Statutes, codes, and regulations
Wyoming Administrative Code
Agency 048 - Health, Department ofSubagency 0037 - Medicaid
Chapter 7 - WYOMING NURSING HOME REIMBURSEMENT SYSTEM
Section 7-15 - Price and Rate Setting - Legislative Appropriation

048-7 Wyo. Code R. § 7-15

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Current through April 27, 2019
Section 7-15 - Price and Rate Setting - Legislative Appropriation

(a) Reimbursement will be a combination of a prospective fixed price system and a cost-based system with the health care component subject to an acuity adjustment. The legislature will provide an annual budget each year. The budget will be used to set the cost and price based rates as follows:

(b) Property Price. The first round of legislative allocations will be used to determine the reimbursement necessary to fund the price-based property rental rate system. The property rental rate methodology is defined at Section 18 of this Chapter.

(c) Exempt Cost Per Diem. The second round of allocations will be to determine the reimbursement necessary to fund the exempt cost-based reimbursement category. Exempt costs are defined at Section 9(d) of this Chapter.

(d) Health care and Operating Prices. The balance of the legislative appropriation will be used to fund the prices for the health care and operating categories. The balance of the funding will be allocated between the operating and health care categories based on the statewide total percentage of audited or desk reviewed costs classified to these categories.

  • (i) The operating price will be the same price reimbursed to all providers, regardless of their cost.
  • (ii) The health care price will begin with the same price to all providers, regardless of their cost. Each provider's starting price will be further adjusted up or down based on the provider's case mix acuity score for each quarter as is described in Section 16.

(e) Rates will be adjusted quarterly with the only change in the rate being the case mix adjustment to the health care component.

(f) Rates will be further adjusted by bed range group. Each group will receive a percentage adjustment increase or decrease so the resulting cost coverage averages of each group are within + or - 3% of each other.

(g) The state may, due to budget reasons, adjust rates in the last quarter to reflect legislative funding.

048-7 Wyo. Code R. § 7-15

Amended, Eff. 6/14/2017.

Amended, Eff. 4/26/2019.