37.86.2806    COST-BASED HOSPITAL, GENERAL REIMBURSEMENT

(1) Cost-based reimbursement shall be applied as follows:

(a) Critical access hospital (CAH) interim reimbursement is based on a hospital specific Medicaid inpatient cost-to-charge ratio (CCR), not to exceed 100%. For dates of service January 1, 2018 through June 30, 2018, CAH interim reimbursement is based on a hospital-specific Medicaid inpatient cost-to-charge ratio (CCR), less 2.99%, not to exceed 100%.

(b) For cost report periods ending on or prior to December 31, 2017, CAH final reimbursement is for reasonable costs of hospital services limited to 101% of allowable costs, as determined in accordance with ARM 37.86.2803(1). For cost report periods ending January 1, 2018 through June 30, 2018, CAH final reimbursement is for reasonable costs of hospital services limited to 97.98% of allowable costs as determined in accordance with ARM 37.86.2803(1). For cost report periods ending on or after July 1, 2018, CAH final reimbursement is for reasonable costs of hospital services limited to 101% of allowable costs as determined in accordance with ARM 37.86.2803(1).

(2) Where applicable, the statewide CCR for cost-based hospitals is determined in accordance with ARM 37.86.2905(6).

(3) Cost-based hospital reimbursement for capital expenses is as determined in accordance with ARM 37.86.2912(3).

(4) Certified registered nurse anesthetist (CRNA) reimbursement for CAHs is as determined in accordance with ARM 37.86.2924.

(5) Cost-based hospitals may be eligible to receive a disproportionate share hospital (DSH) payment in accordance with ARM 37.86.2925.

(6) All diagnostic services are included in the cost-based payment. Diagnostic services that are performed at a second hospital because the services are not available at the first hospital (e.g., a CT scan) are included in the first hospital's payment. This includes transportation to the second hospital and back to the first hospital. Arrangement for payment to the transportation provider and the second hospital where the services were actually performed must be between the first and second hospital and the transportation provider.

(7) Cost-based hospital claims for clients with partial eligibility shall be billed from the first date of Medicaid eligibility.

(8) The following are cost-based hospital claims that are not eligible for final reimbursement through cost settlement:

(a) elective deliveries as set forth in ARM 37.86.2801; and

(b) services that are reimbursed at a set rate outside of the CCR.

 

History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-113, MCA; NEW, 2008 MAR p. 1983, Eff. 10/1/08; AMD, 2010 MAR p. 1534, Eff. 7/1/10; AMD, 2014 MAR p. 1415, Eff. 7/1/14; AMD, 2016 MAR p. 1712, Eff. 10/1/16; AMD, 2017 MAR p. 2287, Eff. 1/1/18; AMD, 2018 MAR p. 2057, Eff. 10/20/18.