048-19 Wyo. Code R. §§ 19-8 - Medicaid Reimbursement
(a) Completion of
screening. No facility shall receive Medicaid reimbursement for nursing
facility services furnished to a client until:
(i) The completion of the Level I screening
which indicates that there is no need for Level II screening or, if the Level I
screening indicates the need for Level II screening, the completion of the
Level II screening and a determination that nursing facility services are
appropriate; and
(ii) The
completion of the evaluation of medical necessity pursuant to the Rules and
Regulations of Wyoming Medicaid, Chapter 22, Nursing Facility Long Term
Care/Home/Community Based Evaluation, which indicates that nursing facility
services are medically necessary.
(b) Retroactive payments.
(i) For clients that do not require Level II
screening, Medicaid reimbursement shall commence upon receipt by the Department
of the results of the Level I screening indicating that there is no need for a
Level II screening. Reimbursement shall be retroactive to the date of the
completion of the Level I screening, provided there was an evaluation of
medical necessity pursuant to the Rules and Regulations of Wyoming Medicaid,
Chapter 22, Nursing Facility Long Term Care/Home/Community Based
Evaluation.
(ii) For clients that
require Level II screening, Medicaid reimbursement shall commence upon the
completion of the Level II screening which indicates that nursing facility
services are appropriate, except as specified in Section
7 of
this Chapter. Reimbursement shall be retroactive to the date of the completion
of the Level II screening, provided there was an evaluation of medical
necessity pursuant to the Rules and Regulations of Wyoming Medicaid, Chapter
22, Nursing Facility Long Term Care/Home/Community Based Evaluation. Payments
for residents permitted to continue to reside in a facility pursuant to the
thirty (30)-month rule, as defined in
42 C.F.R. §
483.130, are subject to the provisions of
this paragraph, except that such payments shall be contingent upon the
completion of a Level II screening, regardless of whether the screening
indicates that nursing facility services are appropriate.
Notes
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