(a) ICFs/IID shall be reimbursed using a per diem rate calculated in accordance with the methodology established below. In addition, ICFs/IID shall be subject to the rules in Chapter 7, Wyoming Nursing Home Reimbursement System, except as otherwise specified by this rule. ICFs/IID shall not be subject to the Chapter 7 rate and price setting Sections 7, 13(d), 14, 15, 16, 17(c), 18, and 19.
(b) Calculation of per diem rates for ICFs/IID. The per diem rate for ICFs/IID shall be calculated independently from the calculation of rates for facilities as defined in Chapter 7. The provider's per diem rate shall be determined utilizing either a desk reviewed or audited cost report. Costs shall not be subject to any form of cap or maximum rate for the Wyoming Life Resource Center. - (i) Effective date. The rates calculated each July 1 shall remain in effect until the following July 1.
- (ii) Per diem rates are established prospectively and shall remain in effect from the rate effective date until re-determined pursuant to this rule.
- (iii) Applicable cost report data. The data used in establishing the rate calculation is from the cost reports which ended two (2) calendar years ago (for example, cost reports ending during the period from January 1, 2013 to December 31, 2013, shall be used to set rates effective July 1, 2015).
- (iv) Cost reports submitted by ICFs/IID shall not be used in any way to calculate per diem rates for facilities as defined in Chapter 7.
- (v) Rates shall be established by inflating adjusted / reviewed costs from the midpoint of the provider's cost reporting year to the midpoint of the rate year. Inflated costs shall be divided by total patient days to arrive at the allowed per diem rate.
(c) Reimbursement of new facilities. A new facility or a newly certified facility shall receive interim payments for services provided to recipients as determined pursuant to this subsection. - (i) Submission of projected costs. A new facility shall, before receiving Medicaid funds for services provided to recipients, submit a cost report to the Department containing projected costs for the facility's first six months of operation.
- (ii) Time of submission of cost report. A new facility shall submit a cost report containing the information specified in paragraph (i) within sixty (60) days after the facility notifies the Department in writing that it wishes to participate in the Medicaid program as a provider and has been certified.
- (iii) Review of projected costs. The Department shall desk audit the cost report submitted pursuant to paragraph (i) to determine the reasonableness of the facility's allowable projected costs. An interim payment rate shall be established using the facility's reasonable, allowable costs. The interim payment rate shall not exceed the lower of the rate determined pursuant to this subsection and seventy-five percent (75%) of the Wyoming Life Resource Center rate in effect.
- (iv) Period of interim payments. Interim payments shall be effective upon the effective date of the facility's provider agreement, and shall remain in effect until a qualifying cost report has been submitted and subjected to audit and used to calculate a rate. No payments shall be made to a new facility until an interim payment rate has been determined pursuant to this subsection.
- (v) Audits of interim payments. Upon receipt of the qualifying cost report, the Department may audit a facility to determine the accuracy and reasonableness of cost reports submitted by the facility. If the audit discloses that the interim payments included non-allowable costs, costs for services and supplies not included in the per diem rate or that budgeted costs exceeded actual costs, the Department shall adjust the per diem rate retroactively to the beginning of the interim rate period and recover any excess payments.
- (vi) Audits shall be conducted in accordance with Section 5(b). Providers other than Wyoming Life Resource Center shall have rates limited to the lower of the provider's audited cost in accordance with Section 5(b) or seventy-five percent (75%) of the Wyoming Life Resource Center rate.
048-20 Wyo. Code R. § 20-5