Ch. 7, § 20. Distressed Facilities

(a) The Department may pay a contracted rate to a distressed nursing facility. The contracted rate may exceed the nursing facility's per diem rate but must not exceed the lesser of: (i) The Medicare rate "PDPM Case-Mix Adjusted Federal Rates and Associated Indexes—RURAL" as recorded in the Federal Register; or (ii) A max percentage cap which must not exceed 200% of the nursing facility's per diem rate. (b) The Department must consider the criteria below: (i) Factors: (A) Financial stability and solvency of the nursing facility; (B) Occupancy (low occupancy as a percentage of capacity or drops quickly) of the nursing facility; (C) Whether or not the Department has assumed temporary management of the nursing facility; and (D) Geographic location of the nursing facility. (ii) Objectives: (A) Decrease official and unofficial complaints; (B) Maintenance or improvement of nursing facility survey results; (C) Maintenance of a provider network in rural or underserved areas; and (D) Avoidance of client abandonment by the dissolution or insolvency of the distressed nursing facility. (c) The Department will negotiate with providers determined to be in distress on an individual basis to determine whether a contracted rate is appropriate for that nursing facility, using the Department's distressed facility criteria. (i) Prior to negotiations, a nursing facility must submit to the Department, in the format prescribed by the Department: (A) All relevant financial records and medical records which demonstrate the distressed status of the facility; (B) A proposed method of monitoring and building overall census; and (C) The additional cost the nursing facility will reasonably and necessarily be incurring to maintain required daily operations in compliance with all State and Federal provisions. (ii) If the Department requests, the nursing facility must furnish additional information to document the distressed status and added costs. (iii) The contracted rate will be agreed upon by the nursing facility and the Department for the maintenance of daily operations focused on client health and safety. The contracted rate applies to all Medicaid clients in the nursing facility unless otherwise stated. (iv) The Department may establish monitoring criteria and procedures to determine whether the nursing facility continues to maintain client health and safety. (v) If the Department determines that the client's health and safety are not being maintained in accordance with State and Federal standards, the Department must suspend the nursing facility's temporary rate contract and work with the Office of Healthcare Licensing and Survey to take appropriate action. The contracted rate will be the rate set for a new owner of a distressed nursing facility Upon expiration of the contracted rate, the nursing facility may request up to an additional six months at the contract rate. The Department may extend the contract rate for up to six additional months or terminate the contract rate. A provider can only request to be designated as a distressed rate and receive the temporary rate 12 months within a 5-year period. (d) The contract rate is an all inclusive per diem rate for all services and supplies furnished by the nursing facility, except as otherwise specified in this Chapter or the contracted rate agreement. (e) The contracted rate must not exceed the nursing facility's actual costs. (f) The Department's refusal to agree to a contracted rate requested by a nursing facility is not an adverse action for purposes of Wyoming Department of Health, Medicaid Rules.