Rule 20.15.102 - A PROVIDER MUST ENROLL IN MEDICAID AND ACCEPT THE MEDICAID REIMBURSEMENT RATE TO RECEIVE PAYMENT BY STATE(1) To receive payment from the State for health care services provided to an individual identified in 53-6-1312, MCA, a provider must: (a) be enrolled as a Montana Medicaid provider;(b) accept the Montana Medicaid rates as full payment for all health care services; and(c) comply with the requirements of this subchapter.(2) A provider who accepts an individual identified in 53-6-1312, MCA, as a patient is agreeing to accept the Medicaid rate as payment in full.(3) In service settings where an individual identified in 53-6-1312, MCA, is accepted as a patient by a provider who arranges for services by other providers, all providers performing services are deemed to have accepted reimbursement from the State at the Montana Medicaid rates.(4) A provider may not "balance bill" or seek payment in addition to, or in lieu of, the payment by the State. "Balance bill" means a provider bills the patient, or responsible party, the difference between the amount the state reimburses for services and what the provider chooses to charge.Mont. Admin. r. 20.15.102
NEW, 2016 MAR p. 313, Eff. 2/20/2016.AUTH: 53-1-203, 53-6-1318, MCA; IMP: 53-6-1312, MCA