(a) In general. Except as otherwise specified in this Chapter, the Department reimburses hospitals providing outpatient hospital services to recipients using Medicare principles of cost reimbursement. The Medicaid allowable payment shall be the lower of the hospitals usual and customary charges and the allowable payment determined pursuant to this section.
(b) Interim rate. The interim rate for outpatient hospital services shall be the interim rate established for inpatient services reduced by twenty percent.
(c) Negotiated rate. A hospital may negotiate an interim rate which is lower than the interim rate which would otherwise be in effect pursuant to this Section.
(d) New hospitals. A new hospital shall receive an initial rate equal to the lowest rate for outpatient services established for a hospital located in Wyoming pursuant to paragraph (e)(i) until the hospital files its most recently settled Medicare cost report.
(e) Hospitals located in Wyoming. - (i) Interim rate. The Department shall establish an interim rate for outpatient hospital services based on the most recently settled cost report submitted by the hospital to the Medicare intermediary.
- (A) Rate effective date. The interim rate shall be effective for all outpatient hospital services provided on or after December 1, 1992;
- (B) Rate period. The interim rate shall remain in effect for all outpatient hospital services until redetermined pursuant to this Section;
- (C) Except as otherwise specified b this rule, the interim rate shall be applied to all claims submitted by the provider.
- (ii) Cost settlement. The Department shall Cost settle, pursuant to Section 8, Medicaid reimbursement for outpatient hospital services provided during each rate period.
(f) Hospitals located outside Wyoming. - (i) Reimbursement rate. The Department shall determine a reimbursement rate for outpatient hospital services provided by hospitals located outside the State of Wyoming pursuant to paragraph .(ii) and (iii). Such rate shall remain in effect for all outpatient hospital services until redetermined pursuant to this subsection.
- (ii) Hospitals which submit cost reports.
- (A) Submission of cost reports. Hospitals located outside Wyoming . which provide outpatient hospital services to Wyoming recipients may submit cost reports as set forth in subsection 5(g).
- (B) Determination of reimbursement rate. The Department shall establish a reimbursement rate for each hospital which submits a cost report using the methods and standards set forth in paragraph 5(g)(ii), as modified by subsection 6(b). Rates shall be effective as set forth in sub-paragraphs 5(g)(ii)(z) and (E). (F) Cost settlement. The may cost settle, pursuant to Section 8, unless the Department determines that it is not cost-effective to do so.
- (iii) Hospitals which do not submit cost reports. The reimbursement rate for hospitals which elect not to submit cost reports pursuant to paragraph (ii) shall be established using the methods and standards set forth in subsection 5 (g!(iii), as modified by subsection ! . Rates shall be effective as set forth in paragraph 5(g)(ill).
048-24 Wyo. Code R. § 24-6