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Committee advances bill to speed Medicaid settlements for critical‑access hospitals
Summary
The House Health and Human Services Committee voted to send House Bill 732 to the floor after sponsors and hospital leaders said the measure would allow Medicaid to initiate interim cost settlements for critical‑access hospitals instead of waiting years for Medicare audits.
Representative David Beatty, sponsor of House Bill 732, told the House Health and Human Services Committee the bill would create an interim settlement process for Medicaid cost reports submitted by Montana’s critical‑access hospitals. “Presently, some of our hospitals are waiting for years to receive Medicaid settlements, which places a financial strain on those facilities,” Beatty said, adding he drafted an amendment that includes an appropriation to address a backlog (estimated at $52,000) and ongoing program costs the department estimated at $15,000 a year.
Supporters — including the Montana Hospital Association and CEOs from several rural hospitals — described multi‑year delays that followed pandemic‑era audits. “This delay is causing a financial hardship on many of our small facilities,” Duane Preshinger of the Montana Hospital Association said, and cited department reporting that some hospitals have not been cost‑settled since 2020–2022. John Bishop, CEO of Bitter Health (a critical‑access facility), said the current practice defers Medicaid settlements until Medicare completes a final audit and that initiating tentative Medicaid settlements at filing would improve cash flow.
Mary Lemieux, division administrator for DPHHS’s Health Resources Division, said the department supports the change and explained how a contract amendment with the Medicare administrative contractor could allow Medicaid to issue tentative payments up front and then true up after Medicare’s final audit. Lemieux told the committee the change can be implemented administratively but would require appropriations to address the existing backlog and to fund the process going forward.
During committee questioning, members pressed whether administrative rulemaking could accomplish the change; Lemieux said the authority exists but the appropriation is necessary to operationalize the new settlement timing. No opponents testified in the room. The committee adopted the sponsor’s amendment adding an appropriation and voted HB732 do‑pass as amended; staff said the bill will move to the House floor for further action.
The committee recorded proxy and voice votes during executive action; the committee report will reflect the sponsor’s amendment and the fiscal language added in committee.
