Ch. 7, § 25. Payment of Out-of-State Provider

(a) The payment rate for an out-of-state nursing facility providing services to a Wyoming client is the lesser of: (i) The Medicaid per diem rate the nursing facility receives on July 1 of the rate year for the same or similar services from the most recently available rate for the Medicaid program in the state where the nursing facility is located; (ii) The average Medicaid day weighted average rate in effect in Wyoming as of July 1 of the rate year that the provider needs a rate calculated; or (iii) The nursing facility's usual and customary rate. (b) The average Medicaid day weighted average rate in effect shall be determined by: (i) Multiplying the number of Medicaid days in each nursing facility by each facility's Medicaid per diem rate; (ii) Adding the products determined pursuant to (i); and (iii) Dividing the sum determined pursuant to (ii) by the total number of Medicaid days in the state. (c) An out-of-state provider need not submit cost reports to the Department. (d) An out-of-state nursing facility must submit with each claim a certification of the nursing facility's per diem rate under the Medicaid program in the state where the nursing facility is located and the nursing facility's usual and customary charge. (e) The calculated rate will remain in effect until the following July 1. Out of state nursing facilities are not subject to quarterly case mix acuity adjustments.