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Nursing Facilities Services

Price-Based Reimbursement System

Nursing facilities are reimbursed under a case mix price-based system where rates are determined annually, effective July 1. Each nursing facility receives a facility specific rate. The statewide price for nursing facility services is established annually through a public process. Each nursing facility’s payment is comprised of two components, the operating component including capital and the direct resident care component.

 Each nursing facility receives the same operating per diem rate, which is 80% of the statewide price. The remaining 20% of the statewide price represents the direct resident care component of the rate and is acuity adjusted. Each facility’s direct resident care component rate is specific to the facility based upon the acuity of the Medicaid residents served in the facility. For state fiscal years 2002 and 2003, a hold harmless provision provided facilities with a minimum 2% rate increase over their June 30, 2001 rate for each state fiscal year was utilized. For state fiscal year 2004 and thereafter, each facility will be reimbursed according to the case mix price-based nursing facility reimbursement system.

The address for the Montana Medicaid Nursing Facility Rules can be located at:

http://www.dphhs.mt.gov/legalresources/index.shtml
Click on the Link, Click on the Administrative Rules of Montana, Click on Arm Title 37 and then click on Chapter 40 for the nursing facility rules.

The nursing facility rules start at 37.40.301 (page 37-8733) and end at 37.40.361 (page 37-8877). The Montana Medicaid payment methodology is at 37.40.307 (page 37-8759).