Mont. Admin. R. 37.86.4420 - RURAL HEALTH CLINICS AND FEDERALLY QUALIFIED HEALTH CENTERS, ALTERNATIVE PAYMENT METHODOLOGIES
(1) In
the case of a catastrophic event or extraordinary circumstance that would
directly impact the cost of medical services provided by an RHC or FQHC, or
upon mutual agreement of the department and the RHC or FQHC the department may
provide for payment in any year to an RHC or FQHC for services described in
section 1905(a) (2) (B) and (C) of the Social Security Act in an amount
determined under an alternative payment methodology that:
(a) is agreed to by the department and the
RHC or FQHC; and
(b) results in
payment to the RHC or FQHC of an amount which is at least equal to the
amount.
(2) Beginning
July 1, 2019, RHC or FQHC providers may elect to be reimbursed under an
Alternative Payment Methodology (APM) equal to the per-visit cost as calculated
utilizing the two most recently completed as-filed Medicare cost reports and/or
other requested information. Examples include the Uniform Data Systems report,
audited financial statements, and Electronic Health Record visit
reconciliation.
(a) The APM per-visit rate
will not be less than the RHC's or FQHC's existing baseline PPS rate.
(b) RHC or FQHC providers who choose to be
reimbursed under the APM, must make the request to the department in writing no
later than July 1, 2020.
(c) The
department will provide a written notification of the calculated APM per-visit
rate to the RHC or FQHC within 90 days of receiving all information related to
the request.
(3) The
effective date of the APM per-visit rate will be the later of the start of the
facility's fiscal year following the most recent submitted Medicare as-filed
cost report or July 1, 2019.
(4) If
the required information as outlined in (2) is not received prior to July 1,
2020, the option to be reimbursed on the APM is not available.
Notes
AUTH: 53-2-201, 53-6-113, MCA; IMP: 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
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