ARM 37.86.3005. OUTPATIENT HOSPITAL SERVICES, REIMBURSEMENT AND QUALIFIED RATE ADJUSTMENT PAYMENT

(1) The department will reimburse for outpatient hospital services and birthing center services compensable under the Montana Medicaid program as provided in this rule. (2) Outpatient hospital services that are not provided by exempt hospitals or critical access hospitals as defined in ARM 37.86.2901 will be reimbursed under ARM 37.86.3007, 37.86.3009, 37.86.3016, 37.86.3018, 37.86.3020, 37.86.3025, 37.86.3109, and 37.86.3037 for medically necessary services. (3) Birthing center services as defined in ARM 37.86.3001 will be reimbursed under ARM 37.86.3007, 37.86.3016, 37.86.3018, and 37.86.3020, for medically necessary services. (4) For critical access hospitals and exempt hospitals, interim reimbursement for outpatient hospital services is based on hospital specific Medicaid outpatient cost to charge ratio, not to exceed 100%. Critical access hospitals and exempt hospitals will be reimbursed their actual allowable costs determined according to ARM 37.86.2803. (5) Subject to the availability of sufficient county and federal funding, the department will pay in addition to the established Medicaid rates provided in this rule a qualified rate adjustment payment to an eligible rural hospital in Montana as provided in ARM 37.86.2810.