048-7 Wyo. Code R. §§ 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.
Notes
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