Statutes, codes, and regulations
Wyoming Administrative Code
Agency 048 - Health, Department ofSubagency 0037 - Medicaid
Chapter 37 - FEDERALLY QUALIFIED HEALTH CENTERS (FQHC) AND RURAL HEALTH CLINICS (RHC)
Section 37-9 - Medicaid Allowable Payment for New Providers

048-37 Wyo. Code R. § 37-9

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Current through April 27, 2019
Section 37-9 - Medicaid Allowable Payment for New Providers

(a) The Medicaid allowable payment for a provider that qualifies as a FQHC or RHC after September 30, 1999, shall be equal to one hundred percent (100%) of the reasonable costs used in calculating the rates of FQHCs or RHCs with similar caseloads located in the State during the same FQHC or RHC fiscal year. If there are no FQHCs or RHCs located in Wyoming with a similar caseload, then the Department shall calculate the rate for the new FQHC or RHC based on projected costs after applying tests of reasonableness.

  • (i) The FQHC or RHC shall submit a financial information worksheet, in the form and manner specified by the Department, which:
    • (A) In the case of an existing FQHC or RHC, reports the FQHC's or RHC's costs for its most recently completed fiscal year, the number of patient visits during that period, the services furnished to those patients, and any pending changes in services; or
    • (B) In the case of a new FQHC or RHC, estimates the FQHC's or RHC's cost for its next fiscal year, the number of patients the FQHC or RHC expects to serve during that period, and the services which the FQHC or RHC expects to offer during that period.
  • (ii) Using the information provided pursuant to Section 9(a)(i), the Department shall establish an interim rate based on the FQHC's or RHC's reported or estimated Medicaid allowable costs.

(b) The rate determined pursuant to Section 9(a) shall remain in effect until the FQHC or RHC has submitted a cost report for one (1) FQHC or RHC fiscal year, at which time the FQHC's or RHC's rate shall be recalculated pursuant to this Chapter, st except that the FQHC's or RHC's base period shall be its first (1 ) 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.

048-37 Wyo. Code R. § 37-9

Amended, Eff. 1/6/2015.

Amended, Eff. 9/6/2018.