Mont. Admin. R. 37.86.4412 - RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH CENTERS, REIMBURSEMENT
(1) This subchapter
specifies requirements applicable to provision of and reimbursement for RHC and
FQHC services. These rules are in addition to requirements generally applicable
to Medicaid providers as otherwise provided in state and federal statute,
rules, regulations, and policies.
(2) Unless otherwise provided in these rules,
this subchapter applies to rate years beginning on or after January 1, 2001.
Reimbursement and other substantive RHC and FQHC requirements for earlier
periods are subject to the laws, regulations, rules, and policies then in
effect. Procedural and other nonsubstantive provisions of these rules are
effective upon adoption.
(3) All
RHCs and FQHCs will be reimbursed on a prospective payment system (PPS)
beginning January 1, 2001 and each succeeding calendar year. The PPS will apply
equally to provider based and independent RHCs and FQHCs.
(4) On January 1 of each succeeding calendar
year, the rate for the preceding year must be adjusted by the percentage
increase in the medicare economic index (MEI) applicable to primary care
services for that calendar year.
(5) The department will reimburse the RHC or
FQHC for the rate change in (4) retroactive to the effective date of January 1
of the calendar year, beginning with January 1, 2002.
(6) For RHCs or FQHCs that had their initial
Medicaid prospective payment system base visit rate calculated in 2001 or
starting with the third fiscal year (for "new" RHCs or FQHCs as defined at ARM
37.86.4413
), the prospective payment system per visit rate may be adjusted to take into
account any increase or decrease in the scope of service.
(7) Effective July 1, 2017, approved RHCs and
FQHCs participating in Promising Pregnancy Care (PPC) will be reimbursed an
enhanced PPS rate. Therefore, RHCs and FQHCs will be reimbursed their existing
PPS rate plus an additional amount, in accordance with the fee schedule adopted
and effective as provided in ARM
37.85.105,
whenever a member attends the educational aspect of the PPC session.
(8) Effective July 1, 2017, RHCs and FQHCs
will be reimbursed separately for long-acting reversible contraceptives (LARCs)
in addition to their PPS rate. LARCs include intrauterine devices (IUDs) and
birth control implants.
Notes
AUTH: 53-2-201, 53-6-113, MCA; IMP: 53-6-101, 53-6-111, 53-6-113, MCA
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