This chapter establishes reimbursement standards for designated hospitals and other treatment providers that furnish services under Wyoming's Involuntary Commitment Act. Providers must submit itemized billing documentation, medical records, court orders, and insurance certification within one year of the service date to receive payment. The Department caps reimbursement at Medicaid rates, a fixed per diem, or contracted Behavioral Health Division rates, and will only pay for care directly related to the emergency detention or involuntary hospitalization and deemed medically necessary for the patient's mental illness.
View official sourceHealth, Department of
State Hospital
Chapter 8: Standards for the Reimbursement of Designated Hospitals and Treatment Providers
Effective Date:
04/04/2017 to Current
Rule Type:
Current Rules & Regulations
Reference Number:
048.0053.8.04042017
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CHAPTER 8
Standards for Reimburs
ement of Designated Hospitals and
Treatment Providers
Section 1.
Authority.
This Chapter is promulgated by the Department of Health ("the Department") pursuant to the Involuntary Commitment Act ("the Act"), codified at Wyo. Stat. Ann. §§ 25-10-101
through -305,
and the Wyoming Administrative Procedure Act at Wyo. Stat. Ann. §§ 16-3-101 through -115
.
Section 2.
Purpose and Applicability.
(a) These rules have been adopted to establish standards for the reimbursement of designated hospitals or other treatment providers and to establish standards to manage costs billed to the Department pursuant to Wyo. Stat. Ann. § 25-10-112.
(b) The Department may issue manuals
or
bulletins to interpret the provisions of these rules
, which
reflect the policies contained in these rules and regulations. The provisions contained in manuals or bulletins shall be subordinate to the provisions of these rules and regulations.
Section 3.
Filing of Claims.
(a) Designated hospitals or treatment providers filing claims with the Department
or responsible county
under Wyo. Stat. Ann. § 25-10-112 for services provided pursuant to Wyo. Stat. Ann. §
25-10-109,
Wyo. Stat. Ann. § 25-10-110 or Wyo. Stat. Ann. §
25-10-110.1 shall provide documentation to the Department
or responsible county
detailing the services rendered
and the
payment requested. This documentation shall include, but is not limited to:
(
i
) All relevant and requested medical records directly related to the services for
which
payment is being requested;
(ii) An itemized billing statement (for services provided by designated hospitals) for services
, including
:
(1) A universal billing form;
(2) A CMS 1500.
(iii) The emergency detention notice, Form 3-81
,
and the continued emergency detention court order
, if applicable
;
(iv) The
involuntary hospitalization court order, if applicable, and any papers showing the patient's release from involuntary hospitalization, Form 14-81.
(v) A certification signed by the designated hospital representative or treatment provider, indicating that the patient has no public or private health insurance and that there are no other governmental benefit programs from which it can recover the costs of treatment;
(vi) Documentation
of all efforts made to recover costs of treatment from public and private health insurance, and from government benefit programs prior to seeking payment from the Department.
(b)
T
he Department
may not pay claims
submitted
more than
one (1) year
after
the service date.
(c)
The Department may not pay c
laims for medical treatment for conditions that are not directly related to the emergency detention
or involuntary hospitalization.
Section 4.
Payment of Claims.
(a) Payment made by the Department pursuant to Wyo. Stat. Ann. § 25-10-112, for services provided by a designated hospital or other treatment provider under Wyo. Stat. Ann. § 25-10-109 and Wyo. Stat. Ann. § 25-10-110, shall not exceed:
(
i
) The current rate for similar services as determined by Medicaid
;
(ii) A fixed, all-inclusive per diem rate as determined by the Department; or
(iii) Payments arranged through mental health or substance abuse contracts with the Behavioral Health Division, if applicable.
(b)
In considering a claim for payment, t
he Department
shall determine if the costs submitted by the designated hospital or treatment provider are reasonably related to the care furnished to the patient and if the care furnished to the patient was medically necessary for the specific treatment of the patient's mental illness.
(c) After a designated hospital has submitted all documentation as required in Section
4
(
b
)
of Chapter 7
, the Department shall pay each claim within 45 days of receipt of the claim pursuant to Wyo. Stat. Ann. § 16-6-602.
Section 5.
Implementation of Chapter.
(a) The order in which the provisions of this Chapter appear is not to be construed to mean that any provision is more or less important than any other provision.
(b) The text of this Chapter shall control the titles of its various provisions.
Section 6.
Superseding Effect.
When promulgated, this Chapter supersedes all prior rules or policy statements issued by the Department, including manuals or bulletins, which are inconsistent with this Chapter
.
Section 7.
Severability.
If any portion of this Chapter is found to be invalid or unenforceable, the remainder shall continue in full force and effect.
For questions regarding the content or application of a specific rule, please contact the agency responsible for the rule. A directory of
agencies
is also available online. For questions about the rulemaking process, please send your questions and comments to
Rules@wyo.gov
.