Wyoming Administrative Code
Agency 048 - Health, Department of
Sub-Agency 0037 - Medicaid
Chapter 40 - PSYCHIATRIC RESIDENTIAL TREATMENT FACILITIES
Section 40-13 - Medicaid allowable payment for covered services

Universal Citation: WY Code of Rules 40-13

Current through September 21, 2024

(a) The Department reimburses for covered services provided to clients under age twenty-one (21) using an all-inclusive per diem rate determined pursuant to this Section.

(b) The rates shall be established by the Department of Health based on reasonable, actual costs for services and treatment of residents in the PRTF. Rates are provider-specific, all-inclusive for room and board and the treatment services specified in the treatment plan.

(c) Reported PRTF costs and adjustments are used to develop the data set to calculate the room and board and licensed treatment rate components.

(i) Reported costs and days data from providers using Medicaid's PRTF cost report.

(ii) Reported costs are adjusted to standardize data for analysis and to remove non-allowable costs.

(iii) Administrative cost adjustments occur.

(iv) Adjustments to reported days occur.

(d) The costs of medical and ancillary services not provided by the PRTF, excluding those services in the treatment plan, shall not be included in the all-inclusive prospective per diem rate, and shall be billed as a separate service by the provider of those services and Medicaid shall pay for those covered services using the appropriate Medicaid fee schedule.

(e) The rate shall not exceed the facility's usual and customary rate.

(f) Newly enrolling PRTFs shall receive the in-state average rate for in-state providers and out-of-state PRTFs shall receive the out-of-state average rate until they qualify to submit a PRTF cost report. Upon submission of the cost report, PRTF per diem rates may be updated using the PRTF cost report pursuant to funding availability.

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