1. (1) To receive payment from the State for health care services provided to an individual identified in 53-6-1312, MCA, a provider must:

   1. (a) be enrolled as a Montana Medicaid provider;
   2. (b) accept the Montana Medicaid rates as full payment for all health care services; and
   3. (c) comply with the requirements of this subchapter.
2. (2) A provider who accepts an individual identified in 53-6-1312, MCA, as a patient is agreeing to accept the Medicaid rate as payment in full.
3. (3) In service settings where an individual identified in 53-6-1312, MCA, is accepted as a patient by a provider who arranges for services by other providers, all providers performing services are deemed to have accepted reimbursement from the State at the Montana Medicaid rates.
4. (4) A provider may not "balance bill" or seek payment in addition to, or in lieu of, the payment by the State. "Balance bill" means a provider bills the patient, or responsible party, the difference between the amount the state reimburses for services and what the provider chooses to charge.

Authorizing statute(s): 53-6-1318, MCA

Implementing statute(s): 53-6-1312, MCA

History: NEW, 2015 MAR p. 2313, Eff. 1/1/16.