Nursing Facility

Prior Authorization Forms Claim Jumper Newsletters

General Information for Providers  

Medicaid manual with general information for all provider type

Nursing Facility and Swing Bed Services 

This manual has information specific to your provider type.

January 2014

PDF: January 2014 Ancillary Services Rev. 06/27/2017   Cover Sheet: January 2014 Ancillary Services Rev. 06/27/2017
Excel:  January 2014 Ancillary Services Rev. 06/27/2017
TXT: January 2014 Ancillary Services Rev. 06/27/2017

2021

09/16/2021 Billing Update - Licensed Marriage and Family Therapist (LMFT)
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

2020

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

07/17/2020  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

04/22/2020  Suspension of Prior Authorizations or Continued Stay Reviews and Clinical Requirements for Some Medicaid Programs


04/07/2020  Requirements and Billing for Telehealth Services by Nursing Facilities
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

01/10/2020  Co-Payment Assessed in Error for January 6, 2020 Payment

2019

12/27/2019 Elimination of Copayments
11/18/2019 HCPCS Modifiers - XE, XS, and XU (Reissued Notice)
05/20/2019 Nurse Visit - Appropriate Billing Reminder - Revised Clarification rev. 05/30/2019

2018

11/20/2018  Appropriate Billing Reminder
11/08/2018  Rate Updates Mass Adjustment
10/19/2018 Medicaid Fee Schedules
07/11/2018  Nursing Facility Claim Billers - Rates Effective 07/01/2018
07/02/2018 Updated CLIA Claims Editing
06/13/2018 Nursing Facility Claim Billers - Rates Effective 06/13/2018 REVISED 06/21/2018
06/04/2018 Coding Resources Change
04/04/2018  Updated Passport Eligible Populations & Reimbursement
03/14/2018  Prior Authorization for Genetics Testing for Youth Mental Health
02/26/2018  New Rendering Only Provider Enrollment Application

Nursing Facilities Forms

Medicaid Cost Report Instructions
Therapeutic Home Visit
Therapeutic Home Visit 72 Hours
Hospital Hold
 

Additional forms for all provider types are found on the Forms Page.

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 443-0320 or 1-800-219-7035. Questions regarding this correspondence can be directed to either Shaunda Hildebrand at (406) 444-4209 or Jill Sark at (406) 444-4544.

What is MDS 3.0?
Changes to the federal minimum data set (MDS) tool (Version 3.0 assessment), went into effect on October 1, 2010.  One of these changes relates to Nursing Facilities (SNFs/NFs), States, and other qualified entities to identify individuals that are interested in returning to the community.

Frequently Asked Questions
Letter to Nursing Facilities
Community Alternatives
Your Discharge Planning Check List

Civil Money Penalties Program (CMP)
A civil money penalty (CMP) is a monetary penalty the Centers for Medicare & Medicaid Services (CMS) may impose against skilled nursing facilities (SNF’s), nursing facilities (NF’s), and dually-certified SNF/NF for either the number of days or for each instance a facility is not in substantial compliance with one or more Medicare and Medicaid participation requirements for Long Term Care Facilities. A portion of CMP’s collected from facilities are returned to the States in which the CMP’s are imposed to provide grant funding to benefit nursing facility residents.

Civil Money Penalty (CMP) Reinvestment Application Template

Civil Money Penalties (CMP) Reinvestment Application Instructions and Information rev. 08/26/2021

CMS CMP Toolkits and other helpful resources
Civil Monetary Penalties (CMP) Awardees