Mont. Admin. r. 37.86.2920 - INPATIENT HOSPITAL PROSPECTIVE REIMBURSEMENT, HOSPITAL RESIDENTS

(1) Payment for hospital residents will be made as follows:

(a) the hospital must request residency status from the department prior to submission of the first claim;

(b) prior to obtaining hospital residency status, claims for that recipient may be billed on an interim basis as provided in ARM 37.86.2905(4);

(c) final payment for the first hospital stay will be paid the APR-DRG payment for the case as computed in ARM 37.86.2907 plus any appropriate outlier and add-on payments:

(i) the hospital stay is from admit through the request for residency, if approved by the department; and

(ii) the length of stay must be greater than or equal to 180 days of inpatient care at the same facility.

(d) final payment for all client care subsequent to the request date, which must be greater than 180 days will be reimbursed at 80% of the hospital specific estimated cost-to-charge ratio as computed by the department without cost settlement; and

(e) the hospital must provide medical records upon request of the department or the department's designated review organization for continued stay reviews.

Notes

Mont. Admin. r. 37.86.2920

NEW, 2004 MAR p. 482, Eff. 2/27/04; AMD, 2008 MAR p. 1983, Eff. 10/1/08; AMD, 2010 MAR p. 1534, Eff. 7/1/10.

2-4-201, 53-2-201, 53-6-113, MCA; IMP, 2-4-201, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA;