Wyo. Code R. 048-0053-8
Effective Date: 04/04/2017 to Current
Rule Type: Current Rules & Regulations
Reference Number: 048.0053.8.04042017
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.
(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.
(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) The Department may not pay claims submitted more than one (1) year after the service date.
(c) The Department may not pay claims for medical treatment for conditions that are not directly related to the emergency detention or involuntary hospitalization.
(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, the 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.
(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.
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.
If any portion of this Chapter is found to be invalid or unenforceable, the remainder shall continue in full force and effect.