Wyoming Administrative Code
Agency 048 - Health, Department of
Sub-Agency 0037 - Medicaid
Chapter 45 - DD WAIVER PROVIDER STANDARDS, CERTIFICATION, AND SANCTIONS
Section 45-11 - Rate Reimbursement Requirements
Universal Citation: WY Code of Rules 45-11
Current through September 21, 2024
(a) Providers shall be reimbursed for services through the rate methodology established in the corresponding waiver agreement with CMS.
(b) Rates paid to providers for waiver services shall be less than or equal to the usual and customary rates for similar non-waiver services.
(i) The
Department shall consult with waiver service providers, developmental
disability waiver program participants and their families to gather information
about reimbursement rates prior to calculating the new reimbursement
rates.
(ii) If third party
expertise is necessary, the Department shall follow a competitive bidding
process to procure the services of an expert in the development of cost-based
waiver program payments to assist with the development of new reimbursement
rates for waiver providers.
(iii)
The Department shall receive approval from CMS prior to the implementation of a
new or modified reimbursement rate setting methodology.
(c) Upon request, providers shall submit the following information to the Division:
(i)
Cost data;
(ii) Claims data;
and
(iii) Participant needs
assessment data.
(d) Providers shall participate in reasonable audits of the data submitted in subsection (c).
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