Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 2 - STATE LICENSED SHELTER CARE ELIGIBILITY AND SERVICES › Section 2-27 - Reconsideration

Current through July 13, 2024
(a) Request for reconsideration. A provider
				may request reconsideration of the matters specified in subsection (d). Such a
				request must be mailed to WDH, by certified mail, return receipt requested,
				within twenty (20) days after the date the provider receives notice of the
				action. The request must state with specificity the reasons for the request.
				Failure to provide such a statement shall result in the dismissal of the
				request with prejudice.
(b)
				Reconsideration. WDH shall review the matter and send written notice by
				certified mail, return receipt requested, to the provider of its final decision
				within forty-five (45) days after receipt of the request for reconsideration or
				the receipt of any additional information requested pursuant to (c), whichever
				is later.
(c) Request for
				additional information. WDH may request additional information from the
				provider as part of the reconsideration process. Such a request shall be made
				in writing by certified mail, return receipt requested. The provider must
				provide the requested information within the time specified in the request.
				Failure to provide the requested information shall result in the dismissal of
				the request with prejudice.
(d)
				Matters subject to reconsideration. A provider may request reconsideration of a
				decision to recover excess payments, except that the recovery of excess
				payments based on a change in the provider's per diem rate pursuant to Chapter
				VII shall not be subject to reconsideration or an administrative hearing. The
				provider's right to request reconsideration pursuant to Chapter VII shall be
				the provider's sole remedy.
(e)
				Reconsideration shall be limited to whether WDH has complied with the
				provisions of this Chapter.
(f)
				Informal resolution. The provider or the Department may request an informal
				meeting before the final decision on reconsideration to determine whether the
				matter may be resolved. The substance of the discussions and/or settlement
				offers made pursuant to an attempt at informal resolution shall not be
				admissible as part of a subsequent administrative hearing or judicial
				proceeding.
(g) Administrative
				hearing. A provider may request an administrative hearing regarding the final
				agency decision pursuant to Chapter I of these rules by mailing by certified
				mail, return receipt requested or personally delivering a request for hearing
				to WDH within twenty (20) days after the date the provider receives notice of
				the final agency decision. At the hearing, the burden shall be on the provider
				to show that the agency's final decision does not comply with this
				Chapter.
(h) Failure to request
				reconsideration. A provider which fails to request reconsideration pursuant to
				this Section may not subsequently request an administrative hearing pursuant to
				Chapter I.
(i) Matters not subject
				to reconsideration.
(i) The use or
				reasonableness of the reimbursement methodologies set forth in this Chapter;
				or
(ii) A change in a payment rate
				caused by a change in the reimbursement methodology as the result of a change
				in state or federal law, including an amendment to this Chapter or other rules
				of WDH.