Admin. R. Mont. 37.86.3005 – Outpatient Hospital Services, Reimbursement

(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.

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

Implementing statute(s): 53-2-201, 53-6-101, 53-6-111, 53-6-113, 53-6-141, MCA

History: NEW, 1987 MAR p. 1658, Eff. 10/1/87; AMD, 1991 MAR p. 1027, Eff. 7/1/91; AMD, 1993 MAR p. 1520, Eff. 7/16/93; AMD, 1994 MAR p. 1732, Eff. 7/1/94; AMD, 1995 MAR p. 1162, Eff. 7/1/95; AMD, 1995 MAR p. 1961, Eff. 10/1/95; AMD, 1996 MAR p. 1539, Eff. 7/1/96; AMD, 1996 MAR p. 3218, Eff. 12/20/96; AMD, 1997 MAR p. 548, Eff. 3/25/97; AMD, 1997 MAR p. 1209, Eff. 7/8/97; AMD, 1998 MAR p. 2168, Eff. 8/14/98; AMD, 1999 MAR p. 1806, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 481; AMD, 2001 MAR p. 564, Eff. 1/12/01; EMERG, AMD, 2001 MAR p. 1119, Eff. 6/22/01; AMD, 2002 MAR p. 797, Eff. 3/15/02; AMD, 2002 MAR p. 1991, Eff. 8/1/02; AMD, 2003 MAR p. 1652, Eff. 8/1/03; AMD, 2004 MAR p. 482, Eff. 2/27/04; AMD, 2006 MAR p. 1640, Eff. 6/23/06; AMD, 2006 MAR p. 3078, Eff. 1/1/07; AMD, 2012 MAR p. 1382, Eff. 7/13/12.