(a) Capital costs. Capital costs shall be reimbursed using a three year phase-in of the statewide median per discharge prospective capital rate. - (i) Year one (July 1, 1994 through June 30, 1995). Capital costs shall be reimbursed using a blended rate equal to fifty percent of the hospital-specific capital prospective capital payment; and fifty percent of the state-wide average prospective capital rate.
- (ii) Year two (July 1, 1995 through June 30, 1996). Capital costs shall be reimbursed using a blended rate equal to twenty-five percent of the hospital-specific capital prospective capital payment; and seventy-five percent of the state-wide average prospective capital rate.
- (iii) Year three (July 1, 1996 through June 30, 1997) and thereafter. Capital costs shall be reimbursed at 100 percent of the statewide median prospective capital rate.
(b) To determine hospital-specific per discharge capital payment rates, the Department shall: - (i) Extract total capital costs and total inpatient discharges from each participating providers most recently settled cost report received by the Department on or before October 15, 1993;
- (ii) Determine total inpatient capital costs by applying the percent of the hospitals inpatient revenue as reported on the cost report specified in paragraph (i) to total capital costs.
- (iii) Divide total inpatient capital costs determined pursuant to paragraph (ii) by the total discharges determined pursuant to paragraph (i).
(c) To determine the state-wide average prospective capital rate, the Department shall take the midpoint of the arrayed hospital-specific capital payments determined pursuant to (b)(iii). An adjustment to a providers capital rate pursuant to subsection (e) shall not result in the redetermination of the state-wide average prospective capital rate.
(d) No capital payment shall be made to non-participating providers.
(e) Adjustments to capital rates. A provider may request an adjustment of its hospital specific capital rate pursuant to Section 29 only to: - (i) Compensate for capital expenditures resulting from extraordinary circumstances; or
- (ii) Reflect capital expenditures made after the base period and on or before June 30, 1994, if Medicare has approved a redetermination of the providers 1990 base year capital costs.
- (iii) The burden shall be on the provider to demonstrate that it is entitled to an adjustment to its capital rate pursuant to this subsection.
(f) If the request is made pursuant to (e)(ii), the following standards apply: - (i) Redetermination of hospital-specific capital rates for PPS hospitals. APPS hospital may request the redetermination of the hospital-specific portion of the capital rate if the Medicare intermediary has approved a redetermination in the hospitals 1990 base period Medicare hospital-specific rate. If the intermediary approves a redetermination to reflect changes in obligated capital recognized as old capital and put into use subsequent to the hospitals 1990 base period, a request must be submitted to the Division within thirty days of the request for redetermination submitted to Medicare. The Departments final decision will be based on the final approval for redetermination by the Medicare intermediary. The Department will recalculate the hospital-specific capital rate within thirty days of Medicare's final determination. Requests for redetermination will not be recognized for any conditions not allowed under Medicare principles.
- (ii) Redetermination of hospital-specific capital rates for non-PPS hospitals. Non- PPS hospitals may request the redetermination of the hospital-specific portion of the capital rate for obligated capital recognized as old capital. The determination of obligated capital will be made in accordance with the Medicare definition of obligated capital. The hospital must provide the appropriate support documentation consistent with Medicare principles. Such a request must be submitted to the Department within ninety days after the close of the cost reporting year that will serve as the new base period. No redetermination will be made for periods beginning after June 30, 1994. The Departments final decision will be based upon Medicare principles used to evaluate PPS hospital base year capital redetermination appeals. The Department will respond to such a request within sixty days after the receipt of the request for redetermination. Requests for redetermination will not be recognized for any conditions not allowed under Medicare principles.
- (iii) Any request for adjustment made pursuant to this section must be made in writing and mailed to the Division by certified mail, return receipt requested.
- (iv) A redetermination pursuant to this subsection will be effective thirty days after the Department issues a notice of rate adjustment.
- (v) The state-wide base year capital rate will not be adjusted to reflect adjustments to hospital-specific rates pursuant to this subsection.
(g) Capital rates shall not be inflated.
048-30 Wyo. Code R. § 30-18