Current through September 21, 2024
(a) ICFs/IID shall
be reimbursed using a per diem rate calculated in accordance with the
methodology established below. In addition, ICFs/IID shall be subject to the
rules in Chapter 7, Wyoming Nursing Home Reimbursement System, except as
otherwise specified by this rule. ICFs/IID shall not be subject to the Chapter
7 rate and price setting Sections
7, 13(d), 14, 15, 16, 17(c), 18, and
19.
(b) Calculation of per diem
rates for ICFs/IID. The per diem rate for ICFs/IID shall be calculated
independently from the calculation of rates for facilities as defined in
Chapter 7. The provider's per diem rate shall be determined utilizing either a
desk reviewed or audited cost report. Costs shall not be subject to any form of
cap or maximum rate for the Wyoming Life Resource Center.
(i) Effective date. The rates calculated each
July 1 shall remain in effect until the following July 1.
(ii) Per diem rates are established
prospectively and shall remain in effect from the rate effective date until
re-determined pursuant to this rule.
(iii) Applicable cost report data. The data
used in establishing the rate calculation is from the cost reports which ended
two (2) calendar years ago (for example, cost reports ending during the period
from January 1, 2013 to December 31, 2013, shall be used to set rates effective
July 1, 2015).
(iv) Cost reports
submitted by ICFs/IID shall not be used in any way to calculate per diem rates
for facilities as defined in Chapter 7.
(v) Rates shall be established by inflating
adjusted / reviewed costs from the midpoint of the provider's cost reporting
year to the midpoint of the rate year. Inflated costs shall be divided by total
patient days to arrive at the allowed per diem rate.
(c) Reimbursement of new facilities. A new
facility or a newly certified facility shall receive interim payments for
services provided to recipients as determined pursuant to this subsection.
(i) Submission of projected costs. A new
facility shall, before receiving Medicaid funds for services provided to
recipients, submit a cost report to the Department containing projected costs
for the facility's first six months of operation.
(ii) Time of submission of cost report. A new
facility shall submit a cost report containing the information specified in
paragraph (i) within sixty (60) days after the facility notifies the Department
in writing that it wishes to participate in the Medicaid program as a provider
and has been certified.
(iii)
Review of projected costs. The Department shall desk audit the cost report
submitted pursuant to paragraph (i) to determine the reasonableness of the
facility's allowable projected costs. An interim payment rate shall be
established using the facility's reasonable, allowable costs. The interim
payment rate shall not exceed the lower of the rate determined pursuant to this
subsection and seventy-five percent (75%) of the Wyoming Life Resource Center
rate in effect.
(iv) Period of
interim payments. Interim payments shall be effective upon the effective date
of the facility's provider agreement, and shall remain in effect until a
qualifying cost report has been submitted and subjected to audit and used to
calculate a rate. No payments shall be made to a new facility until an interim
payment rate has been determined pursuant to this subsection.
(v) Audits of interim payments. Upon receipt
of the qualifying cost report, the Department may audit a facility to determine
the accuracy and reasonableness of cost reports submitted by the facility. If
the audit discloses that the interim payments included non-allowable costs,
costs for services and supplies not included in the per diem rate or that
budgeted costs exceeded actual costs, the Department shall adjust the per diem
rate retroactively to the beginning of the interim rate period and recover any
excess payments.
(vi) Audits shall
be conducted in accordance with Section
5(b). Providers other than
Wyoming Life Resource Center shall have rates limited to the lower of the
provider's audited cost in accordance with Section
5(b) or seventy-five
percent (75%) of the Wyoming Life Resource Center rate.
