048-3 Wyo. Code R. § 3-10

Current through April 27, 2019

Section 3-10 - Medicaid allowable payment

(a) Except as otherwise specified in this Chapter or the other rules of the Department, the Medic-aid allowable payment shall not exceed the lower of the provider's usual and customary charges and the Medicaid fee schedule in effect on the date services were provided. The Medicaid fee schedule may include specific fees for services and/or a methodology for establishing such fees. The fee schedule is available upon request from the Division.

(b) Adjustment to Medicaid fee schedule. The Division shall review the Medicaid fee schedule periodically. The Medicaid fee schedule may be adjusted when necessary to:

• (i) Enlist enough provider's so that services are available to recipients to the extent that those services are available to the general population; and

• (ii) Ensure that payments are consistent with efficiency, economy and quality of care.

(c) Laboratory fees. The Division shall review laboratory fees periodically and adjust the fees as necessary to ensure that the Medicaid payment does not exceed Medicare allowable payment for clinical laboratory procedures. If the Medicaid allowable payment exceeds the Medicare allowable payment, the Medicaid allowable payment shall be automatically adjusted to equal the Medicare allowable payment. Such adjustment shall be retroactive to the effective date of the Medicare allowable payment. Any Medicaid payments made in excess of the Medicare allowable payment shall be considered excess payments.

048-3 Wyo. Code R. § 3-10