Section 30-16 - Reimbursement of outliers (a) The Medicaid allowable payment for outliers shall be the applicable level of care payment plus a payment equal to: - (i) The difference between the hospitals allowable costs for the outlier and the outlier threshold. For purposes of this Section, allowable costs are calculated as the hospital specific cost-to-charge ratio for each level of care, multiplied by the allowable charges submitted on the claim for that level of care. Facilities with cost-to-charge ratios greater than 1.0 shall be capped at the statewide cost-to-charge ratio for each level of care.
- (ii) Multiplied by seventy-five (75) percent.
- (iii) If a facility does not have a hospital-specific cost-to-charge ratio, the statewide cost-to-charge ratio shall be used.
(b) Submission of claims. Claims for outlier payments shall be submitted in the form specified by the Department in Provider Manuals or Provider Bulletins.
(c) Discharge planning. No hospital shall receive an outlier payment for a patient that is not discharged because of the hospitals failure to do appropriate discharge planning.
048-30 Wyo. Code R. § 30-16