§ 42-11-106 — Payments to private ground ambulance service providers

Wyoming § 42-11-106

• Jurisdiction: Wyoming
• Title 42: Welfare
• Ch. 11: PRIVATE GROUND AMBULANCE SERVICE PROVIDER

Text

(a) Subject to W.S. 42-11-107, the initiation of
assessments under W.S. 42-11-104(c) and the federal approval
authorized in W.S. 42-11-108, the department shall make
quarterly adjustment payments to or implement rate enhancements
for private ground ambulance service providers as set forth in
this section.
(b) Each private ground ambulance service provider that
pays assessments under this chapter and meets the eligibility
standards set by subsection (c) of this section shall be
eligible to receive quarterly adjustment payments as provided in
this section. The department shall distribute quarterly
adjustment payments in amounts up to but not to exceed the
applicable upper payment limit gap. The department shall
establish a uniform methodology by which to distribute payments
in compliance with applicable federal and state Medicaid laws
and regulations.
(c) Unless otherwise prohibited by federal law, only
private ground ambulance service providers who meet all of the
following requirements shall be eligible to receive a quarterly
adjustment payment authorized in subsection (b) of this section:
(i) Private ground ambulance service providers who
provide ground ambulance services to Medicaid beneficiaries;
(ii) Private ground ambulance service providers who
provide ground ambulance services to Medicare beneficiaries;
(iii) Private ground ambulance service providers who
accept as full payment for ground ambulance services any
payments made under Wyoming's worker's compensation system; and
(iv) Private ground ambulance service providers who:
(A) Are network providers for all insurers
offering private health benefit plans in this state who maintain
not less than a twenty percent (20%) share of the state's
individual or small group health insurance market; or
(B) Have made a bonafide and reasonable offer to
become a network provider to all of the insurers identified in
subparagraph (A) of this paragraph by offering to accept as
network provider reimbursement not more than double the Medicaid
reimbursement rate for relevant medical services. The offer
required by this subparagraph may be higher to the extent the
private ground ambulance service provider demonstrates to the
department that the actual cost of providing relevant medical
services plus six percent (6%) of the actual cost is an amount
higher than double the Medicaid reimbursement rate for the
relevant medical services.
(d) To the extent rate enhancements are approved by the
Centers for Medicare and Medicaid Services and subject to the
collection of assessments under W.S. 42-11-104(b), the
department shall provide rate enhancement payments to private
ground ambulance service providers consistent with applicable
federal and state requirements.
(e) Quarterly payments or rate enhancements shall not be
used to offset any other payment by Medicaid for ground
ambulance services to Medicaid beneficiaries, including without
limitation any fee-for-service, per diem, adjustment or cost
settlement payments.
(f) No private ground ambulance service provider is
guaranteed, expressly or otherwise, that quarterly adjustment
payments or rate enhancements will equal or exceed the amount of
private ground ambulance service provider assessments due under
this chapter.
(g) Monies made available by this chapter shall not be
used to replace other general revenues appropriated and funded
by the legislature or other revenues used to support Medicaid.