37.86.1506    HOME INFUSION THERAPY SERVICES, REIMBURSEMENT

(1) Subject to the requirements of these rules, the Montana Medicaid program will pay for home infusion therapy services on a fee basis, as specified in the department's home infusion therapy services fee schedule. The department adopts and incorporates by reference the Home Infusion Therapy Services Fee Schedule as provided in ARM 37.85.105(3). A copy of the department's fee schedule is posted at the Montana Medicaid provider web site at http://medicaidprovider.mt.gov. A copy of the Home Infusion Therapy Services Fee Schedule may also be obtained from the Department of Public Health and Human Services, Health Resources Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951. The specified fees are on a per day or a per dose basis as specified in the fee schedule. The fees are bundled fees which cover all home infusion therapy services as defined in ARM 37.86.1501.

(2) For home infusion therapy services also reimbursed for the person by the Medicare program, Medicare payments will be considered to be third party payments and, if the Medicare payment is less than the Medicaid fee schedule amount, Medicaid will pay the difference between the Medicare payment and the Medicaid fee specified in the home infusion therapy fee schedule described in (1).

(3) Covered drugs prepared and administered as part of a person's home infusion therapy program are separately billable under the Montana Medicaid Outpatient Drug program as specified in ARM 37.86.1102 and 37.86.1105.

(4) Nursing services provided by licensed nurses employed by the home infusion therapy agency will be reimbursed to the agency as specified in the Home Infusion Therapy Fee Schedule. Home nursing services for infusion/specialty drug administration are not billable when the home infusion therapy program is provided in a nursing facility.

History: 53-2-201, 53-6-113, MCA; IMP, 53-6-101, 53-6-113, MCA; NEW, 1996 MAR p. 2599, Eff. 10/4/96; TRANS, from SRS, 2000 MAR p. 481; AMD, 2003 MAR p. 1314, Eff. 7/1/03; AMD, 2004 MAR p. 750, Eff. 4/9/04; AMD, 2007 MAR p. 1824, Eff. 11/9/07; AMD, 2008 MAR p. 1156, Eff. 7/1/08; AMD, 2009 MAR p. 2029, Eff. 10/30/09; AMD, 2010 MAR p. 1533, Eff. 7/1/10; AMD, 2011 MAR p. 1384, Eff. 7/29/11; AMD, 2012 MAR p. 1270, Eff. 7/1/12; AMD, 2013 MAR p. 1111, Eff. 7/1/13.