scope of service, and the fiscal year in which the change in scope of service occurred;

(c) for FQHCs the Uniform Data System reports for the calendar year prior to the change in scope of service, and the calendar year in which the change in scope of service occurred;

(d) a description of each cost center on the cost report affected by the change in scope of service;

(e) an attestation statement that certifies the accuracy, truth, and completeness of the information in the application signed by an officer or administrator of the RHC or FQHC; and

(f) any approved changes in scope of project as defined by the Health Resources and Services Administration (HRSA).

(4) The department may request additional information from the RHC or FQHC. The requested information must be received by the department no later than 30 calendar days from the date of the request, or otherwise the application is deemed untimely.

(5) After receiving a completed application, the department shall calculate the RHC's or FQHC's allowable cost of services both with and without the added or removed services to establish the incremental change to the baseline PPS rate. The department shall notify in writing the RHC or FQHC of the incremental change to the baseline PPS rate within 90 calendar days of receiving the information requested in (3) and (4).

(6) For timely applications, the effective date of the incremental change to the baseline PPS rate is the beginning of the facility's fiscal year following the retrospective change in scope of service. For untimely applications, the effective date of the incremental change to the baseline PPS rate is the date all required information is received by the department.

Disclaimer: These regulations may not be the most recent version. Montana may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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