Applicable Rules
Administrative Rules of Montana at 37.40.401-421 pertains to the Medicaid requirements and payments for services in swing bed hospitals.
Participation Requirements
Admission Requirements
Transfer Requirements
Medicaid member must be discharged to an appropriate nursing facility bed within the 25-mile radius of the swing bed hospital/critical access hospital when such bed becomes available.
Waiver of Transfer
Physician may request in writing a waiver of the 25-mile transfer requirement if:
Senior and Long-Term Care Division evaluates this information and will either approve or deny this request for a waiver in writing to the swing bed hospital.
Medicaid Reimbursement Rate
Medicaid swing bed hospital per diem rate is the statewide average Medicaid per diem rate paid to all nursing facilities for routine services for the previous calendar year. Rates are computed annually and are the same for each swing bed provider:
FY 2022 (1/1/22 -12/31/22) $211.62
FY 2021 (1/1/21 -12/31/21) $207.36 $209.60 (Direct Care Wage**)
** The nursing facility rate methodology changed July 1, 2020. The new methodology no longer includes the direct care wage that was included in the rate from 2009. Therefore, the direct care wage has also been eliminated from the swing bed rate.
Billing
Swing bed providers bill the per diem rate established by Medicaid on the Form MA-3. Beginning March 4, 2010, swing bed facilities may now bill Montana Medicaid electronically for per diem charges. Services that are included in the swing bed per diem rate and the services that can be billed in addition to the per diem are the same as for nursing facility providers.
Providers
There are currently 46 Montana facilities enrolled in the Medicaid swing bed program.
Contacts
For reimbursement rates, contact Dee Burnham at (406) 444-4129.
For waivers of the transfer requirements, contact Jenifer Thompson at (406) 444-3997.
General Information for Providers
Medicaid manual with general information for all provider types.
Nursing Facility and Swing Bed Services 10/2017
This manual has information specific to your provider type.
Code of Federal Regulations (Title 42)
Montana Code Annotated - https://leg.mt.gov/ (Choose “Laws & Bills” then “ Montana Statutes – MCA”)
Applicable Section: Title 53, Chapter 6
09/15/2023 Claims Payment Discrepancy Update
09/14/2023 Claims Payment Discrepancy Identified
09/08/2023 Medicaid Claims Payment Delayed
08/01/2023 Provider License Expiration Reminder Letters
07/06/2023 Provider Rate Increases
06/28/2023 Wheelchair and Bariatric Equipment Coverage for Nursing Facility Residents
06/28/2023 Nursing Facility QMB Claims
05/30/2023 Add-Ons Moving to Mountain-Pacific Quality Health
05/26/2023 Medicaid Reimbursement and Court Ordered Services REVISED
04/10/2023 Resumption of Face-to-Face Requirements for Selected Programs REVISED
03/22/2023 Coverage and Reimbursement Policy for Telemedicine/Telehealth Services
03/22/2023 End of Public Health Emergency (PHE) Effects on Pharmacy Coverage
03/22/2023 Non-Covered Services Agreement Policy Return to Requirements
03/22/2023 Reinstatement of the Primary Care Provider Referral for Passport
03/22/2023 Resumption of Face-to-Face Requirements for Selected Programs
03/22/2023 Resumption of Prior Authorization Requirements Revised 04/03/2023
03/17/2023 End of Temporary Revision to Case Management General Provisions
03/10/2023 Provider Meetings for Medicaid Eligibility Redetermination and Unwinding PHE Flexibilities
03/09/2023 Add-on and E&M Code Editing
03/03/2023 End of Public Health Emergency
01/04/2023 Montana Healthcare Programs Support Services Holiday Closures
12/15/2021 Health Behavior Assessment and Intervention Billing Codes Rev. 04/26/2022
12/10/2021 New Provider Services Portal
09/16/2021 Billing Update - Licensed Marriage and Family Therapist (LMFT)
07/20/2021 Enrollment Update – Licensed Marriage and Family Therapist
07/06/2021 Adoption Of Temporary Emergency Rule To Allow for COVID-19-Related
Regulatory Discretion Beyond The Expiration Of The Governor-Declared State Of Emergency
06/11/2021 COVID-19 Vaccine Administration Billing Guidance
05/17/2021 Process to Enter PASRR requests through the Qualitrac portal
04/02/2021 New Provider Type – Licensed Marriage and Family Therapist
01/28/2021 Montana Healthcare Programs Support Services Holiday Closures
01/11/2021 Provider Support Services Closed for Martin Luther King Day, Monday, January 18, 2021
12/07/2020 Medicaid Expansion Extended Through December 31, 2021
10/28/2020 Provider Relief Fund General Allocation
08/28/2020 Provider Relief Fund General Allocation rev. 08/28/2020
08/11/2020 Provider Relief Fund General Allocation rev. 08/11/2020
07/24/2020 Provider Relief Fund General Allocation
7/17/2020 Medicaid Reimbursement and Court Ordered Services
06/17/2020 National Correct Coding Initiative Announcement
05/15/2020 Temporary Revision to Case Management General Provisions
04/30/2020 National Correct Coding Initiative Announcement
04/28/2020 Temporary Suspension of the PCP Referral Requirement
04/27/2020 Non-Covered Services Agreement Policy Change
04/01/2020 Suspension of Face to Face Requirements for Some Medicaid Programs
03/19/2020 Telemedicine Medicaid Coverage and Reimbursement Policy for Telemedicine/Telehealth rev 03/27/2020
Level of Care Screens (LOC) for Nursing Facility Residents
Level of care screening must be completed for Medicaid patients in order to receive Medicaid payments for nursing facility stays. The level of care screening must be requested prior to admission or Medicaid coverage as they may only be backdated 30 days if the individual meets level of care and has completed a Level I screen. Please review the information below regarding level of care.
Please review the following:
LOC Level of Care Screening Information
LOC Cover letter
LOC Flow Chart
LOC Determination form
If you have any questions about LOC(s), please contact Mountain Pacific Quality Health at (406) 443-0320 or (800) 219-7035. Questions regarding this correspondence can be directed to either Shaunda Hildebrand at (406) 444-4209 or Jill Sark at (406) 444-4544.
Local Contact Agencies
Local Contact Agencies - RPOs
Area Agencies on Aging
Montana Ombudsman
Long Term Care Ombudsman Resources
Montana's Long Term Care Ombudsman Program - Brochure
Assisted Living Facility - Assessment Checklist - Brochure
10 Tips for Choosing a Quality Long Term Care Facility - Brochure
Your Rights as a Nursing Home Resident - Brochure
Your Rights as a Assisted Living Facility Resident - Brochure
Can Medicaid Help Me With My Nursing Home Bills - Brochure
Montana Lien and Estate Recovery Program - Brochure