reglab/statecodes huggingface dataset:
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0036 - Land Commissioners, Board of › Chapter 1 - GENERAL PROVISIONS › Section 1-1 - Authority

Current through July 13, 2024
These rules and regulations are promulgated by the Community
				  and Family Health Division pursuant to its authority under the general
				  provision of
				  W.S.
				  9-2-106(a)(vii).
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0036 - Land Commissioners, Board of › Chapter 1 - GENERAL PROVISIONS › Section 1-2 - Purpose and Applicability

Current through July 13, 2024
(a) These rules and
				regulations are adopted to implement the authority of Wyoming Children's
				Special Health (CSH) Program, Maternal High Risk (MHR) Program, and Newborn
				Intensive Care (NBIC) Program, Community and Family Health Division
				to:
(b) Provide family-centered,
				community-based, culturally competent, coordinated care, case management and
				limited financial assistance to maternal and child population, including
				children with special need;
(c) The
				Department may issue Provider Manuals, Provider Bulletins, or both, to
				interpret the provisions of these rules and regulations. Such Provider Manuals
				and Provider Bulletins shall be consistent with and reflect the policies
				contained in these rules and regulations. The provisions contained in Provider
				Manuals or Provider Bulletins shall be subordinate to the provisions of these
				rules and regulations.
(d) The
				incorporation by reference of any external standard is intended to be the
				incorporation of that standard as it is in effect on the effective date of
				these rules and regulations.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0036 - Land Commissioners, Board of › Chapter 1 - GENERAL PROVISIONS › Section 1-5 - Changes or Restrictions in Service Reimbursement

Current through July 13, 2024
The MCH Section Programs may restrict or categorize service
				  reimbursement to meet budgetary limitations.
(a) Services will be prioritized based upon
				medical necessity, and funding availability.
(b) In the event that the MCH Programs
				benefits must be reduced, they will be reduced in a manner that takes into
				consideration medical necessity and family financial eligibility.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0036 - Land Commissioners, Board of › Chapter 1 - GENERAL PROVISIONS › Section 1-6 - Payment of Program Benefits

Current through July 13, 2024
(a) MCH programs
				are the payor of last resort following all other third party payors.
(b) Payments are made directly to approved
				providers for covered services. No payments will be made to families.
(c) Payment to approved providers is based on
				Wyoming EqualityCare rates with any applicable modifiers.
(d) Total annual payment for services for any
				MCH Program eligible client will be capped.
(e) All services must be approved for
				payment.
(f) Payment is made
				through the MCH fiscal agent(s).
(g) Services provided prior to the MCH
				eligibility date will not be paid.
(h) No payment will be made unless required
				billing is received by MCHs fiscal agent(s) within one (1) year from date of
				service.
(i) Any recovery of money
				by the family through legal actions, third party payors or other liabilities,
				shall be paid to the state to the extent that the state has incurred
				expenses.
(j) Excess payments may
				be recovered.
(k) Denial of
				non-covered services. The denial of services because they are not covered
				services is not an adverse action and the insured shall not be entitled to a
				reconsideration or administrative hearing.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0036 - Land Commissioners, Board of › Chapter 2 - ELIGIBILITY REQUIREMENTS › Section 2-2 - Eligibility

Current through July 13, 2024
(a) An applicant will be eligible to receive
				MCH benefits when Program approval is given, after meeting the following
				requirements:
(i) Has made application
				through:
(A) A Public Health Nursing Field
				Office; or
(B) An MCH designated
				representative;
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0036 - Land Commissioners, Board of › Chapter 2 - ELIGIBILITY REQUIREMENTS › Section 2-3 - Application Process/Residency Requirements

Current through July 13, 2024
In making application, a parent/guardian must submit or have
				  submitted the following documents:
(a)
				MCH requires families to apply to EqualityCare or Kid Care (CHIP) at the time
				of their application and annual renewal. All applicants will be screened for
				benefits from other programs for which they may be eligible, and informed of
				potential eligibility. Parents must apply to all available payment resources
				prior to being eligible for MCH services.
(b) A properly completed and signed original
				Application for Program Benefits.
(c) If there is a question regarding
				residency, the following documents can be used as evidence of residency. Copies
				of any two (2) of the following documents would be considered acceptable:
(i) Current, valid Wyoming driver's license,
				or an identification card with a current address and telephone
				number;
(ii) Current mortgage or
				rent payment receipts;
(iii)
				Current utility payment receipts;
(iv) Current, valid Wyoming EqualityCare
				card;
(v) Current
				employment/unemployment records; or
(vi) Current postal verification of
				address.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0036 - Land Commissioners, Board of › Chapter 2 - ELIGIBILITY REQUIREMENTS › Section 2-4 - Financial

Current through July 13, 2024
(a) The family's adjusted annual income shall
				be calculated by:
(i) Totaling all cash
				receipts before taxes from all sources for a twelve month period. These sources
				include:
(A) Wages, tips, salaries, and
				commissions before deductions (gross income).
(B) Regular payments from Social Security,
				unemployment compensation, Workman's compensation, retirement, strike benefits,
				and training stipends.
(C) Alimony,
				child support and family military allotments, or other regular support from an
				absent family member or someone not living in the household.
(D) Payments towards household expenses from
				other adults living full or part-time in the household.
(E) Private pensions, government employee
				pensions, and regular or annuity payments for all family members.
(F) Dividends, interest, rents, royalties or
				periodic receipts from estates or trusts for all family members.
(G) Funds received in the
				parent(s)/guardian(s) name, through donations, legal action, third party payor,
				or other sources.
(H) Savings above
				an established amount.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0036 - Land Commissioners, Board of › Chapter 2 - ELIGIBILITY REQUIREMENTS › Section 2-5 - Incomplete Applications

Current through July 13, 2024
(a) An application
				shall be deemed incomplete for any one of the following reasons:
(i) Failure to provide information requested
				on the application form;
(ii) Lack
				of supporting documents;
(iii) Lack
				of proper signature;
(iv) Lack of
				legal residency documentation; or
(v) Lack of financial
				documentation.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0036 - Land Commissioners, Board of › Chapter 2 - ELIGIBILITY REQUIREMENTS › Section 2-7 - Medical Eligibility Statement of Purpose

Current through July 13, 2024
(a) Children's
				Special Health in Wyoming provides services for Children with Special Health
				Care Needs who have chronic conditions which may be rehabilitated. MHR/NBIC
				provides limited financial assistance to high risk pregnant women and/or
				infants receiving tertiary care as ordered by their provider(s).
(i) The CSH Program provides services for
				Children with Special Health Care Needs such as congenital anomalies, cardiac
				problems, neurological difficulties, tumors, rehabilitation secondary to trauma
				or infectious disease, and other specific chronic conditions.
(ii) MCH is not a health care provider. Each
				client is expected to have a primary care physician, obstetrician, or
				pediatrician to provide care.
(iii)
				Case management of each client is done by the family and health care providers
				in conjunction with MCH.
(iv) CSH
				may provide for diagnostic evaluation regarding conditions that may qualify for
				the Program. Following the initial diagnostic evaluation, a determination is
				made regarding medical eligibility.
(v) MCH clients are treated by providers who
				are approved by MCH. Specific requirements for provider approval are available
				at the MCH State office.
(vi) CSH
				Wyoming health care providers are given priority when equivalent care is
				available Wyoming,
(vii) MCH
				coverage is only provided for those diagnoses for which the client has been
				determined to be medically eligible.
(viii) MCH services shall be authorized by
				the Program before reimbursement is honored.
(ix) Financial assistance through MCH is
				constrained by available funding. Services may be altered to reflect current
				resources available.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0036 - Land Commissioners, Board of › Chapter 3 - DENIAL OF APP/MODIFICATION/SUSPENSION/TERMINATION OF CLIENT BENEFITS › Section 3-1 - Statement of Purpose

Current through July 13, 2024
These rules and regulations are adopted to implement the
				  Divisions authority to deny application or modify, suspend or terminate
				  benefits under any MCH Program for the following reasons:
(a) The applicant/client is not a bona fide
				resident of the State;
(b) The
				applicant fails or refuses to provide documentation of residency;
(c) The applicant/client fails or refuses to
				submit, within a required time frame, a financial status report for the purpose
				of determining reimbursement obligation/co-pay liability;
(d) The applicant/client fails or refuses to
				apply for benefits from other payment sources;
(e) The applicant/client submits false
				statements of fact designed to enhance that person's eligibility status for MCH
				Program benefits;
(f) The
				applicant/client fails to meet financial and/or medical eligibility
				requirements;
(g) The
				applicant/client refuses to reimburse the Program after being notified of third
				party benefits or recipient reimbursement obligation;
(h) The applicant/client notifies the Program
				that MCH benefits are no longer required;
(i) The client is requesting and/or receiving
				services from a provider who is not enrolled in MCH;
(j) The applicant/client fails to file
				application in a timely manner;
(k)
				The applicant/client submits false claims to the MCH Program;
(l) The applicant/client has not complied
				with the MCH approved medical treatment plan;
(m) The funds allocated for payment on behalf
				of the client are exhausted;
(n)
				The CSH client reaches their 19th
				birthday;
(o) The client
				dies;
(p) The day an MHR client
				completes genetic testing; or
(q)
				The day an MHR/NBIC client is discharged from a tertiary care
				facility.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0036 - Land Commissioners, Board of › Chapter 3 - DENIAL OF APP/MODIFICATION/SUSPENSION/TERMINATION OF CLIENT BENEFITS › Section 3-2 - Procedure for the Denial of Applications ; Modification, Suspension, or Termination of Benefits

Current through July 13, 2024
(a) Any applicant
				for (MCH) Program benefits will be notified in writing if their application has
				been denied. The notification will state the reasons for denial and the right
				to request a hearing.
(b) Any
				recipient of benefits from the MCH Program will be notified if benefits are to
				be modified, suspended or terminated. Notification will be by mail (with
				forwarding address requested), to the most recent address known to the Program.
				The notice shall contain the reasons for the intended action, as well as the
				contestant's right to a hearing and the method by which a hearing may be
				obtained.
(c) These procedures do
				not apply to adjustments made by the MCH Program in the type of Program
				benefits or the amount of benefits available when such adjustments are applied
				to all clients in order to conform to budgetary limitations or legislative
				mandate.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0036 - Land Commissioners, Board of › Chapter 4 - Grazing and Agricultural Leasing › Section 4-1 - Statement of Purpose

Current through July 13, 2024
These rules and regulations are adopted to implement the
				  Divisions authority to allow appeal by any applicant/client, aggrieved by the
				  Maternal and Child Health Programs decision to deny an application, or modify,
				  suspend, or terminate benefits.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0036 - Land Commissioners, Board of › Chapter 4 - Grazing and Agricultural Leasing › Section 4-2 - Notice to Contestant of Right to a Hearing

Current through July 13, 2024
(a) The Division
				must inform every applicant in writing:
(i)
				Of the right to a hearing;
(ii) Of
				the method by which a hearing may be obtained; and
(iii) That representation may be by self, or
				use of legal counsel, a relative, a friend, or other spokesperson.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0036 - Land Commissioners, Board of › Chapter 4 - Grazing and Agricultural Leasing › Section 4-3 - Administrative Hearing Availability

Current through July 13, 2024
(a) Hearings shall
				be available to the following aggrieved party when all other requirements are
				met:
(i) A person requesting or receiving
				services or benefit administered by the Division; or
(ii) A representative of the above.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0036 - Land Commissioners, Board of › Chapter 4 - Grazing and Agricultural Leasing › Section 4-4 - Request for Hearing

Current through July 13, 2024
(a) Any client or
				their representative may make a request to the Division in writing, for a
				hearing.
(b) Any unclear request
				for a hearing shall be clarified by the contestant upon request by the
				Division. The contestant shall be assisted in putting the request in writing,
				if needed.
(c) The request shall
				contain at least:
(i) The name, address, and
				telephone number of the person requesting the hearing; and
(ii) The reason for the request, including
				the nature of the Division action, order, or determination being
				contested.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0036 - Land Commissioners, Board of › Chapter 4 - Grazing and Agricultural Leasing › Section 4-5 - Maintaining Services

Current through July 13, 2024
(a) If the Division
				mails the ten (10) day notice (Section
				2. c)
				as required above, and the contestant requests, in writing, a hearing before
				the date of action, the Division may not terminate or reduce services until a
				decision is rendered after the hearing.
(b) If the Divisions action is sustained by
				the final decision, the agency may institute recovery procedures against the
				applicant or client to recoup the cost of any services furnished.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0036 - Land Commissioners, Board of › Chapter 4 - Grazing and Agricultural Leasing › Section 4-6 - Local Conference

Current through July 13, 2024
(a) A local
				conference shall be offered to determine if the issue can be resolved
				informally.
(b) The contestant
				shall be advised that:
(i) The local
				conference is optional, and
(ii) It
				does not delay or replace the contested hearing, and
(iii) It may be attended by the worker who
				took the action, the program manager or their supervisor and the contestant
				and/or representative.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0036 - Land Commissioners, Board of › Chapter 4 - Grazing and Agricultural Leasing › Section 4-7 - Applicability

Current through July 13, 2024
Administrative hearings within the Division of Community and
				  Family Health shall be conducted in accordance with these rules, unless
				  specifically provided otherwise by statute, unless this procedure would
				  conflict with federal regulations.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0036 - Land Commissioners, Board of › Chapter 4 - Grazing and Agricultural Leasing › Section 4-8 - Notice of Hearing

Current through July 13, 2024
(a) In any
				contested case, the Director shall afford reasonable notice of the hearing to
				all parties.
(i) Reasonable notice, as used
				in this section, shall be not less than 20 days prior to the hearing date. The
				time period specified herein may be waived by the contestant upon written or
				oral notification to the Department. Where notification of waiver is made
				orally it shall be reduced to writing by the Department and entered in the
				contestants record.
(ii) Notice
				shall be served personally or by certified mail to the last known address of
				the party.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0036 - Land Commissioners, Board of › Chapter 4 - Grazing and Agricultural Leasing › Section 4-9 - Procedural Rights of Contestant

Current through July 13, 2024
The contestant, or his representative, must be given the
				  opportunity to:
(a) Examine at a
				reasonable time before the date of the hearing and during the hearing:
(i) The content of the contestant's case
				file; and
(ii) All documents and
				records to be used by the Division at the hearing.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0036 - Land Commissioners, Board of › Chapter 4 - Grazing and Agricultural Leasing › Section 4-10 - Failure to Appear

Current through July 13, 2024
If a contestant fails to appear at the place, date, and time
				  specified in a notice, the hearing officer may, within his discretion:
(a) Continue the hearing to a later date and
				provide proper notice as prescribed in these rules; or
(b) Proceed to conduct the hearing without
				the contestant and dispose of the contested case as provided, unless prohibited
				by Federal or State statute; or
(c)
				Deny or dismiss a hearing if:
(i) The
				contestant withdraws the request in writing; or
(ii) The contestant fails to appear at a
				scheduled hearing without good cause.
(A)
				Good cause shall be determined by considering circumstances which are beyond
				the contestant's control, such as illness, illness of another household member
				requiring the presence of the contestant, a household emergency or other such
				circumstances that the hearing officer determines were beyond the contestant's
				control.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0036 - Land Commissioners, Board of › Chapter 4 - Grazing and Agricultural Leasing › Section 4-12 - Prehearing Conference

Current through July 13, 2024
(a) Lessees of
				state land shall have the right to construct or make improvements upon the land
				in an amount not to exceed $2,000.00 per section for each separate improvement,
				without first obtaining permission.
(b) Lessees shall request permission, on a
				form provided by the Office, prior to construction of any improvement valued in
				excess of $2,000.00 per section for each separate improvement.
(c) The Director shall have authority to
				grant permission to construct improvements in excess of $2,000.00 per section
				for each separate improvement for fencing, water development, livestock
				handling facilities and range enhancements. However, any improvement,
				regardless of value, which will restrict existing public access or alter
				existing authorized use(s) of the lands must be approved by the
				Board.
(d) Any other improvement in
				excess of $2,000.00 per section for each separate improvement shall be applied
				for under a special use lease in accordance with Wyoming Statute
										36-5-114 and Chapter 5 of Board
				rules.
(e) Any applicant applying
				to lease state lands upon which there are improvements of any kind belonging to
				another shall, before receiving the lease, pay to the Director for the use and
				benefit of the owner or maker of any improvements at the time of the execution
				of the lease, the contributory value of improvements or the owner of the
				improvements shall have the right to remove the improvements in a manner which
				minimizes injury to the land; provided, that the improvements be removed within
				a period of one hundred twenty (120) days from the expiration of the lease or
				final Board decision in a related contested case proceeding. Should the owner
				of the improvements elect to remove the improvements, the owner must notify the
				Director in writing within thirty (30) days from the expiration of the lease or
				final Board decision in a related contested case proceeding. For the purposes
				of this section "contributory value" means the increased value of the property
				after the lessee's improvements are considered.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0036 - Land Commissioners, Board of › Chapter 4 - Grazing and Agricultural Leasing › Section 4-13 - Informal Disposition

Current through July 13, 2024
The Office shall investigate any allegation of fraud, deceit,
				  or misrepresentation in the procurement of leases and shall monitor all leases
				  for violations of lease covenants. When grounds for cancellation exist under
				  W.S.
				  36-5-113 or the terms and provisions of the
				  lease, the Director shall request that the Board cancel leases under the
				  procedure at Chapter 1, Section
				  9, of these rules.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0036 - Land Commissioners, Board of › Chapter 4 - Grazing and Agricultural Leasing › Section 4-14 - Hearing Officer

Current through July 13, 2024
Lessee is required to work in cooperation with the Office to
				  make every reasonable effort to control noxious weeds and pests. Lessee may
				  work in conjunction with County Weed and Pest Control Districts to develop
				  projects to be submitted to the Office for reimbursement pursuant to Chapter 28
				  of these rules.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0036 - Land Commissioners, Board of › Chapter 4 - Grazing and Agricultural Leasing › Section 4-15 - Evidence and Testimony

Current through July 13, 2024
(a) Except as may
				be otherwise ordered by the hearing officer, the contestant bears the burden of
				proof.
(b) Admissibility of
				evidence:
(i) The parties shall be entitled
				to present any oral or documentary evidence, submit rebuttal evidence and
				conduct cross-examinations, as may be required for a full disclosure of the
				facts. All documentary or physical evidence submitted for consideration shall
				be marked as exhibits. Respondent's exhibits shall be marked by letters of the
				alphabet beginning with "A". Contestant's exhibits will be marked by numbers
				beginning with "1".
(ii) The
				hearing officer shall allow any oral or documentary evidence, except that he
				may exclude irrelevant, immaterial, or unduly repetitious evidence.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0036 - Land Commissioners, Board of › Chapter 4 - Grazing and Agricultural Leasing › Section 4-16 - Representation

Current through July 13, 2024
(a) All parties have a right to represent
				themselves, to be represented by an attorney licensed to practice law in
				Wyoming, or any other person chosen by the contestant to appear on their
				behalf. If the contestant is represented by an attorney, payment of attorney's
				fees and cost are the responsibility of the contestant. Contestant may be
				eligible for legal services available through the Legal Services Corporation if
				they meet the applicable guidelines of that agency.
(i) Only the contestant, their attorney, or
				their representative may examine or cross- examine witnesses.
(ii) The hearing officer may examine
				witnesses.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0036 - Land Commissioners, Board of › Chapter 4 - Grazing and Agricultural Leasing › Section 4-17 - Order of Procedure

Current through July 13, 2024
(a) As nearly as
				practicable, the following order of procedure shall be followed:
(i) The hearing officer shall announce the
				hearing is open and call by docket number and title the case to be heard. The
				hearing officer shall ask if parties are ready to proceed and will allow
				parties an opportunity to dispose of any preliminary matters.
(ii) The hearing officer shall administer the
				oath to all witnesses who will present testimony.
(iii) The hearing officer may, in his/her
				discretion, allow evidence to be heard in an order other than that prescribed
				here.
(iv) Opening statements may
				be made, contestant first, then respondent.
(v) Evidence will be heard, contestant first,
				then respondent. Contestant may then offer rebuttal evidence. Parties may each
				exercise the right to cross-examine.
(vi) No testimony shall be received by the
				Hearing Officer unless given under oath/affirmation administered by the Hearing
				officer.
(vii) Closing statements
				may be made, contestant first, the n respondent, then the contestant in
				rebuttal.
(viii) The hearing
				officer may limit the time for opening and closing statements.
(ix) The hearing officer may recess the
				proceedings as appropriate.
(x)
				After all parties have had an opportunity to be heard, the hearing officer
				shall excuse all witnesses and close the evidence.
(A) Evidence may be reopened only upon a
				motion by a party to the proceeding on a showing of good cause.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0036 - Land Commissioners, Board of › Chapter 4 - Grazing and Agricultural Leasing › Section 4-18 - Decisions

Current through July 13, 2024
(a) The hearing officer shall make proposed
				findings of fact and conclusions of law within 20 working days of the close of
				the hearing and forward them to the Director for final determination. This time
				may be extended if the parties or other interested persons are to submit
				briefs; but, in no event may this time be extended by more than ten (10)
				working days, unless a later date is stipulated, in writing, by contestant and
				respondent.
(b) Within ten (10)
				working days of receipt of the hearing officer's proposed findings of fact and
				conclusions of law, the Director or assigned designee will make and enter in
				the record the final decision in the case. This decision shall be made and
				served on all parties of the proceeding. The decision shall include:
(i) A statement of the findings of fact and
				conclusions of law, stated separately, with a concise and explicit statement of
				the underlying facts supporting the findings; and
(ii) The appropriate rule, order, relief or
				denial thereof. The decision shall be based upon a consideration of the whole
				contested case record or any portion stipulated to by the parties. The decision
				shall state all facts officially noticed and relied upon as provided by
				statute. It shall be made on the basis of a preponderance of evidence contained
				in the record.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0036 - Land Commissioners, Board of › Chapter 4 - Grazing and Agricultural Leasing › Section 4-19 - Appeals

Current through July 13, 2024
(a) Appeals from a final decision of the
				Department shall be taken in accordance with
				W.S.
				16-3-114 and Rule 12 of the Wyoming Rules of
				Appellate Procedure.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0036 - Land Commissioners, Board of › Chapter 4 - Grazing and Agricultural Leasing › Section 4-20 - Transcripts and Record

Current through July 13, 2024
(a) When a
				contested case is set for hearing, the Director or assigned designee shall
				assign a docket number to each case and enter the case with its number and date
				of filing in a docket book maintained by the Director or assigned designee. The
				Director or his assigned designee shall maintain a separate file for each
				docketed case in which all pleadings, transcripts, correspondence, papers, and
				exhibits for that case shall be maintained. All such items shall have noted
				thereon the assigned docket number and the date of filing.
(b) The Department shall record all contested
				case proceedings electronically, through the use of a qualified court reporter
				or any other appropriate means determined by the agency, or the hearing
				officer. Transcriptions of oral proceedings or written transcripts of a
				witness's testimony may be obtained by contestant upon payment of the cost.
(i) In a non-public investigatory proceeding,
				requests for copies or transcripts may be limited to testimony of the
				requesting party.
(ii) Where
				contestant can demonstrate that he/she is indigent and that he/she cannot
				effectively perfect his/her appeal without such transcription the Department
				may waive the payment of the fee.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 1 - DEFINITIONS › Section 1-1 - Authority

Current through July 13, 2024
This Chapter is promulgated by the Department of Health
				  pursuant to the Medical Assistance and Services Act at W.S. §
									
										42-4-101,
et seq.
and the
				  Wyoming Administrative Procedure Act at W.S. §
									
										16-3-101,
et
				  seq.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 1 - DEFINITIONS › Section 1-2 - Purpose and Applicability

Current through July 13, 2024
(a) This Chapter
				has been adopted to govern the definitions for all other chapters of the
				Wyoming Department of Health Medicaid Rules which come into effect on or after
				the effective date of this Chapter.
(b) The incorporation by reference of any
				external standard is intended to be the incorporation of that standard as it is
				in effect on the effective date of this Chapter.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 2 - STATE LICENSED SHELTER CARE ELIGIBILITY AND SERVICES › Section 2-1 - Authority

Current through July 13, 2024
This rule is promulgated by the Department of Health pursuant
				  to W.S.
				  9-2-1209 and the Wyoming Administrative
				  Procedures Act at W.S. W.S.
				  W.S.
				  16-3-101 et seq.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 2 - STATE LICENSED SHELTER CARE ELIGIBILITY AND SERVICES › Section 2-2 - Purpose and Applicability

Current through July 13, 2024
(a) This Chapter is
				being adopted to implement
				W.S.
				9-2-1204 and
				9-2-1209, which create the state
				licensed shelter care program. Except as otherwise specified, the Department of
				Health will implement and administer the program through DFS.
(b) This Chapter is being adopted to
				establish eligibility standards, define the scope of covered services, and
				establish the methods and standards for reimbursing provider's of state
				licensed shelter care services. This Chapter applies to state licensed shelter
				care services provided on or after July 1, 1994.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 2 - STATE LICENSED SHELTER CARE ELIGIBILITY AND SERVICES › Section 2-3 - General Terms

Current through July 13, 2024
(a) This Chapter is
				intended to implement and be read in conjunction with
				W.S.
				9-2-1209.
(b) DFS may issue Manuals or Medical Training
				Letters (MTLs) to interpret the eligibility provisions of this Chapter. Such
				Manuals or MTLs shall be consistent with and reflect the policies contained in
				this Chapter.
(c) HCF may issue
				Provider Manuals or Provider Bulletins to interpret the services and
				reimbursement provisions of this Chapter. Such Manuals or Bulletins shall be
				consistent with and reflect the policies contained in this Chapter.
(d) The Department may issue Manuals,
				Provider Bulletins, or both, to provider's and/or other affected parties to
				interpret the provisions of this Chapter. Such Manuals and Provider Bulletins
				shall be consistent with and reflect the policies contained in this Chapter.
				The provisions contained in Manuals or Provider Bulletins shall be subordinate
				to the provisions of this Chapter.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 2 - STATE LICENSED SHELTER CARE ELIGIBILITY AND SERVICES › Section 2-4 - Definitions

Current through July 13, 2024
Except as otherwise specified, the definitions of Chapter
				  II, Section
				  3,
				  are incorporated by this reference. The following definitions apply only to
				  state licensed shelter care services.
(a) "Applicant." An individual that has
				submitted an application for state licensed shelter care services.
(b) "Attachment A." Attachment A to Chapter
				VII, which is incorporated by this reference.
(c) "Appropriate bed." A certified bed in a
				nursing facility that is:
(i) Available;
				and
(ii) In a room where the other
				bed, if any, is occupied by a member of the same sex or the spouse of the
				recipient.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 2 - STATE LICENSED SHELTER CARE ELIGIBILITY AND SERVICES › Section 2-13 - Income

Current through July 13, 2024
The provisions set forth in Chapter II, Section
				  13,
				  and Chapter II.II, Section
				  14
				  apply and are incorporated by this reference.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 2 - STATE LICENSED SHELTER CARE ELIGIBILITY AND SERVICES › Section 2-14 - Resources

Current through July 13, 2024
The provisions set forth in Chapter II, Section
				  14,
				  and Chapter II.II, Sections
				  15
				  and
				  16
				  apply and are incorporated by this reference.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 2 - STATE LICENSED SHELTER CARE ELIGIBILITY AND SERVICES › Section 2-15 - Eligibility for state licensed shelter care services

Current through July 13, 2024
(a)
				Eligibility for state licensed shelter care services is limited to individuals
				that:
(i) Are elderly;
(ii) Are not eligible for Medicaid because of
				excess income;
(iii) Meet the
				medical necessity requirements of Section
				17;
(iv) Reside or intend to reside in a nursing
				facility designated by WDH pursuant to (b); and
(v) Are financially eligible pursuant to (c);
				or
(vi) Were receiving state
				licensed shelter care services on April 1, 1991, or
(vii) Receive partial month care.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 2 - STATE LICENSED SHELTER CARE ELIGIBILITY AND SERVICES › Section 2-17 - Determination of medical necessity

Current through July 13, 2024
An applicant or recipient must undergo an evaluation of
				  medical necessity pursuant to Chapter XXII, which is incorporated by this
				  reference, before a provider may receive reimbursement for state licensed
				  shelter care services provided to that individual.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 2 - STATE LICENSED SHELTER CARE ELIGIBILITY AND SERVICES › Section 2-18 - Mandatory establishment of trusts

Current through July 13, 2024
(a) Mandatory
				establishment of trusts. A recipient who is not eligible for Medicaid, but who
				could become eligible for Medicaid through the establishment of a trust
				pursuant to Chapter 2.7, must establish such a trust by the end of the fourth
				month after the last day of the month in which the individual becomes eligible
				for state licensed shelter care services, except individuals that are eligible
				for State Licensed Shelter Care Services pursuant to paragraph
				15(a)(vi).
(b) The failure to
				comply with this Section shall result in the termination of state licensed
				shelter care services, unless termination would result in an undue
				hardship.
(c) Once an individual
				becomes eligible for Medicaid, the designation of nursing facility requirements
				of subsection
				15(b) shall no longer
				apply.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 2 - STATE LICENSED SHELTER CARE ELIGIBILITY AND SERVICES › Section 2-21 - Reimbursement for state licensed shelter care services

Current through July 13, 2024
(a) Per
				diem rate. The per diem payment for state licensed shelter care services shall
				be equal to the nursing facility's Medicaid per diem rate, minus the
				recipient's contribution.
(b)
				Recipient contribution. The recipients contribution to the cost of state
				licensed shelter care services shall be the recipient's income minus:
(i) The personal needs allowance permitted by
				Medicaid;
(ii) The spousal
				allowance permitted by Medicaid;
(iii) The dependent allowance permitted by
				Medicaid;
(iv) Medical and/or
				health insurance premiums; and
(iii) Other medical expenses which the
				recipient incurs and pays, including co-payments and
				deductibles.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 2 - STATE LICENSED SHELTER CARE ELIGIBILITY AND SERVICES › Section 2-23 - Submission of claims

Current through July 13, 2024
(a) General
				requirements. Payment of claims shall be pursuant to the procedures of Chapter
				III regarding Medicaid claims, which procedures are incorporated by this
				reference.
(b) Certification. Each
				claim must contain a certification by the provider that the service was
				medically necessary, that it was provided on the date specified, that third
				party liability has been paid or, if third party liability has been denied,
				documentation of that denial is attached, and that the reimbursement sought is
				not in excess of the provider's usual and customary charge for the
				service.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 2 - STATE LICENSED SHELTER CARE ELIGIBILITY AND SERVICES › Section 2-24 - Audits

Current through July 13, 2024
(a) Field audits and desk reviews. WDH may
				perform a field audit or a desk review of a provider at any time to determine
				the accuracy and reasonableness of claims submitted by the provider.
(b) Excess payments. If an audit discloses
				that a provider has received excess payments, WDH shall recover the excess
				payments pursuant to Section
				26.
(c) Financial or medical records
				which are not made available at the time of an audit shall not be admissible at
				an administrative hearing held pursuant to Section
				27
				unless the provider shows good cause for not making the records available at
				the time of the audit.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 2 - STATE LICENSED SHELTER CARE ELIGIBILITY AND SERVICES › Section 2-25 - Medical necessity reviews

Current through July 13, 2024
(a) WDH may review
				medical records or conduct on-site medical necessity reviews to determine
				whether the services a recipient is receiving are medically
				necessary.
(b) Unnecessary
				services. If a medical necessity review discloses that a provider has been
				furnishing services that are not medically necessary and has received Medicaid
				payments for those services, the Department shall recover the excess payments
				pursuant to Section
				26.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 2 - STATE LICENSED SHELTER CARE ELIGIBILITY AND SERVICES › Section 2-26 - Recovery of excess payments

Current through July 13, 2024
(a) Notice of
				excess payments. After determining that a provider has received excess
				payments, WDH shall send written notice to the provider by certified mail,
				return receipt requested, stating:
(i) The
				amount of the excess payments;
(ii)
				The basis for WDH's determination of excess payments; and
(iii) The provider's right to request
				reconsideration of the determination pursuant to Section
				27,
				except as provided in Section
				27(d).
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 2 - STATE LICENSED SHELTER CARE ELIGIBILITY AND SERVICES › Section 2-28 - Insufficient funds

Current through July 13, 2024
(a) Upper limit.
				The aggregate reimbursement for state licensed shelter case services shall not
				exceed the amount appropriated by the Wyoming Legislature for such
				services.
(b) Anticipated
				shortfall. If it appears, based on patterns and projected patterns of
				utilization of services, and rates and projected rates of reimbursement, that
				there will be insufficient appropriated funds to cover the costs of reimbursing
				provider's for state licensed shelter care services furnished to all recipients
				and/or all applicants that are likely to become recipients, WDH shall:
(i) Limit eligibility to the number of
				recipients that WDH determines can be covered without exceeding the
				appropriated funds (WDH shall make the determination using patterns and
				projected patterns of utilization, and rates and projected reimbursement
				rates); and
(ii) Establish a
				waiting list, to be used in determining which applicants and/or recipients
				shall be covered by the program.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 2 - STATE LICENSED SHELTER CARE ELIGIBILITY AND SERVICES › Section 2-29 - Superseding effect

Current through July 13, 2024
When promulgated, this Chapter supersedes all prior rules or
				  policy statements issued by WDH or DFS, including provider manuals and provider
				  bulletins, which are inconsistent with this rule.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 3 - PROVIDER ENROLLMENT AND PARTICIPATION, PRE-AUTHORIZATION, PAYMENT AND SUBMISSION OF CLAIMS BY PROVIDERS › Section 3-1 - Authority

Current through July 13, 2024
The Wyoming Department of Health (Department) promulgates
				  this Chapter pursuant to the Wyoming Medical Assistance and Services Act at
				  Wyoming Statute
										42-4-101 through -124.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 3 - PROVIDER ENROLLMENT AND PARTICIPATION, PRE-AUTHORIZATION, PAYMENT AND SUBMISSION OF CLAIMS BY PROVIDERS › Section 3-2 - Purpose and Applicability

Current through July 13, 2024
(a) The Department adopts this Chapter to
				govern the enrollment and participation in the Medicaid program by providers of
				covered services, including pre-authorization, and payment and submission of
				claims by providers, except as otherwise specified in the rules of the
				Department.
(b) This Chapter
				applies to all clients and providers for all furnished Medicaid
				services.
(c) The Department may
				issue manuals and bulletins to interpret this Chapter. Such manuals and
				bulletins shall be consistent with and reflect the rules contained in this
				Chapter. The provisions contained in manuals or bulletins shall be subordinate
				to this Chapter.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 3 - PROVIDER ENROLLMENT AND PARTICIPATION, PRE-AUTHORIZATION, PAYMENT AND SUBMISSION OF CLAIMS BY PROVIDERS › Section 3-3 - Definitions

Current through July 13, 2024
Except as otherwise specified in Wyoming Medicaid Rules
				  Chapter 1, the terminology used in this Chapter is the standard terminology and
				  has the standard meaning as used in health care, Medicaid and Medicare.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 3 - PROVIDER ENROLLMENT AND PARTICIPATION, PRE-AUTHORIZATION, PAYMENT AND SUBMISSION OF CLAIMS BY PROVIDERS › Section 3-4 - Provider Qualifications

Current through July 13, 2024
(a) The Department shall establish
				qualifications for individuals or entities to enroll as a provider of Medicaid
				covered services consistent with state and federal law.
(b) To qualify for enrollment as a provider
				of covered Medicaid services, an individual or entity shall, at a minimum,
				satisfy the following criteria:
(i) Meet
				applicable licensing and certification standards found in Wyoming statutes and
				rules, or in the statutes and regulations of the state in which the provider is
				located, or in the statutes and regulations of the state in which the services
				are provided. If applicable, a provider shall comply with Medicare
				certification standards;
(ii) Not
				be excluded from participation in federally funded health care programs by the
				U.S. Department of Health and Human Services, Office of Inspector General;
				and,
(iii) Be assigned a National
				Provider Identifier (NPI) number by the National Plan and Provider Enumeration
				System, as applicable.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 3 - PROVIDER ENROLLMENT AND PARTICIPATION, PRE-AUTHORIZATION, PAYMENT AND SUBMISSION OF CLAIMS BY PROVIDERS › Section 3-5 - Provider Enrollment and Participation

Current through July 13, 2024
(a) The Department shall not pay Medicaid
				Funds to any individual or entity that provides services to a client unless the
				individual or entity is a party to a fully executed provider agreement and is
				enrolled by the Department.
(b) The
				following procedure governs the enrollment of providers in the Medicaid
				program:
(i) An individual or entity that
				wishes to participate in the Medicaid program shall apply to be a provider on
				the forms specified by the Department, and shall submit the qualifying
				documentation and information required by the Department to be enrolled as a
				provider.
(ii) The Department or
				its designated agent shall review and make a determination on the application
				within thirty (30) calendar days of the date it receives the application and
				all necessary qualification documentation, including any supplemental
				information requested by the Department.
(iii) If the application is approved, the
				provider and the Department shall execute a provider agreement as specified by
				the Department.
(iv) If the
				application is denied, the Department shall notify the applicant of its
				decision in writing in accordance with Wyoming Medicaid Rules Chapter
				4.