(1) For services provided on or after August 1, 2003, hospitals receiving provider based status from the Centers for Medicare and Medicaid Services (CMS) must send a copy of the CMS letter granting provider based status to the department's hospital program officer at Department of Public Health and Human Services, Health Resources Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951 and must receive department approval prior to billing as a provider based clinic.

(2) Medicaid does not allow self-attestation of provider based status.

(3) The provider based entity must provide the department a list of facilities, clinics, and all professional staff and their Medicaid provider numbers who will be billing provider based visits to Medicaid.

(4) Notification must be provided to the department within 30 days of staff changes.