Statutes, codes, and regulations
Wyoming Administrative Code
Agency 048 - Health, Department ofSubagency 0037 - Medicaid
Chapter 27 - RULES AND REGULATIONS FOR MEDICAID PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE)
Section 27-9 - Provider Payment

048-27 Wyo. Code R. § 27-9

Download
PDF
Current through April 27, 2019
Section 27-9 - Provider Payment

(a) Provider payment is based on a capitated rate calculated on a per member per month (PMPM) methodology. The payments will be automatically generated by the Medicaid Management Information System (MMIS) based on the individuals that are enrolled in the PACE provider's program on the system.

(b) Capitated rates calculation.

  • (i) Capitated rates shall be no less than ninety percent (90%) of the fee-for-service equivalent cost, including the cost of administration that the Department estimates would be payable for all services provided by the PACE provider if all of those services were to be provided on a fee-for-service basis.
    • (A) The non-PACE population group used to determine the PMPM capitated rate must include individuals that match the participant criteria for the PACE program as described in Section 5.

(c) The monthly capitation payments shall be considered full payment for all services provided for PACE participants.

048-27 Wyo. Code R. § 27-9

Adopted, Eff. 7/12/2016.