(1) Subject to the availability of sufficient county and federal funding, the department will pay, in addition to the established Medicaid rates provided in ARM 37.88.907, a service access rate adjustment payment to an eligible community mental health center in Montana as defined at 53-21-201 , MCA when:

(a) the community mental health center's usual and customary (billed) charges are greater than the reimbursement received from Montana Medicaid; and

(b) the community mental health center is funded, or partially funded, including tax district funding, by a county with fewer than six residents per square mile based on the latest population data published by the United States Bureau of the Census; and

(c) the community mental health center is reimbursed under Montana Medicaid; and

(d) county funds are transferred directly to the department and are certified by the contributing county as match for payment of services eligible for federal financial participation in accordance with 42 CFR 433.51. The county funds shall not be federal funds or shall be federal funds authorized by federal law to be used to match other federal funds; and

(e) the community mental health center has executed and entered into a written agreement with the department concerning rural access to services and the provision of telephone crisis services and has agreed to abide by the terms of the written agreement.

(i) The written agreement between the department and the community mental health center must be executed prior to the issuance of the service access rate adjustment payment.

(ii) A community mental health center that does not enter into a written agreement with the department or does not abide by the terms of the agreement will not be eligible for the service access rate adjustment payment process.

(2) The department will calculate the amount of the service access rate adjustment payment for each eligible community mental health center using paid claims data from the community mental health center established pursuant to 53-21-204 , MCA, for the quarter ending one quarter before the quarter in which the service access rate adjustment payment will be paid. The service access rate adjustment payment for each eligible community mental health center shall be the least of:

(a) the difference between the community mental health center's usual and customary (billed) charges and the reimbursement received from Montana Medicaid;

(b) the amount of county funds transferred to the department and any state funds the department chooses to use for this purpose plus federal financial participation; or

(c) a premium over the established rates determined by the department but not to exceed 25%.

(3) No aggregate rate of Medicaid reimbursement, including established Medicaid rate and service access rate adjustment payments, for all community mental health centers shall exceed the corresponding Medicare rate, if any.

(4) For the community mental health centers eligible for the service access rate adjustment payment, the department will pay the service access rate adjustment payment quarterly beginning July 1, 2001.

(5) The department shall include all service access rate adjustment payments in the department's quarterly reports as required by federal law and regulations.

(6) The service access rate adjustment payment is subject to the restrictions imposed by federal law.