Are there special rules for provider reimbursement from the Medical Assistance program under The Montana law?
Nothing in the Montana law changes the rules or policies on provider reimbursements in the MA program. MA will use the same Third Party Liability (TPL) rules as it does today and as it does with all other services and with other conditions besides autism. Providers must be enrolled in the MA Program to be eligible to receive payment, including private insurance copayments, from the MA program, The MA program will not pick up the copay for and has no jurisdiction over providers who are not enrolled in the MA program. Under the rules of the MA program, the combined amount the MA provider receives from the insurance company and the amount paid by the MA Program is considered payment in full. Providers must bill MA, and not the families. All providers who are enrolled in MA have agreed to these rules and they will remain in force.
