Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.40 - SENIOR AND LONG TERM CARE SERVICES › Subchapter 37.40.3 - Reimbursement for Skilled Nursing and Intermediate Care Services › Rule 37.40.330 - SEPARATELY BILLABLE ITEMS

Current through Register Vol. 13, July 5, 2024
(1) In addition
				to the amount payable under the provisions of ARM
				37.40.307(1) or
				(4), the department will reimburse nursing
				facilities located in the state of Montana for the following separately
				billable items. Refer to the department's nursing facility fee schedule for
				specific codes and refer to healthcare common procedure coding system (HCPCS)
				coding manuals for complete descriptions of codes:
(a) ostomy surgical tray;
(b) ostomy face plate;
(c) ostomy skin barriers;
(d) ostomy filter;
(e) ostomy bags (pouches);
(f) ostomy belt;
(g) adhesive;
(h) adhesive remover;
(i) ostomy irrigation set and
				supplies;
(j) ostomy
				lubricant;
(k) ostomy
				rings;
(l) ostomy irrigation
				supply, cone/catheter, including brush;
(m) catheter care kit;
(n) urine test or reagent strips or
				tablets;
(o) blood tubing, arterial
				or venous;
(p) blood glucose test
				strips for dialysis;
(q) blood
				glucose test or reagent strips for home blood glucose monitor;
(r) implantable access catheter (venous,
				arterial, epidural, subarachnoid, peritoneal, etc.) external access;
(s) gastrostomy/jejunostomy tube, any
				material, any type;
(t)
				oropharyngeal suction catheter;
(u)
				implanted pleural catheter;
(v)
				external urethral clamp or compression device;
(w) urinary catheters;
(x) urinary insertion trays (sets);
(y) urinary collection bags;
(z) tracheostomy care kit for established
				tracheostomy;
(aa) tracheostomy,
				inner cannula (replacement only);
(ab) oxygen contents, portable,
				liquid;
(ac) oxygen contents,
				portable, gas;
(ad) oxygen
				contents, stationary, liquid;
(ae)
				oxygen contents, stationary, gas;
(af) cannula, nasal;
(ag) oxygen tubing;
(ah) regulator;
(ai) mouth piece;
(aj) stand/rack;
(ak) face tent;
(al) humidifier;
(am) breathing circuits;
(an) respiratory suction pump, home model,
				portable, or stationary;
(ao)
				nebulizer, with compressor;
(ap)
				feeding syringe;
(aq) nasal
				interface (mask or cannula type) used with positive airway device;
(ar) stomach tube - levine type;
(as) nasogastric tubing (with or without
				stylet);
(at) nutrition
				administration kits;
(au) feeding
				supply kits;
(av) nutrient
				solutions for parenteral and enteral nutrition therapy when such solutions are
				the only source of nutrition for residents who, because of chronic illness or
				trauma, cannot be sustained through oral feeding. Payment for these solutions
				will be allowed only where the department determines they are medically
				necessary and appropriate, and authorizes payment before the items are provided
				to the resident;
(aw) routine
				nursing supplies used in extraordinary amounts and prior authorized by the
				department;
(ax) oxygen
				concentrators and portable oxygen units (cart, E tank and regulators), if prior
				authorized by the department.
(i) The
				department will prior authorize oxygen concentrators and portable oxygen units
				(cart, E tank and regulators) only if:
(A)
				The provider submits to the department documentation of the cost and useful
				life of the concentrator or portable oxygen unit, and a copy of the purchase
				invoice.
(B) The provider
				maintains a certificate of medical necessity indicating the PO2 level or oxygen
				saturation level. This certificate of medical necessity must meet or exceed
				Medicare criteria and must be signed and dated by the patient's physician. If
				this certificate is not available on request of the department or during audit,
				the department may collect the corresponding payment from the provider as an
				overpayment in accordance with ARM
				37.40.347.
(ii) The provider must
				attach to its billing claim a copy of the prior authorization form.
(iii) The department's maximum monthly
				payment rate for oxygen concentrators and portable oxygen units (cart, E tank
				and regulators) will be the invoice cost of the unit divided by its estimated
				useful life as determined by the department. The provider is responsible for
				maintenance costs and operation of the equipment and will not be reimbursed for
				such costs by the department. Such costs are considered to be covered by the
				provider's per diem rate.