(f) Hospitals located outside Wyoming.
(i) Reimbursement rate. The Department shall
determine a reimbursement rate for inpatient services provided by hospitals
located outside the State of Wyoming pursuant to paragraphs (ii) and (iii).
Such rate shall remain in effect for all inpatient services until redetermined
pursuant to this subsection.
(ii)
Hospitals which submit cost reports. Hospitals located outside Wyoming which
provide inpatient hospital services to Wyoming recipients may submit their most
recently settled Medicare cost reports.
(A)
Submission and preparation of cost reports. Except as otherwise specified by
this subsection, hospitals which submit cost reports shall prepare and submit
them pursuant to Section 7.
(B)
Time of submission. A hospital shall submit its most recently settled Medicare
cost report on or before October 31st of each year.
(I) The cost report must not have been
previously submitted or used for a previous rate period, and it must be for a
year subsequent to the year reported in the hospital's most recently submitted
cost report.
(II) If the hospital
cannot submit a cost report which meets the requirements of this subparagraph
because of delay caused by the intermediary, the hospital must submit
verification of the delay from the intermediary on or before October 31st of
the relevant year. If there is a verifiable delay caused by the intermediary,
the hospital shall receive a rate equal to the lowest cost to charge ratio
established for a hospital located in Wyoming pursuant to paragraph (e)(i) of
this Section for the current State of Wyoming fiscal year. The hospital must
submit its cost report promptly after it becomes available, and in no event
later than 9 months after the October 1st due date. The Department shall
determine the hospitals cost to charge ratio and shall adjust the hospitals
rate retroactively to the original rate effective date. A hospital which fails
to submit a cost report within 9 months after the due date shall receive no
retroactive adjustment to its rate.
(C) Determination of reimbursement rate. The
Department shall establish a reimbursement rate for each hospital which submits
a cost report using Medicare principles of cost reimbursement, as modified by
this rule, based on the most recently settled Medicare cost report submitted by
the hospital to the Department. The reimbursement rate shall be the hospitals
cost to charge ratio for combined inpatient and outpatient services.
(D) Rate effective date. Reimbursement rates
for hospitals which submit cost reports shall be effective for 'services
provided on or after July 1, 1992. The rate shall be adjusted each December 1
thereafter, assuming the hospital submits a cost report pursuant to
(B).
(E) Duration of reimbursement
rate. Rates determined pursuant to this paragraph shall remain in effect for
services provided during the twelve months following the rate
(F) Cost settlement. The Department shall
cost settle pursuant to Section 8, unless the Department determines that it is
not cost-effective to do so.
(iii) Hospitals which do not submit cost
reports. The reimbursement rate for hospitals which elect not to submit cost
reports pursuant to (ii) shall be the lesser of the hospital's submitted
charges and the lowest cost to charge ratio established for a hospital located
in Wyoming pursuant to paragraph (e)(i) for the current State of Wyoming fiscal
year. The rate shall be effective for all services provided on after July 1,
1992. The rate shall be adjusted each December 1 thereafter to correspond with
the then current lowest cost to charge ratio established pursuant to paragraph
(e)(i).
