048-37 Wyo. Code R. §§ 37-8 - Medicaid Allowable Payment for New Providers

(a) A provider that qualifies as a FQHC or RHC after September 30, 1999, must submit a settled or "as filed" Medicare Cost Report to the Department, which will serve as the basis for the provider's rate calculation. Upon submission of a settled or an "as filed" Medicare Cost Report a visit rate will be calculated as described by the cost formula in Section 7.

(b) If the FQHC or RHC does not have a settled or an "as filed" Medicare Cost Report, the provider shall submit cost information to the Department for services previously provided indicating estimates for its next fiscal year and the number of patients and services it expects to offer during that period.

(c) The Medicaid allowable payment for a new provider shall be an interim visit rate equal to one hundred (100) percent of the reasonable costs used in calculating the rates of FQHCs or RHCs with similar caseloads located in the state during the same facility fiscal year, adjusted by the percentage increase in MEI, as described by the cost formula in Section 7. Interim visit rates will be specific to each provider type: Independent RHCs, Hospital-based RHCs, and FQHCs.

(i) If there are no FQHCs or RHC's with similar caseloads, the Medicaid allowable payment for a new provider shall be an interim visit rate equal to the Medicaid statewide average visit rate for the calendar year, adjusted by the percentage increase in MEI, as described by the cost formula in Section 7. Interim visit rates will be specific to each provider type: Independent RHCs, Hospital-based RHCs, and FQHCs.

(d) The interim rate determined pursuant to subsection (c) shall remain in effect until the FQHC or RHC has submitted a settled Medicare Cost Report, at which time the FQHC's or RHC's rate shall be recalculated pursuant to Section 7, except that the new FQHC's or RHC's base period shall be its first fiscal year during which the FQHC or RHC provided Medicaid services. The Department shall not retroactively reimburse the FQHC or RHC for any underpayment or recover any overpayment based on changes in the calculated rate.

Notes

048-37 Wyo. Code R. §§ 37-8

Amended, Eff. 1/6/2015. Amended, Eff. 9/6/2018. Amended, Eff. 8/11/2023.