048-7 Wyo. Code R. § 7-28

Current through April 27, 2019

Section 7-28 - Reimbursement of Out-of-State Providers

(a) The reimbursement rate for out-of-state facilities providing services to Wyoming clients shall be the lesser of:

• (i) The Medicaid reimbursement rate the nursing facility receives on July 1 of the rate year for the same or similar services from the Medicaid program in the state where the nursing facility is located;

• (ii) The average Medicaid day weighted average rate in effect in Wyoming as of July 1 of the rate year that the provider needs a rate calculated; or

• (iii) The nursing facility's usual and customary rate.

(b) The average Medicaid day weighted average rate in effect shall be determined by:

• (i) Multiplying the number of Medicaid days in each nursing facility by each facility's Medicaid per diem rate;

• (ii) Adding the products determined pursuant to (i) and;

• (iii) Dividing the sum determined pursuant to (ii) by the total number of Medicaid days in the state.

(c) No cost reports. An out-of-state provider need not submit cost reports to the Department.

(d) Billing requirements. An out-of-state provider shall submit with each claim a certification of the provider's reimbursement rate under the Medicaid program in the state where the provider is located and the nursing facility's usual and customary charge.

(e) The calculated rate will remain in effect until the following July 1. Out of state providers are not subject to quarterly case mix acuity adjustments.

048-7 Wyo. Code R. § 7-28

Amended, Eff. 6/14/2017.

Amended, Eff. 4/26/2019.