Section 45-11 - Rate Reimbursement Requirements (a) Providers shall be reimbursed for services through the rate methodology established in the corresponding waiver agreement with CMS.
(b) Rates paid to providers for waiver services shall be less than or equal to the usual and customary rates for similar non-waiver services. - (i) The Department shall consult with waiver service providers, developmental disability waiver program participants and their families to gather information about reimbursement rates prior to calculating the new reimbursement rates.
- (ii) If third party expertise is necessary, the Department shall follow a competitive bidding process to procure the services of an expert in the development of cost-based waiver program payments to assist with the development of new reimbursement rates for waiver providers.
- (iii) The Department shall receive approval from CMS prior to the implementation of a new or modified reimbursement rate setting methodology.
(c) Upon request, providers shall submit the following information to the Division: - (iii) Participant needs assessment data.
(d) Providers shall participate in reasonable audits of the data submitted in subsection (c).
048-45 Wyo. Code R. § 45-11