37.85.1111    REGISTRATION, ATTESTATIONS, AND CERTIFICATION

(1) Upon receipt of notification from the CMS NLR of a Montana EP or EH registration, the department will accept the provider's request to register for the department's MMPIP program via secure web portal application.

(2) An EP must attest to qualifying patient volume threshold calculation as specified by 42 CFR 495.306 (2011), calculated as follows: (Total Medicaid (or needy individuals) Patient Encounters in any 90-day period in the review calendar Year) divided by (All Patient Encounters over the Same Period). Provider will submit the timeframe for the 90-day time period selected for the patient encounters measure, identify the source the information was obtained from, and submit the numerator and denominator with the resulting percentage for the Medicaid and/or needy patient volume.

(a) For all EPs except pediatricians, the minimum patient volume threshold is 30%. For pediatrician EPs, the minimum patient volume threshold is 20%.

(b) Group practices or clinics (GP/C) will be permitted to calculate patient volume at the GP/C level if all the following requirements are met:

(i) The GP/C patient volume is appropriate as a measure of patient volume for each EP;

(ii) Each EP working in the GP/C accepts Medicaid and/or needy individuals as patients;

(iii) There is an auditable data source to support the GP/C patient volume determination;

(iv) All EPs in GP/C use the same methodology for the payment year;

(v) The GP/C uses the entire practice or clinic's patient volume and does not limit patient volume in any way; and

(vi) If an EP works inside and outside of the GP/C practice, the patient volume calculation only includes patient encounters associated with the clinic or group practice, and not the EP's outside encounters.

(c) EPs practicing at FQHC or RHC must demonstrate that more than 50% of their clinical encounters occurred at an FQHC/RHC over a six-month period and that a minimum of 30% of their patient volume consists of needy individuals. EPs practicing predominantly at FQHC/RHC must provide the clinic location, the needy patient encounters for the location, the EP's total patient encounters, and the resulting percentage. This information must be for an identified six-month period.

(3) An EP or EH will report the amount of nonstate or local funds for an EHR system received that coincides with the payment year being requested, or certify that it has not received nonstate or local funds for EHRs.

History: 53-6-113, MCA; IMP, 53-6-111, MCA; NEW, 2011 MAR p. 1374, Eff. 7/29/11.