Mont. Admin. R. 37.86.3015 - OUTPATIENT HOSPITAL REIMBURSEMENT, OUTPATIENT HOSPITAL REIMBURSEMENT ADJUSTOR
(1) The outpatient
hospital reimbursement adjustor (HRA) payment is payable to a PPS hospital or
critical access hospital, as those terms are defined in
50-5-101,
MCA, that provides outpatient hospital services. Eligibility to receive the
outpatient HRA is based on a hospital's year-end reimbursement
status.
(2) An individual
hospital's outpatient HRA payment will be based upon total hospital Medicaid
outpatient charges and will be computed as follows: HRA = (J รท D) x P.
(a) "HRA" represents the calculated hospital
specific outpatient HRA payment.
(b) "J" equals the total outpatient hospital
charges billed to Medicaid by the hospital for which the payment is
calculated.
(c) "D" equals the
total outpatient hospital charges billed to Medicaid by all hospitals eligible
to receive an outpatient HRA payment.
(d) "P" equals the distributable revenue
generated by the outpatient hospital utilization fee plus applicable federal
financial participation.
(3) Data sources for the department to
determine which hospitals meet the criteria to receive an outpatient HRA
payment and the amount of the payment may include, but are not limited to:
(a) the Montana Hospital Association (MHA)
database;
(b) the Medicaid paid
claims database for the most recent calendar year;
(c) filed or settled cost reports;
and
(d) reports from the Licensure
Bureau of the Quality Assurance Division.
(4) Eligibility evaluations, payment
calculations, and payments will be made annually.
(5) The Montana State Hospital or a hospital
or facility operated by the state, a political subdivision of the state, the
United States, or an Indian Tribe or any facility authorized under the Indian
Health Care Improvement Act are not eligible for the HRA payment.
Notes
AUTH: 2-4-201, 53-2-201, 53-6-113, MCA; IMP: 2-4-201, 53-2-201, 53-6-101, 53-6-113, 53-6-149, MCA
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