048-7 Wyo. Code R. §§ 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.
Notes
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