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2023 Wyoming Statutes › Title 42 - Welfare › Chapter 6 - Long Term Care Choices Program › Section 42-6-103 - Rulemaking; Guidance.

42-6-103. Rulemaking; guidance.
The department is authorized to promulgate rules and regulations to implement this act. The rules and regulations shall seek to implement the objectives of this act by expanding the long term care system to one emphasizing consumer choice and home, home like and community based care alternatives.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 6 - Long Term Care Choices Program › Section 42-6-105 - Adult Foster Care Homes; Licensure; Suspension or Revocation.

42-6-105. Adult foster care homes; licensure; suspension or revocation.
(a) The department may initiate and license an adult foster care pilot project subject to the following:
(i) The applicant shall pay a one-time fee of one hundred dollars ($100.00) which shall be deposited in the general fund;
(ii) The department, a public health nurse or other employee of a local department of health shall complete an inspection of the proposed adult foster care home;
(iii) The proposed home shall comply with all state and local building, sanitation, utility, fire and zoning codes applicable to single family dwellings;
(iv) Repealed by Laws 2015, ch. 176, 2.
(v) Repealed by Laws 2015, ch. 176, 2.
(vi) The pilot program shall consist of no more than ten (10) adult foster care homes. At least three (3) of the homes shall be in counties with a population of thirty thousand (30,000) or less.
(b) The department may, after notice and opportunity for hearing, revoke or suspend any license issued pursuant to this section, may prohibit a facility from accepting new resident clients, may place conditions on the continuation of a license, or may require a facility to take specified remedial actions within a specified time, if:
(i) There is a threat to the health, safety or welfare of any resident client;
(ii) There is credible evidence of abuse, neglect or exploitation of any resident client;
(iii) The facility is not operated in compliance with this act or any rules and regulations promulgated pursuant to this act.
(c) If, in the professional judgment of the state health officer, there is a clear and present threat to the health or safety of a resident client, the state health officer may close an adult foster care home and transfer the residents to another place. The department shall also initiate proceedings pursuant to subsection (b) of this section within three (3) working days.
(d) The department shall complete a criminal records check on any individual employed by adult foster care homes and on any individual, other than a resident client or a resident client's spouse, who at the time of licensure is expected to live in the adult foster care home or who, after licensure, lives or comes to live in the adult foster care home. The department may refuse to license a facility or prohibit the individual from living in the facility if he has been convicted of a felony indicating he may abuse a resident or steal from a resident.
(e) The department shall promulgate rules and regulations consistent with this act to govern the pilot project.
(f) Repealed by Laws 2015, ch. 59, 2.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 6 - Long Term Care Choices Program › Section 42-6-106 - Home and Community Based Waiver Program Expanded; Requirements.

42-6-106. Home and community based waiver program expanded; requirements.
(a) Repealed By Laws 2013, Ch. 117, 2.
(b) The department is authorized to increase the provider reimbursement levels by an amount up to three dollars ($3.00) per hour for hourly services or seventeen and six-tenths percent (17.6%) above the prevailing rate for nonhourly services as of December 1, 2006. The department shall report to the joint labor, health and social services interim committee by November 1, 2007 the extent to which reimbursement improvements and any other changes made have improved the availability of home health care services and any additional remedies that may be needed. The length of the report shall not exceed one thousand (1,000) words plus any appropriate charts and graphs. Additional reports may be made from time to time as the need arises.
(c) The department shall set goals for expanding the number of Medicaid home and community based clients in self directed budget options and shall report progress toward those goals to the joint labor, health and social services interim committee no later than November 1, 2007, November 1, 2008 and November 1, 2009. The department shall allow these options to be managed by persons designated to do so in advanced health care directives.
(d) Consistent with approved budgets, the department shall make available a pool of state funds to meet transitional needs of clients moving from a more restrictive to a less restrictive environment in circumstances where Medicaid funds are not available due to federal restrictions. If sufficient funds are available, these state funds may also be used to meet short term needs of clients seeking to avoid placements in more restrictive environments. The department shall govern the expenditure of these funds though contracts, policies and rules and regulations as needed.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 6 - Long Term Care Choices Program › Section 42-6-107 - Assisted Living Expansion; Reimbursement Increase.

42-6-107. Assisted living expansion; reimbursement increase.
The department shall seek federal approval to increase the number of allowed slots in the assisted living Medicaid waiver from one hundred forty-six (146) to one hundred sixty-eight (168) slots.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 6 - Long Term Care Choices Program › Section 42-6-108 - Adult Day Care.

42-6-108. Adult day care.
The department shall investigate adult day care providers in Wyoming with respect to access, rates, administration of rules and regulations and their impact on providers and clients, and shall report its findings to the joint labor, health and social services interim committee and to the advisory council on aging. The report shall not exceed two thousand (2,000) words in length plus appropriate charts and graphs.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 6 - Long Term Care Choices Program › Section 42-6-109 - Aging and Disability Resource Centers.

42-6-109. Aging and disability resource centers.
(a) The department is authorized, using competitive grants and contracts, to fund a statewide network of aging and disability resource centers.
(b) Locations of the aging and disability resource centers shall be determined by the department of health, aging division. In selecting locations for aging and disability resource centers, the department of health, aging division, shall require a degree of local community funding, which may include in kind contributions, for a center.
(c) The purpose of each center shall be to create a single, coordinated system of information and assistance for all persons seeking long term support. Each center shall assist eligible persons in making informed decisions about health care access and long term care service and support options and shall serve as a referral agency to the long term care support system. Centers shall provide information and assistance to individuals needing either public or private resources, professionals seeking assistance on behalf of their clients and individuals planning for their future long term care needs.
(d) Repealed by Laws 2015, ch. 59, 2.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 7 - Long-Term Care Partnership Program › Section 42-7-102 - Definitions.

42-7-102. Definitions.
(a) As used in this act:
(i) "Agency" means the department of health;
(ii) "Asset disregard" means, with respect to qualification for state Medicaid benefits, the disregard of any assets or resources in an amount equal to the insurance benefit payments that are made to or on behalf of an individual who is a beneficiary under a qualified long-term care insurance partnership policy;
(iii) "Department" means the department of insurance;
(iv) "Medicaid" means the program administered by the state pursuant to the Wyoming Medical Assistance and Services Act and this act and partly funded by the federal government pursuant to title XIX of the federal Social Security Act;
(v) "Qualified long-term care insurance partnership policy" means a policy that meets all of the following requirements:
(A) The policy covers an insured who was a resident of Wyoming when coverage first became effective under the policy;
(B) The policy is a qualified long-term care insurance policy as defined in section 7702B(b) of the Internal Revenue Code of 1986 issued not earlier than the effective date of the state plan amendment;
(C) The director of the department certifies that the policy meets the model regulations and requirements of the national association of insurance commissioners model specified in paragraph (5) of title VI, section 6021 of the federal Deficit Reduction Act of 2005; and
(D) If the policy is sold to an individual who:
(I) Has not attained age sixty-one (61) as of the date of purchase, the policy provides compound annual inflation protection;
(II) Has attained age sixty-one (61) but has not attained age seventy-six (76) as of such date, the policy provides some level of inflation protection; or
(III) Has attained age seventy-six (76) as of such date, the policy may, but is not required to, provide some level of inflation protection.
(vi) "State plan amendment" means a state Medicaid plan amendment made with the approval of the federal department of health and human services that provides for the disregard of any assets or resources in an amount equal to the insurance benefit payments that are made to or on behalf of an individual who is a beneficiary under a qualified long-term care insurance partnership policy.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 7 - Long-Term Care Partnership Program › Section 42-7-104 - Administration.

42-7-104. Administration.
(a) The agency and the department are authorized to adopt rules to implement and administer the provisions of this act.
(b) The agency and department shall comply with all federal rules developed in accordance with title VI, section 6021 of the federal Deficit Reduction Act of 2005, regarding data reporting, reciprocity with other states that develop long-term care insurance partnership programs, and any other matters, and shall have the authority to adopt regulations relative to the provisions of any federal rules and their administration.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 8 - Nursing Care Facility Assessment Act › Section 42-8-102 - Definitions.

42-8-102. Definitions.
(a) As used in this article:
(i) "Account" means the nursing care facility assessment account created under W.S. 42-8-103;
(ii) "Department" means the department of health;
(iii) "Fiscal year" means the twelve (12) month period beginning October 1 and ending September 30;
(iv) "Medicaid" means as defined in W.S. 42-7-102(a)(iv);
(v) "Medicare resident day" means a resident day funded by the Medicare program, a Medicare advantage or special needs plan or by the Medicare hospice program;
(vi) "Net patient service revenue" means gross inpatient revenues from services provided to nursing care facility patients less reductions from gross inpatient revenue resulting from an inability to collect payment of charges. Inpatient care revenue excludes nonpatient care revenue such as beauty and barber, vending income, interest and contributions, revenues from the sale of meals and all outpatient revenues. Reductions from gross revenue includes bad debts, contractual adjustments, uncompensated care, discounts and adjustments and other revenue deductions;
(vii) "Nursing care facility" means a facility providing nursing care, but does not include a facility solely providing assisted living care, a facility solely providing rehabilitative services or a facility solely providing a combination of assisted living care and rehabilitative services;
(viii) "Resident day" means a calendar day of care provided to a nursing facility resident, including the day of admission and excluding the day of discharge, provided that one (1) resident day shall be deemed to exist when admission and discharge occur on the same day;
(ix) "Upper payment limit" means the limitation established pursuant to 42 C.F.R. 447.272 that disallows federal matching funds when state Medicaid agencies pay certain classes of nursing care facilities an aggregate amount for services furnished by that class of nursing care facilities that would exceed the amount that would be paid under Medicare payment principles.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 8 - Nursing Care Facility Assessment Act › Section 42-8-103 - Nursing Care Facility Assessment Account.

42-8-103. Nursing care facility assessment account.
(a) The nursing care facility assessment account is created.
(b) The state treasurer shall invest amounts deposited within the account in accordance with law, and all investment earnings shall be credited back to the account.
(c) The account shall consist of:
(i) Amounts collected or received by the department from nursing care facility assessments under this article;
(ii) All federal matching funds received by the department as a result of expenditures made by the department attributable to the account;
(iii) Any interest or penalties levied in conjunction with the administration of this article.
(d) The account is created for the purpose of receiving funds as specified in this section. Collected assessment funds shall be used to secure federal matching funds available through the state Medicaid plan, which shall be used to make Medicaid payments for nursing care facility services which exceed the amount of nursing care facility Medicaid rates, in the aggregate, as calculated in accordance with the approved state Medicaid plan in effect on October 1, 2010. The fund shall be used exclusively for the following purposes:
(i) To pay administrative expenses incurred by the department or its agent in performing the activities authorized by this article, provided that such expenses shall not exceed a total of one percent (1%) of the aggregate assessment funds collected in the fiscal year;
(ii) To increase nursing care facility payments to fund covered services to Medicaid beneficiaries within Medicare upper payment limits, as negotiated with the department. The upper payment limit for private nursing care facilities, state government-owned facilities and nonstate government-owned nursing facilities shall be calculated by the department using the higher of the cost-based or prospective payment system approach in accordance with the provisions of 42 C.F.R. 447.272;
(iii) To repay the federal government any excess payments made to nursing facilities if the state plan, after approval by the federal centers for Medicare and Medicaid services, is subsequently disapproved for any reason and after the state has appealed. Nursing care facilities shall refund the excess payments to the assessment account. The department shall return the excess payments to the federal government and nursing care facility providers in the same proportion as the original financing. Individual nursing care facilities shall be reimbursed based on the proportion of the individual nursing care facility's assessment to the total assessment paid by nursing care facilities. If a nursing care facility is unable to refund payments as provided in this paragraph, the department shall develop a payment plan and deduct amounts from future Medicaid payments. The department shall refund the federal government for the federal portion of those overpayments; or
(iv) To make quarterly adjustment payments as provided in W.S. 42-8-108.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 8 - Nursing Care Facility Assessment Act › Section 42-8-104 - Assessments.

42-8-104. Assessments.
(a) Each nursing care facility shall pay the nursing care facility assessment to the account in accordance with this article.
(b) The aggregated amount of assessments for all nursing facilities during a fiscal year shall be the lesser of the amount necessary to fund the provisions of this article or the maximum amount that may be assessed pursuant to the indirect guarantee threshold as established pursuant to 42 C.F.R. 433.68(f)(3)(i). The department shall determine the assessment rate prospectively for the applicable fiscal year on a per-resident-day basis, exclusive of Medicare resident days. The per-resident-day assessment rate shall be uniform. The department shall promulgate rules for facility reporting of non-Medicare resident days and for payment of the assessment.
(c) The department shall collect, and each nursing care facility shall pay, the assessment under this section on a quarterly basis. The initial payment shall be due not later than forty-five (45) days after the state plan has been approved by the federal centers for Medicare and Medicaid services unless a later date is set by the department. Subsequent payments are due not later than forty-five (45) days after the end of each calendar quarter.
(d) Nursing care facility operators may increase their charges to incorporate the cost of paying the assessment under this section, but shall not create a separate line-item charge on the bill reflecting the assessment.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 8 - Nursing Care Facility Assessment Act › Section 42-8-105 - Approval of State Plan.

42-8-105. Approval of state plan.
(a) The department shall seek necessary federal approval in the form of state plan amendments in order to implement the provisions of this article.
(b) The department shall adopt rules and regulations necessary to implement the provisions of this article or obtain approval of the state plan amendments.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 8 - Nursing Care Facility Assessment Act › Section 42-8-107 - Penalties for Failure to Pay Assessment.

42-8-107. Penalties for failure to pay assessment.
(a) If a nursing care facility fails to pay an assessment when due under this article, there shall be added to the assessment a penalty equal to five percent (5%) of the amount of the assessment that was not paid when due. The penalty under this section may be waived by the department for good cause. Any payments after a penalty is assessed under this section shall be credited first to unpaid assessment amounts rather than to penalty or interest amounts, beginning with the most delinquent installment.
(b) In addition to the penalty under subsection (a) of this section, the department may implement any of the following remedies for failure of a nursing care facility to pay its assessment when due under this article:
(i) Withhold any medical assistance reimbursement payments until the assessment is paid;
(ii) Suspend or revoke the nursing care facility's license; or
(iii) Develop a plan that requires the nursing care facility to pay any delinquent assessment in installments.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 8 - Nursing Care Facility Assessment Act › Section 42-8-108 - Quarterly Adjustment Payments.

42-8-108. Quarterly adjustment payments.
(a) Each nursing facility is eligible for quarterly adjustments as provided in this section.
(b) The department shall determine the number of days that nursing care facility services were paid for by the Wyoming medical assistance program for the applicable annual cost report. That number of days shall be utilized by the department to determine the nursing care facility adjustment payment. Adjustment payments shall be paid by the department on a quarterly basis to reimburse covered Medicaid expenditures in the aggregate within the upper payment limit. Each quarterly payment shall be made not later than thirty (30) days after the end of the calendar quarter with the initial adjustment payment due not later than thirty (30) days after the approval by the federal centers for Medicare and Medicaid services of the state's plan reflecting facility adjustment payments.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 8 - Nursing Care Facility Assessment Act › Section 42-8-109 - Discontinuation of the Assessment and Quarterly Adjustment Payments.

42-8-109. Discontinuation of the assessment and quarterly adjustment payments.
(a) The assessment imposed by this article shall be discontinued if:
(i) The state plan amendment reflecting the quarterly nursing care facility adjustment payments under W.S. 42-8-108 is not approved by the federal centers for Medicare and Medicaid services. The department may modify the rate adjustment provisions as necessary to obtain the federal centers for Medicare and Medicaid services approval if such changes do not exceed the authority and purposes of this article;
(ii) The department reduces rates to a level less than the rates effective on October 1, 2010 plus revenue increases from the account, including matches by federal financial participation;
(iii) The department or any other state agency attempts to utilize the money in the account for any use other than permitted by this article;
(iv) If federal financial participation to match assessments under this article becomes unavailable under federal law. In such case, the department shall terminate the imposition of assessments beginning on the date the federal statutory, regulatory or interpretive change takes effect.
(b) If collection of the assessment is discontinued as provided in this section, quarterly adjustment payments shall be discontinued and any amount in the account shall be returned to the nursing care facility from which the assessment was collected on the same basis as it was collected.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 9 - Private Hospital Assessment Act › Section 42-9-102 - Definitions.

42-9-102. Definitions.
(a) As used in this chapter:
(i) "Account" means the private hospital assessment account created by W.S. 42-9-103;
(ii) "Department" means the department of health;
(iii) "Fiscal year" means the twelve (12) month period beginning October 1 and ending September 30;
(iv) "Medicaid" means the medical assistance program established by title XIX of the federal Social Security Act and administered in this state by the department pursuant to the Wyoming Medical Assistance and Services Act;
(v) "Medicare cost report" means the annual hospital cost report as determined by the centers for medicare and medicaid services and as reported to the health care cost report information system;
(vi) "Net hospital patient revenue" means gross hospital revenue as reported on the most recently filed medicare cost report, excluding estimated nonhospital ancillary revenue, multiplied by the hospital s ratio of total net to gross revenue. The department shall establish a procedure to reconcile filed cost report information with information from the settled cost report. If a hospital does not file a medicaid cost report, the department shall establish a procedure to determine what the hospital would have reported as net patient hospital revenue if the hospital had filed a medicaid cost report;
(vii) "Private hospital" means those institutions licensed by the department as hospitals which are not owned or operated by the state or any city, town, county, special district or other political subdivision of the state or local government;
(viii) "Quarterly adjustment payment" means the payment made to private hospitals pursuant to W.S. 42-9-106;
(ix) "Upper payment limit" means the applicable limitation established pursuant to 42 C.F.R. 447.272, 42 C.F.R. 447.321 or as otherwise established by the centers for medicare and medicaid services;
(x) "Upper payment limit gap" means the amount calculated annually by the department constituting the difference between the applicable upper payment limit and medicaid payments made subject to that limit in a fiscal year, excluding any quarterly adjustment payments authorized by this chapter;
(xi) "Hospital services" means inpatient, outpatient and other services provided by a private hospital or by practitioners employed by, under contract with or in affiliation with a hospital-affiliated professional service provider group. Hospital services for purposes of this act include services provided in a psychiatric residential treatment facility owned, operated by or affiliated with a private hospital.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 9 - Private Hospital Assessment Act › Section 42-9-103 - Private Hospital Assessment Account.

42-9-103. Private hospital assessment account.
(a) The private hospital assessment account is created.
(b) The state treasurer shall invest amounts deposited within the account in accordance with law and all investment earnings shall be credited back to the account. Funds in the account are continuously appropriated to the department for the purposes specified in this section.
(c) The account shall consist of:
(i) Amounts collected or received by the department from private hospital assessments under this chapter;
(ii) All federal matching funds received by the department as a result of expenditures made by the department pursuant to this chapter.
(d) The account shall be used exclusively for the following purposes:
(i) To pay administrative expenses incurred by the department or its agent in performing the activities authorized by this chapter, provided that these expenses shall not exceed a total of three percent (3%) of the aggregate assessment funds collected in the fiscal year;
(ii) To secure federal matching funds available through the state medicaid plan as approved pursuant to W.S. 42-9-108, which shall be used to make quarterly adjustment payments as provided by this chapter;
(iii) To repay to the federal government any excess payments received or made to private hospitals if the state plan, after approval by the centers for medicare and medicaid services, is subsequently disapproved for any reason and after the state has exhausted all appeals. Private hospitals shall refund any excess payments to the assessment account. If a private hospital is unable to refund payments as provided in this paragraph, the department shall develop a payment plan to recoup deficient payments and accordingly deduct amounts from future medicaid payments. The department shall refund the federal government for the federal portion of those overpayments;
(iv) To refund assessments paid by private hospitals for quarterly adjustment payments which were earned but not paid by the department, but only after the payments authorized by paragraphs (i) and (iii) of this section have been made.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 9 - Private Hospital Assessment Act › Section 42-9-104 - Assessments.

42-9-104. Assessments.
(a) Each private hospital shall pay a private hospital assessment to the department in accordance with this section. Hospitals owned or operated by the state or any city, town, county, special district or other political subdivision of the state or local government shall not be required to pay the assessment required by this section.
(b) The assessment due under this section shall be imposed each fiscal year in an amount calculated as a uniform percentage of each hospital's net patient revenue. The assessment rate shall be determined by the department on a prospective basis and shall be based on the percentage of net hospital patient revenue needed to generate an amount not to exceed the nonfederal portion of the upper payment limit gap plus the fee authorized by W.S. 42-9-103(d)(i). In no event shall the assessment rate:
(i) Exceed the indirect guarantee threshold amount established by 42 C.F.R. 433.68(f)(3)(i) or other federal law;
(ii) Exceed two percent (2%) of a hospital's net patient revenue for the first fiscal year in which the hospital is assessed;
(iii) Increase by more than one percent (1%) of a hospital's net patient revenue for each fiscal year following the first fiscal year in which the hospital is assessed without further approval by the legislature.
(c) Unless otherwise determined by the department, the department shall collect and each private hospital shall pay the assessment required by this section on a quarterly basis, each payment constituting twenty-five percent (25%) of the annual assessment determined by the department. The initial payment shall be due not later than forty-five (45) days after the state plan has been approved by the centers for medicare and medicaid services unless a later date is set by the department. Subsequent payments are due not later than forty-five (45) days after the end of each calendar quarter unless a later date is set by the department.
(d) If a private hospital ceases to operate as a hospital or for any reason ceases to be subject to the assessment imposed under this chapter, the assessment for the fiscal year in which the cessation occurs shall be adjusted by multiplying the annual assessment by a fraction, the numerator of which is the number of days in the year during which the hospital is subject to the assessment and the denominator of which is three hundred sixty-five (365). Immediately upon ceasing to operate as a hospital, or otherwise ceasing to be subject to this chapter, the hospital shall pay the assessment for each quarter as adjusted, to the extent not previously paid.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 9 - Private Hospital Assessment Act › Section 42-9-105 - Penalties for Failure to Pay Assessment.

42-9-105. Penalties for failure to pay assessment.
(a) If a private hospital fails to pay an assessment due under this chapter, there shall be added to the assessment a penalty equal to five percent (5%) of the amount of the assessment that was not paid when due. The penalty under this section may be waived by the department for good cause. Any payments made after a penalty is assessed under this section shall be credited first to unpaid assessment amounts rather than to penalty amounts, beginning with the most delinquent installment.
(b) In addition to the penalty under subsection (a) of this section, the department may implement any of the following remedies for failure of a private hospital to pay its assessment when due under this chapter:
(i) Withhold any medicaid payments, including any quarterly adjustment payments, until the assessment is paid; or
(ii) Develop a plan that requires the private hospital to pay any delinquent assessment in installments.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 9 - Private Hospital Assessment Act › Section 42-9-106 - Quarterly Adjustment Payments.

42-9-106. Quarterly adjustment payments.
(a) To preserve the quality and improve access to private hospital services, the department shall make quarterly adjustment payments as set forth in this section.
(b) Each private hospital that pays assessments under this chapter and is eligible to receive medicaid payments shall be eligible to receive quarterly adjustment payments as provided in this section. The department shall distribute quarterly adjustment payments in an amount up to but not to exceed the applicable upper payment limit gap. The department shall establish a uniform methodology by which to distribute quarterly adjustment payments in compliance with applicable federal and state medicaid laws and regulations.
(c) Quarterly adjustment payments shall not be used to offset any other payment by medicaid for hospital services to medicaid beneficiaries, including without limitation any fee-for-service, per diem, private hospital inpatient adjustment or cost settlement payment.
(d) No private hospital shall be guaranteed, expressly or otherwise, that any quarterly adjustment payment will equal or exceed the amount of the private hospital assessments due under this chapter.
(e) 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.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 9 - Private Hospital Assessment Act › Section 42-9-107 - Discontinuation of the Assessment and Quarterly Adjustment Payments.

42-9-107. Discontinuation of the assessment and quarterly adjustment payments.
(a) The assessment imposed by this chapter shall be discontinued if:
(i) The state plan amendment reflecting the quarterly adjustment payments authorized by this chapter is not approved by the centers for medicare and medicaid services. The department may modify the quarterly adjustment payment provisions as necessary to obtain the centers for medicare and medicaid services approval if the changes do not exceed the authority and purposes of this chapter;
(ii) Federal financial participation to match assessments under this chapter becomes unavailable under federal law. In this event, the department shall terminate the imposition of assessments beginning on the date the federal statutory, regulatory or interpretive change takes effect.
(b) If collection of the assessment is discontinued as provided in this section, quarterly adjustment payments shall be discontinued and, after payment of all amounts under W.S. 42-9-103(d)(i) and (iii), any assessments remaining in the account shall be returned to the private hospitals from which the assessments were collected on the same basis as they were collected.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 9 - Private Hospital Assessment Act › Section 42-9-108 - Approval of State Plan; Rulemaking.

42-9-108. Approval of state plan; rulemaking.
(a) The department shall seek necessary federal approval in the form of state plan amendments in order to continue to implement the provisions of this chapter. The department shall be deemed to satisfy this requirement by seeking approval for the operation of an upper payment limit program that provides for quarterly adjustment payments. While seeking federal approval under this subsection, the department may modify payment or qualification provisions as necessary to obtain the Centers for Medicare and Medicaid Services approval if the changes do not exceed the authority and purposes of this chapter.
(b) The department shall adopt rules and regulations necessary to implement the provisions of this chapter and to obtain approval of the state plan amendments.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 10 - Welfare Fraud Prevention Act › Section 42-10-101 - Definitions.

42-10-101. Definitions.
(a) As used in this chapter:
(i) "Identity information" includes the name, alias, date of birth, address, social security number and other related information of an applicant for or recipient of a public welfare benefit;
(ii) "Public welfare benefit" means as provided in W.S. 42-2-102(a)(vii).
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 10 - Welfare Fraud Prevention Act › Section 42-10-102 - Enhanced Identity Authentication Process.

42-10-102. Enhanced identity authentication process.
Prior to awarding any public welfare benefit the department may require an applicant to complete an identity authentication process that confirms the applicant owns the identity presented in the application. The identity authentication process under this section shall consist of financial or personal questions related to the applicant. The authentication process shall be available for applicant interviews in person or by telephone.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 10 - Welfare Fraud Prevention Act › Section 42-10-104 - Case Review Process.

42-10-104. Case review process.
(a) If the department finds a discrepancy or change in circumstances as a result of the activities required by W.S. 42-10-102 or 42-10-103, the department shall review the case using the following procedures:
(i) If the discrepancy or change in circumstances does not affect eligibility, the department shall take no further action;
(ii) If the discrepancy or change in circumstances may affect eligibility, the department shall:
(A) Promptly make a determination of the effect of the discrepancy or change in circumstances on the eligibility of the applicant or recipient; and
(B) Provide written notice to the applicant or recipient describing in detail the circumstances of the discrepancy or change in circumstances, the manner in which the applicant or recipient may respond and the consequences of failing to take any action. The department shall give the applicant or recipient an opportunity to explain the discrepancy or change in circumstances.
(iii) The applicant or recipient shall respond within ten (10) business days from the date of the written notice of the discrepancy or change in circumstances;
(iv) If an applicant or recipient does not respond to a notice of a discrepancy or change in circumstances as provided in paragraph (ii) of this subsection and the department determines that the discrepancy or change in circumstances affects eligibility for a public welfare benefit, the department shall provide a written decision of the intent to deny, reduce the benefit or close the benefit case;
(v) If an applicant or recipient responds to a notice of a discrepancy or change in circumstances as provided in paragraph (ii) of this subsection, the department shall investigate and make a determination of whether or not the discrepancy or change in circumstances has been resolved and determine the applicant's or recipient's eligibility for public welfare benefits. The decision of the department shall be provided to the applicant or recipient in writing;
(vi) A written decision of the department under this section shall constitute a final decision of the department subject to judicial review as provided in W.S. 16-3-114.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 10 - Welfare Fraud Prevention Act › Section 42-10-105 - Referral of Cases for Investigation.

42-10-105. Referral of cases for investigation.
(a) After review of a discrepancy or change in circumstances under W.S. 42-10-104, if the department finds that there is inadequate documentation or upon reasonable suspicion that there is fraud, misrepresentation, identity theft or another violation of law the department shall:
(i) Refer the case to the fraud and recovery unit for investigation, recovery of improper payments and collection of civil penalties, if applicable and, if appropriate, referral to prosecuting authorities for criminal prosecution;
(ii) Refer the information to other agencies, divisions or departments as appropriate for review of eligibility in public programs.
(b) To the extent the department encounters an individual enrolled in Medicaid who the department has reason to believe is not eligible for Medicaid, the department shall inform the individual and the Wyoming Medicaid program of the reason the department does not believe the individual is eligible.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 10 - Welfare Fraud Prevention Act › Section 42-10-106 - Report.

42-10-106. Report.
Not later than November 30 of 2017, 2018 and 2020 the department shall report to the governor and the joint labor, health and social services interim committee on the effectiveness of the eligibility verification system and the number of cases referred under W.S. 42-10-105 including information on the outcome of the cases, if available, and on the cost to the department of the system.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 11 - Private Ground Ambulance Service Provider Assessment Act › Section 42-11-102 - Definitions.

42-11-102. Definitions.
(a) As used in this chapter:
(i) "Account" means the private ground ambulance service provider assessment account created by W.S. 42-11-103;
(ii) "Ambulance" has the same meaning as defined in W.S. 33-36-102(a)(i)(A) and (B);
(iii) "Department" means the department of health;
(iv) "Fiscal year" means the twelve (12) month period beginning October 1 and ending September 30;
(v) "Private ground ambulance service provider" means any person operating a licensed ambulance service designed to operate on the ground, which is not owned or operated by the state or any city, town, county, special district or other political subdivision of the state or local government;
(vi) "License" and "licensed" means an ambulance business license issued under W.S. 33-36-104 that is not expired and has not been revoked or suspended;
(vii) "Medicaid" means the medical assistance program established by title XIX of the federal Social Security Act and administered in this state by the department pursuant to the Wyoming Medical Assistance and Services Act;
(viii) "Net patient revenue" means all amounts received by a private ground ambulance service provider licensed under W.S. 33-36-104 for the provision of licensed, ground ambulance services in the state of Wyoming. The department shall establish a procedure for determining net patient revenue for purposes of the assessment provided under W.S. 42-11-104;
(ix) "Quarterly adjustment payment" means the quarterly payments made to private ground ambulance service providers that the department may establish and distribute pursuant to W.S. 42-11-106;
(x) "Rate enhancement" means Medicaid reimbursement rate increases to private ground ambulance service providers, as determined by the department and approved by the Centers for Medicare and Medicaid Services;
(xi) "Upper payment limit" means a limitation on aggregate Medicaid payments to private ground ambulance service providers, or another applicable class of Medicaid payees, as established by the Centers for Medicare and Medicaid Services;
(xii) "Upper payment limit gap" means the amount calculated annually by the department constituting the difference between the applicable upper payment limit and Medicaid payments made subject to that limit in a fiscal year, excluding any payments authorized by this chapter.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 11 - Private Ground Ambulance Service Provider Assessment Act › Section 42-11-103 - Private Ground Ambulance Service Provider Assessment Account.

42-11-103. Private ground ambulance service provider assessment account.
(a) The private ground ambulance service provider assessment account is created.
(b) The state treasurer shall invest amounts deposited in the account in accordance with law and all investment earnings shall be credited back to the account. Funds in the account are continuously appropriated to the department for the purposes specified in this section.
(c) The account shall consist of:
(i) Amounts collected or received by the department from private ground ambulance service provider assessments under this chapter;
(ii) All federal matching funds received by the department as a result of expenditures made by the department pursuant to this chapter.
(d) The account shall be used exclusively for the following purposes:
(i) To pay administrative expenses incurred by the department or its agent in performing the activities authorized by this chapter, provided that these expenses shall not exceed a total of three percent (3%) of the aggregate assessment funds collected in the fiscal year;
(ii) To secure federal matching funds available through the state Medicaid plan as approved pursuant to W.S. 42-11-108, which shall be used to make quarterly adjustment payments or to provide rate enhancements to private ground ambulance service providers as provided by this chapter;
(iii) To repay to the federal government any excess payments received or made to private ground ambulance service providers if the state plan, after approval by the Centers for Medicare and Medicaid Services, is subsequently disapproved for any reason and after the state has exhausted all appeals. Private ground ambulance service providers shall refund any excess payments to the assessment account. If a private ground ambulance service provider is unable to refund payments as provided in this paragraph, the department shall develop a payment plan to recoup deficient payments and accordingly deduct amounts from future Medicaid payments. The department shall refund the federal government for the federal portion of those overpayments;
(iv) To refund assessments paid by private ground ambulance service providers for payments which were earned but not paid by the department, but only after the payments authorized by paragraphs (i) and (iii) of this subsection have been made.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 11 - Private Ground Ambulance Service Provider Assessment Act › Section 42-11-104 - Assessments.

42-11-104. Assessments.
(a) Each private ground ambulance service provider shall pay a private ground ambulance service provider assessment to the department in accordance with this section.
(b) The assessment due under this section shall be imposed each fiscal year in an amount calculated as a uniform percentage of each private ground ambulance service provider's net patient revenue. The assessment rate shall be determined by the department on a prospective basis and shall be based on the percentage of private ground ambulance service provider net patient revenue necessary to generate an amount not to exceed the nonfederal portion of the upper payment limit gap plus the fee authorized by W.S. 42-11-103(d)(i). If a rate enhancement is paid to private ground ambulance service providers pursuant to this chapter, the assessment rate shall include a uniform percentage of each private ground ambulance service provider's net patient revenue necessary to generate the nonfederal portion of all enhanced rates paid under this chapter plus the fee authorized by W.S. 42-11-103(d)(i). In no event shall assessments or the assessment rate exceed the indirect guarantee threshold amount established by 42 C.F.R. 433.68(f)(3)(i) or other federal law.
(c) Unless otherwise determined by the department, the department shall collect and each private ground ambulance service provider shall pay the assessment required by this section on a quarterly basis, each payment constituting twenty-five percent (25%) of the annual assessment determined by the department. The initial payment shall be due not later than forty-five (45) days after the state plan has been approved by the Centers for Medicare and Medicaid Services unless a later date is set by the department. Subsequent payments are due not later than forty-five (45) days after the end of each calendar quarter unless a later date is set by the department.
(d) If a private ground ambulance service provider ceases to operate as an ambulance service or for any reason ceases to be subject to the assessment imposed under this chapter, the assessment for the fiscal year in which the cessation occurs shall be adjusted by multiplying the annual assessment by a fraction, the numerator of which is the number of days in the year during which the private ground ambulance service provider is subject to the assessment and the denominator of which is three hundred sixty-five (365). Immediately upon ceasing to operate as an ambulance service provider, or otherwise ceasing to be subject to this chapter, the private ground ambulance provider shall pay the assessment for each quarter as adjusted, to the extent not previously paid.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 11 - Private Ground Ambulance Service Provider Assessment Act › Section 42-11-105 - Penalties for Failure to Pay Assessment.

42-11-105. Penalties for failure to pay assessment.
(a) If a private ground ambulance service provider fails to pay an assessment due under this chapter, there shall be added to the assessment a penalty equal to five percent (5%) of the amount of the assessment that was not paid when due. The penalty under this section may be waived by the department for good cause. Any payments made after a penalty is assessed under this section shall be credited first to unpaid assessment amounts rather than to penalty amounts, beginning with the most delinquent installment.
(b) In addition to the penalty under subsection (a) of this section, the department may implement any of the following remedies for failure of a private ground ambulance service provider to pay its assessment when due under this chapter:
(i) Withhold any Medicaid payments, including any quarterly adjustment payments or rate enhancements, until the assessment is paid;
(ii) Develop a plan that requires the private ground ambulance service provider to pay any delinquent assessment in installments;
(iii) Suspend or revoke the private ground ambulance service provider's license.