Montana Administrative Rule Pertaining to Hospital-Acquired Conditions Claims is Proposed

May 30, 2011

A notice of proposed administrative rules containing a provision for reimbursement for hospital-acquired conditions was given by the Montana Department of Public Health and Human Services on May 26, pill 2011.

The proposed administrative rule amends Administrative Rules of Montana, section 37.86.2907 pertaining to Medicaid inpatient hospital services. The amendment provides as follows:

(e) For claims with dates of payment on or after August 1, 2011, when a hospital-acquired condition occurs during hospitalization and the condition was not present or undeterred to be present on admission, claims will be paid as though the diagnosis is not present or undetermined to be present. Hospital-acquired conditions refers to the Centers for Medicare and Medicaid Services (CMS) definition as provided in Section 1886(d)(4) of the Social Security Act.

A public hearing on the proposed rule will be held on June 15, 2011 at 9 a.m. in the auditorium of the Department of Public Health and Human Services Building.

For more information, or to read the proposed rule, click here.

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