(a) In addition to the rate established pursuant to Section 8, a disproportionate share hospital shall be entitled to a disproportionate share payment computed pursuant to this section. This section is intended to implement and be read in conjunction with Section 1923 of the Social Security Act.
(b) Determination of disproportionate share hospital. A disproportionate share hospital is one which has either a: - (i) Medicaid utilization rate at least one standard deviation above the mean Medicaid utilization rate for Wyoming providers; or
- (ii) Low income utilization rate which exceeds twenty-five percent.
(c) Determination of disproportionate share payment. - (i) A hospital which meets the criterion of paragraph (b)(i) shall receive a payment determined as follows: The sum of the statewide mean disproportionate share calculation plus one standard deviation shall be subtracted from the hospital's Medicaid utilization rate. The difference shall be multiplied by the hospital's inpatient Medicaid payment during the hospital's fiscal year. The sum shall be the amount of the disproportionate share payment for the cost reporting year.
- (A) Hospitals located in Wyoming shall be automatically considered for disproportionate share payments pursuant to this paragraph.
- (B) Hospitals located outside Wyoming that wish to be considered for disproportionate share payments pursuant to this paragraph must comply with subsection (e).
- (ii) Disproportionate share payments based on low income utilization rate.
- (A) Request for consideration. A hospital which wishes to be considered for disproportionate share payments pursuant to paragraph (S ii) shall submit a request for consideration of disproportionate share payments based on low income utilization rate.
- (B) Time and contents of request. A request for disproportionate share payment pursuant to paragraph (b)(ii) must be sent to the Department, by certified mall, on or before October 31st of each year. The hospital must submit the correct cost report with the request, if it is available. The hospital must contact the Department before that date to determine which fiscal year's cost report to submit with the request. The failure to timely submit a request, including the correct cost report,.if available, shall preclude the hospital from requesting or receiving disproportionate share payment pursuant to paragraph (b)(ii). If the hospital cannot submit the correct cost report because of delay caused by the intermediary, the hospital must submit verification of the delay from the intermediary on or before the date the request is due. In such a case, the Department shall not compute the hospitals disproportionate share payment until after the hospital submits the correct cost report.
- (C) Calculation of payments. A hospital which meets the criterion of paragraph (b)(ii) shall receive a payment determined in accordance with Section 1923 of the Social Security Act. If the low income utilization rate exceeds twenty-five percent, the hospital shall be entitled to a disproportionate share payment. The disproportionate share payment shall be equal to the low income utilization rate in excess of twenty-five percent multiplied by the total allowable Medicaid costs for inpatient hospital services.
(d) Determination of statewide mean disproportionate share calculation. The Department shall determine the statewide mean disproportionate share calculation for each Wyoming state fiscal year using the most recently settled cost reports submitted for hospitals located in Wyoming.
(e) Disproportionate share payments for hospitals located outside Wyoming. - (i) Request. An out-of-state hospital which wishes to be considered for disproportionate share payments must submit a request for consideration of disproportionate share payments.
- (ii) Time and contents of request. A request for disproportionate share payments must be sent to the Department as set forth in subparagraph 9(c)(ii)(B).
- (iii) Determination of amount of payment. The amount of the disproportionate share payment shall be that proportion of the amount determined pursuant to (c)(i) or (c)(ii) which is attributable to the hospital's Wyoming Medicaid utilization rate.
(f) Notice of disproportionate share payments. The Department shall provide notice to all in-state hospitals which are entitled to disproportionate share payments pursuant to (b)(i) or which request consideration for payments pursuant to (b)(ii), and to all out-of state- hospitals which request disproportionate share payments. Notice of disproportionate share payments must include the hospital's right to request reconsideration of the disproportionate share determination pursuant to Section 17. The reconsideration shall be limited to whether the Department has complied with the provisions of this rule.
(g) Method of payment. The Department shall request the issuance of a payment warrant for the lump sum payment of disproportionate share payments within fifteen days after the date of the notice provided pursuant to subsection (f).
048-24 Wyo. Code R. § 24-9