37.86.3109    OUTPATIENT CARDIAC AND PULMONARY REHABILITATION REIMBURSEMENT

(1) Critical access hospital (CAH) interim reimbursement is based on a hospital-specific Medicaid outpatient cost-to-charge ratio, not to exceed 100%. For dates of service January 1, 2018 through June 30, 2018, the interim reimbursement is based on the hospital specific Medicaid outpatient cost-to-charge ratio (CCR), less 2.99% not to exceed 100%. For dates of service on or after July 1, 2018, the interim reimbursement is based on the hospital-specific Medicaid outpatient cost-to-charge ratio. CAHs will be reimbursed their actual allowable costs determined according to ARM 37.86.2803.

(2) Prospective payment hospitals will be reimbursed on a rate-per-service basis using the outpatient prospective payment system (OPPS) schedules as provided in ARM 37.86.3020.

(3) Out-of-state hospitals will not be reimbursed for these services. 

 

History: 53-2-201, 53-6-111, MCA; IMP, 53-2-201, 53-6-101, MCA; NEW, 2006 MAR p. 1640, Eff. 6/23/06; AMD, 2012 MAR p. 1382, Eff. 7/13/12; AMD, 2017 MAR p. 2287, Eff. 1/1/18; AMD, 2018 MAR p. 2057, Eff. 10/20/18.