Wyoming Administrative Code
Agency 048 - Health, Department of
Sub-Agency 0037 - Medicaid
Chapter 30 - REIMBURSEMENT OF INPATIENT HOSPITAL SERVICES
Section 30-6 - Payment for Rehabilitation Claims

Universal Citation: WY Code of Rules 30-6

Current through December 21, 2024

(a) Payment of a rehabilitation claim shall include a per diem operating cost payment and a per diem capital cost payment, as determined for purposes of the 2010 rehabilitation level of care rebasing.

(b) The Department shall calculate the allowable cost of each rehabilitation claim for each participating hospital using each hospitals' as-filed Medicare cost reports for hospital fiscal years ending in state fiscal years 2005 and 2006 and each hospitals' inpatient claims paid in state fiscal years 2006 and 2007 (base period).

(c) Medical education costs are not considered allowable.

(d) The Department shall identify base period allowable costs as the sum of routine per diem costs and ancillary service costs. The following shall apply to such base period allowable costs:

(i) Base period allowable costs shall be inflated forward from the date of service to the midpoint of SFY 2007 using the CMS-PPS Hospital Market Basket.

(ii) The Department shall determine the number of days of rehabilitation services provided by each hospital from the adjusted base period claims data.

(iii) The Department shall calculate a cost per day for each hospital for rehabilitation services. The following shall apply to such calculations:
(A) For each hospital, the Department shall divide total costs for rehabilitation services in the base period by total days from the base period claims data.

(B) High and low-cost Medicaid outlier costs shall be identified for rehabilitation costs per diem.

(iv) The Department shall determine the base period allowable Medicaid cost per diem for rehabilitation services for each hospital by subtracting high and low-cost Medicaid outliers from the costs determined in subparagraph (A) of this Section.

(v) The Department shall calculate a ventilator payment per day for qualifying services not to exceed a fixed amount per diem. The ventilator payment shall be calculated as an incremental cost of rehabilitation services when a patient is receiving ventilator services. The Department shall calculate the ventilator payment per day to reflect the difference in resources used to provide rehabilitation services to patients with more intensive rehabilitation needs, as measured by an examination of prior year's claims, the relative weights for rehabilitation services under the Medicare MS-DRG methodology and research about other states' payment methodologies.

(e) The Medicaid payment rate for the rehabilitation services shall be the average payment rate for all participating providers. The Medicaid payment rate for non-participating hospitals shall not include reimbursement for capital costs.

(f) The Department shall accept interim claims for inpatient rehabilitation services.

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