37.86.2931    ROUTINE DISPROPORTIONATE SHARE HOSPITAL

(1) A hospital is deemed a routine disproportionate share hospital if:

(a) it has a Medicaid inpatient utilization rate of at least one standard deviation above the mean Medicaid inpatient utilization rate for all hospitals receiving Medicaid payments in Montana or a low income utilization rate exceeding 20%; and

(b) it has a Medicaid inpatient utilization rate of at least 1%.

(2) Urban hospitals must have at least two obstetricians with staff privileges who have agreed to provide obstetric services to Medicaid patients. Rural hospitals must have at least two physicians with staff privileges to perform nonemergent obstetric procedures who have agreed to provide obstetric services to Medicaid recipients.

(3) This rule does not apply to hospitals which:

(a) serve inpatients who are predominantly individuals under 18 years of age; or

(b) do not offer nonemergent obstetric services as of December 21, 1987.

 

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, 53-6-149, MCA; NEW, 2004 MAR p. 482, Eff. 2/27/04; AMD, 2018 MAR p. 1041, Eff. 5/26/18.