37.40.406    SWING-BED HOSPITALS, REIMBURSEMENT

(1) Montana medicaid will reimburse swing-bed hospitals as provided in this rule for swing-bed hospital services provided in accordance with all applicable swing-bed hospital service requirements specified in ARM 37.40.401, 37.40.402, 37.40.405 and this rule and subject to all other applicable laws and regulations.  

(2) For swing-bed hospital services, the Montana medicaid program will pay a provider a per diem rate as specified in (2) (a) for each medicaid patient day, plus additional reimbursement for separately billable items as provided in (2) (b) .

(a) The swing-bed hospital services per diem rate is the average medicaid per diem rate paid to nursing facilities under ARM 37.40.307 for routine services furnished during the calendar year immediately previous to the year in which the swing-bed hospital services are provided. Nursing facility routine services are those services included in the definition of "nursing facility services" specified at ARM 37.40.302.

(b) Separately billable items are those items specified in ARM 37.40.330. Swing-bed hospital service providers will be reimbursed for separately billable items at the rates specified in ARM 37.40.330 and subject to the requirements of ARM 37.40.330.

(c) The Montana medicaid program will not reimburse swing-bed hospital service providers for items billable to residents as specified in ARM 37.40.331.

(3) For purposes of reporting costs under ARM 37.86.2803, inpatient hospital services providers which also provide swing-bed hospital services shall allocate hospital inpatient general routine service costs associated with swing-bed hospital services on the medicare "carve out" method as specified in 42 CFR 413.53(a) (2) . The department adopts and incorporates by reference 42 CFR 413.53(a) (2) (2004) . A copy of 42 CFR 413.53(a) (2) may be obtained from the Department of Public Health and Human Services, Senior and Long Term Care Division, 111 N. Sanders, P.O. Box 4210, Helena, MT 59604-4210.

(4) Providers must bill for all services and supplies in accordance with the provisions of ARM 37.85.406. The department's fiscal agent will pay a provider the amount determined under these rules upon receipt of an appropriate billing which reports the number of patient days of swing-bed hospital services provided to authorized Medicaid recipients during the billing period.

(5) Swing-bed hospital service providers aggrieved by adverse determinations by the department may request administrative review and fair hearing as provided in ARM 37.5.304, 37.5.305, 37.5.307, 37.5.310, 37.5.311, 37.5.313, 37.5.316, 37.5.322, 37.5.325, 37.5.328, 37.5.331, 37.5.334, and 37.5.337.

History: 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, 53-6-141, MCA; NEW, 1984 MAR p. 996, Eff. 6/29/84; AMD, 1984 MAR p. 2047, Eff. 12/28/84; AMD, 1989 MAR p. 670, Eff. 5/26/89; AMD, 1993 MAR p. 3069, Eff. 1/1/94; TRANS & AMD, from SRS, 2000 MAR p. 1653, Eff. 6/30/00; AMD, 2004 MAR p. 482, Eff. 2/27/04; AMD, 2014 MAR p. 3085, Eff. 1/1/15.