Montana Code Annotated 2023



Part 2. Department of Public Health and Human Services

Rate Adequacy -- Plan For Collection Of Data -- Reports

53-2-212. Rate adequacy -- plan for collection of data -- reports. (1) The department of public health and human services, in collaboration with providers, consumers, and other stakeholders, shall develop a plan for collecting expenditure data from medicaid-dependent providers of services that:

(a) assist and support the elderly and persons with mental illness, physical disabilities, and developmental disabilities; and

(b) are administered by the department divisions responsible for overseeing services for the elderly and persons with mental illness, physical disabilities, or developmental disabilities.

(2) The purpose of the plan is to enable the department and the legislature to:

(a) analyze the data;

(b) determine the cost of providing services;

(c) make sound judgments about whether the rates being paid for each service are too high, too low, or appropriate; and

(d) make decisions about rates that are based on sound data and analysis.

(3) The plan must:

(a) identify medicaid-dependent providers;

(b) identify high-volume services based on the units of service and costs;

(c) identify smaller providers who should be exempt from data reporting requirements;

(d) determine a base year for data collection and identify the types of expenditures and the providers who are required to report data in order to make it possible to analyze data and make determinations about rate adequacy;

(e) ensure that expenditure data reporting requirements are consistent across divisions of the department to the extent possible;

(f) identify how often data should be collected for purposes of updating the base year expenditures; and

(g) create a schedule prioritizing the order in which data is collected from various providers in order to transition to a point at which the information will be available regarding all applicable providers and will be updated on a regular basis.

(4) (a) The plan must be completed no later than July 1, 2022, and be provided to the 2023 legislature in accordance with 5-11-210.

(b) Beginning no later than September 1, 2021, the department shall provide quarterly updates to the 2021-2022 children, families, health, and human services interim committee regarding the progress being made in developing the plan.

(5) For the purposes of this section, "medicaid-dependent providers" means providers with more than half of their clients receiving services through the medicaid program.

History: En. Sec. 1, Ch. 384, L. 2021.