Glendive Medical Center6/18/2002
he absence of an express authorization or requirement within the rule. Essentially, GMC argues that nothing in the rule puts GMC on notice that it must deduct VA per diem payments from Medicaid reimbursement claims for individual veterans because DPHHS did not adopt a rule specifically requiring that VA per diem be "treated like" third-party liability.
DPHHS is enabled to adopt rules necessary for the administration of the Montana Medicaid program pursuant to §§ 53-6-113, MCA. The definition of "rule" is provided in the Montana Administrative Procedure Act, §§ 2-4-102(11), MCA. That section provides in part:
"Rule" means each agency regulation, standard, or statement of general applicability that implements, interprets, or prescribes law or policy or describes the organization, procedures, or practice requirements of an agency.
A valid and enforceable agency rule cannot exceed its enabling statute and must be properly adopted pursuant to the requirements in §§ 2-4-301, et seq., MCA. See, e.g., Northwest Airlines, Inc., v. State Tax Appeal Board (1986), 221 Mont. 441, 445, 720 P.2d 676, 678.
GMC does not assert that Rule 46.12.304(2)(a), ARM, exceeds its enabling statute or was improperly adopted, but that it does not provide specific notice that a third-party liability will be something other than an obligation owed to the patient, enforceable by the patient, directly payable to the patient, assignable by the patient and portable. In other words, GMC argues that the definition of a third party in Rule 46.12.304(2)(a), ARM, is inconsistent with its own suggested definition and, as such, provides no notice that VA per diem payments are a third-party liability.
However, the plain language of Rule 46.12.304(2)(a), ARM, provides specific notice that a public agency will be considered a third party if it is liable to pay all or part of the cost of medical treatment and medical-related services for a person's personal injury , disease or illness. VA is a public agency contributing per diem payments for medical services to individual veterans at EMVH. Under a reasonable interpretation permitted by the wording of the rule, this is sufficient for the VA to qualify as a third party. This Court will not conclude that the rule is invalid or unenforceable simply because GMC submits an alternative definition of third party based on the nonexclusive examples within the rule. We conclude that Rule 46.12.304(2)(a), ARM, provides notice, or a "statement of general applicability," pursuant to §§ 2-4- 102, MCA, which sufficiently identifies those considered third parties.
Based upon the undisputed facts and a plain reading of the administrative rule, we conclude that DPHHS's interpretation of Rule 46.12.304(2)(a), ARM, is not plainly inconsistent with the spirit nor the plain language of the rule, but lies within the range of reasonable interpretation permitted by the wording. Consequently, DPHHS was correct in concluding that Rule 46.12.304(2)(a), ARM, when read in conjunction with Rules 46.12.304(1) and 46.12.309(1)(c), ARM, requires GMC to report the VA per diem payments as third-party liability payments for purposes of Medicaid reimbursement. We conclude, therefore, that the District Court did not err in determining that the decision of the Board of Public Assistance was legally correct.
Affirmed.
We concur:
KARLA M. GRAY
TERRY N. TRIEWEILER
JIM REGNIER
W. WILLIAM LEAPHART
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