37.85.1109    ELIGIBLE HOSPITAL ELIGIBILITY VERIFICATION BY DPHHS

(1) The following information will be verified by the department upon receipt of notification from the CMS NLR that a Montana EH enrolled:

(a) the EH has no sanctions preventing participation;

(b) the EH is appropriately licensed by the state of Montana;

(c) the provider is listed on the NLR correctly;

(d) the EH has a 10% Medicaid patient volume; and

(e) the EH is an eligible provider type (e.g., acute care hospital including critical access hospitals, cancer hospital, or children's hospital).

(2) Montana Medicaid will verify eligibility through the Montana Medicaid Management Information System (MMIS). If the EH is listed in the MMIS in an "active" status, the Montana Medicaid fiscal agent has already completed the verification for licensure and sanctions.

(3) An EH must be actively enrolled in Medicaid in order to apply for the MMPIP program. If an EH wants to participate in MMPIP but is not listed as active in the MMIS, the provider must enroll, or clarify enrollment status with the Montana Medicaid fiscal agent, prior to continuing registration in the MMPIP program.

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