Mont. Admin. r. 37.86.2928 - INPATIENT HOSPITAL REIMBURSEMENT, HOSPITAL REIMBURSEMENT ADJUSTOR
(1) The inpatient hospital reimbursement
adjustor (HRA) payment is payable to a PPS hospital or critical access
hospital, as those terms are defined in
50-5-101,
MCA, that provides inpatient hospital services. Eligibility for an HRA payment
will be determined based on a hospital's year-end reimbursement
status.
(2) Revenue generated from
the inpatient hospital utilization fee plus applicable federal financial
participation (FFP) is utilized to calculate the following supplemental
payments:
(a) the continuity of care payment
described in ARM
37.87.1224;
(b) Part 1 of the HRA; and
(c) Part 2 of the HRA.
(3) Part 1 of the HRA payment is payable to
all hospitals, including critical access hospitals, as those terms are defined
in
50-5-101,
MCA. The payment will be based upon Medicaid inpatient utilization, and will be
computed as follows: HRA1 = (M รท D) x P.
(a) For the purposes of calculating Part 1 of
the HRA, the following apply:
(i) "HRA1"
represents the calculated Part 1 HRA payment.
(ii) "M" equals the number of Medicaid
inpatient days provided by the hospital for which the payment amount is being
calculated.
(iii) "D" equals the
total number of Medicaid inpatient days provided by all hospitals eligible to
receive an HRA payment.
(iv) "P"
equals the total amount to be paid via Part 1 of the HRA. "P" consists of a
state-paid amount plus the applicable federal financial participation (FFP).
The portion of "P" that is paid by the state will equal the amount of revenue
generated by Montana's inpatient hospital utilization fee, less all the
following:
(A) 4% of the total revenue
generated by the inpatient hospital utilization fee, which will be expended as
match for continuity of care adjustor payments, as provided in ARM 37.87.1224;
and
(B) 8% of the total revenue
generated by the inpatient hospital utilization fee, which will be expended as
match for Part 2 of the HRA, as provided in (4).
(4) Part 2 of the HRA
payment is limited to critical access hospitals to maintain access and quality
in the most rural areas in Montana. Part 2 will be based upon total hospital
Medicaid charges, and will be computed as follows: HRA2 = (I - D) x P.
(a) For the purposes of calculating Part 2 of
the HRA, the following apply:
(i) "HRA2"
represents the calculated Part 2 HRA payment.
(ii) "I" equals the total hospital charges
from Medicaid paid claims for which Montana Medicaid was the primary payer for
the hospital for which the payment is being calculated.
(iii) "D" equals the total hospital charges
from Medicaid paid claims for which Montana Medicaid was the primary payer for
all hospitals eligible to receive Part 2 of the HRA payment.
(iv) "P" equals the total amount to be paid
via Part 2 of the HRA. "P" will be 8% of the total revenue generated by
Montana's inpatient hospital utilization fee plus applicable FFP.
(5) The numbers used in
(3) through (4) must be from the department's paid claims data for the most
recent calendar year.
Notes
AUTH: 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, 53-6-149, MCA
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