1. (1) Regardless of any other provision of these rules, a provider may not bill the Medicaid program for any patient day, item, service or other amount which could have been or could be paid by any other payer, including but not limited to a private or governmental insurer, or Medicare, regardless of whether the facility participates in such coverage or program. If the department finds that Medicaid has made payments in such an instance, retroactive collections may be made from the provider in accordance with ARM 37.40.347.

   1. (a) This rule does not apply to payment sources which by law are made secondary to Medicaid.
2. (2) The payments allowed under ARM 37.40.307 constitute full payment for nursing facility services and separately billable items provided to a resident. A provider may not charge, bill, or collect any amount from a Medicaid recipient, other than the resident's patient contribution and any items billable to residents under ARM 37.40.331.
3. (3) This rule applies in addition to ARM 37.85.415.

Authorizing statute(s): 53-2-201, 53-6-113, MCA

Implementing statute(s): 53-6-101, 53-6-113, MCA

History: NEW, 1991 MAR p. 2050, Eff. 11/1/91; TRANS, from SRS, 2000 MAR p. 489; AMD, 2000 MAR p. 492, Eff. 2/11/00.