Current through December 21, 2024
(a) In general. Except as otherwise specified
in this Chapter, the Department reimburses hospitals providing outpatient
hospital services to recipients using Medicare principles of cost
reimbursement. The Medicaid allowable payment shall be the lower of the
hospitals usual and customary charges and the allowable payment determined
pursuant to this section.
(b)
Interim rate. The interim rate for outpatient hospital services shall be the
interim rate established for inpatient services reduced by twenty
percent.
(c) Negotiated rate. A
hospital may negotiate an interim rate which is lower than the interim rate
which would otherwise be in effect pursuant to this Section.
(d) New hospitals. A new hospital shall
receive an initial rate equal to the lowest rate for outpatient services
established for a hospital located in Wyoming pursuant to paragraph (e)(i)
until the hospital files its most recently settled Medicare cost
report.
(e) Hospitals located in
Wyoming.
(i) Interim rate. The Department
shall establish an interim rate for outpatient hospital services based on the
most recently settled cost report submitted by the hospital to the Medicare
intermediary.
(A) Rate effective date. The
interim rate shall be effective for all outpatient hospital services provided
on or after December 1, 1992;
(B)
Rate period. The interim rate shall remain in effect for all outpatient
hospital services until redetermined pursuant to this Section;
(C) Except as otherwise specified b this
rule, the interim rate shall be applied to all claims submitted by the
provider.
(ii) Cost
settlement. The Department shall Cost settle, pursuant to Section 8, Medicaid
reimbursement for outpatient hospital services provided during each rate
period.
(f) Hospitals
located outside Wyoming.
(i) Reimbursement
rate. The Department shall determine a reimbursement rate for outpatient
hospital services provided by hospitals located outside the State of Wyoming
pursuant to paragraph .(ii) and (iii). Such rate shall remain in effect for all
outpatient hospital services until redetermined pursuant to this
subsection.
(ii) Hospitals which
submit cost reports.
(A) Submission of cost
reports. Hospitals located outside Wyoming . which provide outpatient hospital
services to Wyoming recipients may submit cost reports as set forth in
subsection 5(g).
(B) Determination
of reimbursement rate. The Department shall establish a reimbursement rate for
each hospital which submits a cost report using the methods and standards set
forth in paragraph 5(g)(ii), as modified by subsection
6(b). Rates shall be
effective as set forth in sub-paragraphs 5(g)(ii)(z) and (E). (F) Cost
settlement. The may 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 paragraph (ii) shall be established using the methods and
standards set forth in subsection 5 (g!(iii), as modified by subsection ! .
Rates shall be effective as set forth in paragraph 5(g)(ill).
