Section 19-8 - Medicaid Reimbursement (a) Completion of screening. No facility shall receive Medicaid reimbursement for nursing facility services furnished to a client until: - (i) The completion of the Level I screening which indicates that there is no need for Level II screening or, if the Level I screening indicates the need for Level II screening, the completion of the Level II screening and a determination that nursing facility services are appropriate; and
- (ii) The completion of the evaluation of medical necessity pursuant to the Rules and Regulations of Wyoming Medicaid, Chapter 22, Nursing Facility Long Term Care/Home/Community Based Evaluation, which indicates that nursing facility services are medically necessary.
(b) Retroactive payments. - (i) For clients that do not require Level II screening, Medicaid reimbursement shall commence upon receipt by the Department of the results of the Level I screening indicating that there is no need for a Level II screening. Reimbursement shall be retroactive to the date of the completion of the Level I screening, provided there was an evaluation of medical necessity pursuant to the Rules and Regulations of Wyoming Medicaid, Chapter 22, Nursing Facility Long Term Care/Home/Community Based Evaluation.
- (ii) For clients that require Level II screening, Medicaid reimbursement shall commence upon the completion of the Level II screening which indicates that nursing facility services are appropriate, except as specified in Section 7 of this Chapter. Reimbursement shall be retroactive to the date of the completion of the Level II screening, provided there was an evaluation of medical necessity pursuant to the Rules and Regulations of Wyoming Medicaid, Chapter 22, Nursing Facility Long Term Care/Home/Community Based Evaluation. Payments for residents permitted to continue to reside in a facility pursuant to the thirty (30)-month rule, as defined in 42 C.F.R. § 483.130, are subject to the provisions of this paragraph, except that such payments shall be contingent upon the completion of a Level II screening, regardless of whether the screening indicates that nursing facility services are appropriate.
048-19 Wyo. Code R. § 19-8