In this subchapter the following definitions apply:

(1)   "Category of service" means a type of medicaid covered service that is furnished in an RHC or FQHC.

(2)   "Crossover claim" means a claim for services provided to medicare/medicaid dual eligibles or qualified medicare beneficiaries.

(3)   "Federally qualified health center (FQHC)" means an entity which is a federally qualified health center as defined in 42 USC 1396d(l)(2)(B) (2003 Supp.). For purposes of defining "federally qualified health center" the department adopts and incorporates by reference 42 USC 1396d(l)(2)(B) (2003 Supp.), which is a federal statute defining "federally qualified health center" for purposes of the medicaid program. A copy of the cited statute is available upon request from the Department of Public Health and Human Services, Health Resources Division, Hospital and Clinical Services Bureau 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

(4)   "FQHC core services" means the FQHC ambulatory services defined in 42 USC 1396d(l)(2)(A) and described in 42 USC 1395x(aa)(1). For purposes of defining and describing FQHC core services, the department adopts and incorporates by reference 42 USC 1396d(l)(2)(A) and 42 1395x(aa)(1) (2003 Supp.). The cited statutes are federal medicaid and medicare statutes defining certain FQHC services for purposes of the medicaid and medicare programs. Copies of the cited statutes are available upon request from the Department of Public Health and Human Services, Health Resources Division, Hospital and Clinical Services Bureau, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

(5)   "FQHC other ambulatory services" means ambulatory FQHC services, other than FQHC core services, that would be covered under the Montana medicaid program if provided by an individual or entity other than an FQHC in accordance with applicable medicaid requirements.

(6)   "FQHC services" means FQHC core services and FQHC other ambulatory services.

(7)   "Increase or decrease in the scope of service" means the addition or deletion of a service or a change in the magnitude, intensity or character of services provided by an FQHC or RHC or one of their sites. The increase or decrease in the scope of service must reasonably be expected to last at least one year. The term includes but is not limited to:

(a)   an increase or decrease in intensity attributable to changes in the types of patients served, including but not limited to HIV/AIDS, the homeless, elderly, migrant or other chronic diseases or special populations;

(b)   any changes in services or provider mix provided by an FQHC or RHC or one or their sites;

(c)   increases or decreases in operating costs that have occurred during the fiscal year and that are attributable to capital expenditures, including new service facilities or regulatory compliance; and

(d)   any approved changes in scope of project as defined by the health resources and service administration (HRSA).

(8)   "Independent entity" means a rural health clinic or an FQHC that is not a provider-based entity.

(9)   "Provider" means the entity enrolled in the Montana medicaid program as a provider of RHC or FQHC services.

(10)   "Provider-based entity" means an FQHC or RHC that is an integral and subordinate part of a hospital, skilled nursing facility, or home health agency that is participating in the medicare program and that is operated with other departments of the provider under common licensure, governance and professional supervision.

(11)   "Reporting period" means a period of 12 consecutive months specified by an RHC or FQHC as the period for which the entity must report its costs and utilization. The reporting period must correspond to the provider's fiscal year. The first and last reporting periods may be less than 12 months.

(12)   "Rural health clinic (RHC)" means a clinic determined by the secretary of the United States department of health and human services to meet the rural health clinic conditions of certification specified in 42 CFR, part 491, subpart A.

(13)   "RHC core services" means the rural health clinic services described in 42 CFR 440.20(b)(1) through (4).

(14)   "RHC other ambulatory services" means other ambulatory services furnished by an RHC as described in 42 CFR 440.20(c).

(15)   "Rural health clinic (RHC) services" means RHC core services and RHC other ambulatory services.

(16)   "Visit" means a face-to-face encounter between a clinic or center patient and a clinic or center health professional for the purpose of providing RHC or FQHC core or other ambulatory services. For purposes of this subchapter, the terms of ARM 37.86.4402 must be used to determine whether an encounter or series of encounters is one or more visits.