Current through September 21, 2024
(a) In addition to
the rate established pursuant to Section 8, a disproportionate share hospital
shall be entitled to a disproportionate share payment computed pursuant to this
section. This section is intended to implement and be read in conjunction with
Section 1923 of the Social Security Act.
(b) Determination of disproportionate share
hospital. A disproportionate share hospital is one which has either a:
(i) Medicaid utilization rate at least one
standard deviation above the mean Medicaid utilization rate for Wyoming
providers; or
(ii) Low income
utilization rate which exceeds twenty-five percent.
(c) Determination of disproportionate share
payment.
(i) A hospital which meets the
criterion of paragraph (b)(i) shall receive a payment determined as follows:
The sum of the statewide mean disproportionate share calculation plus one
standard deviation shall be subtracted from the hospital's Medicaid utilization
rate. The difference shall be multiplied by the hospital's inpatient Medicaid
payment during the hospital's fiscal year. The sum shall be the amount of the
disproportionate share payment for the cost reporting year.
(A) Hospitals located in Wyoming shall be
automatically considered for disproportionate share payments pursuant to this
paragraph.
(B) Hospitals located
outside Wyoming that wish to be considered for disproportionate share payments
pursuant to this paragraph must comply with subsection (e).
(ii) Disproportionate share
payments based on low income utilization rate.
(A) Request for consideration. A hospital
which wishes to be considered for disproportionate share payments pursuant to
paragraph (S ii) shall submit a request for consideration of disproportionate
share payments based on low income utilization rate.
(B) Time and contents of request. A request
for disproportionate share payment pursuant to paragraph (b)(ii) must be sent
to the Department, by certified mall, on or before October 31st of each year.
The hospital must submit the correct cost report with the request, if it is
available. The hospital must contact the Department before that date to
determine which fiscal year's cost report to submit with the request. The
failure to timely submit a request, including the correct cost report,.if
available, shall preclude the hospital from requesting or receiving
disproportionate share payment pursuant to paragraph (b)(ii). If the hospital
cannot submit the correct cost report because of delay caused by the
intermediary, the hospital must submit verification of the delay from the
intermediary on or before the date the request is due. In such a case, the
Department shall not compute the hospitals disproportionate share payment until
after the hospital submits the correct cost report.
(C) Calculation of payments. A hospital which
meets the criterion of paragraph (b)(ii) shall receive a payment determined in
accordance with Section 1923 of the Social Security Act. If the low income
utilization rate exceeds twenty-five percent, the hospital shall be entitled to
a disproportionate share payment. The disproportionate share payment shall be
equal to the low income utilization rate in excess of twenty-five percent
multiplied by the total allowable Medicaid costs for inpatient hospital
services.
(d)
Determination of statewide mean disproportionate share calculation. The
Department shall determine the statewide mean disproportionate share
calculation for each Wyoming state fiscal year using the most recently settled
cost reports submitted for hospitals located in Wyoming.
(e) Disproportionate share payments for
hospitals located outside Wyoming.
(i)
Request. An out-of-state hospital which wishes to be considered for
disproportionate share payments must submit a request for consideration of
disproportionate share payments.
(ii) Time and contents of request. A request
for disproportionate share payments must be sent to the Department as set forth
in subparagraph 9(c)(ii)(B).
(iii)
Determination of amount of payment. The amount of the disproportionate share
payment shall be that proportion of the amount determined pursuant to (c)(i) or
(c)(ii) which is attributable to the hospital's Wyoming Medicaid utilization
rate.
(f) Notice of
disproportionate share payments. The Department shall provide notice to all
in-state hospitals which are entitled to disproportionate share payments
pursuant to (b)(i) or which request consideration for payments pursuant to
(b)(ii), and to all out-of state- hospitals which request disproportionate
share payments. Notice of disproportionate share payments must include the
hospital's right to request reconsideration of the disproportionate share
determination pursuant to Section 17. The reconsideration shall be limited to
whether the Department has complied with the provisions of this rule.
(g) Method of payment. The Department shall
request the issuance of a payment warrant for the lump sum payment of
disproportionate share payments within fifteen days after the date of the
notice provided pursuant to subsection (f).
