reglab/statecodes huggingface dataset:
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 16 - MEDICAID PROGRAM INTEGRITY › Section 16-24 - Effect of Fraud, Waste, or Abuse of Services of Medicare

Current through July 13, 2024
(a) The Department shall suspend or terminate
				any provider who has been suspended or terminated from participation in
				Medicare, or any provider which voluntarily withdraws from Medicare when
				Medicare certification is a prerequisite to enrollment in Medicaid.
(b) The duration of the provider's
				suspension, termination, or withdrawal from participation in Medicaid shall be
				the same as and shall run contemporaneously with the provider's suspension,
				termination, or withdrawal from participation in Medicare.
(c) A provider suspended or terminated from
				participation in Medicaid pursuant to this section shall not be entitled to
				reconsideration or an administrative hearing pursuant to this rule or any other
				rules of the Department. The provider's remedies are limited to those provided
				by Medicare.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 16 - MEDICAID PROGRAM INTEGRITY › Section 16-25 - Disposition of Recovered Funds

Current through July 13, 2024
(a) The Department shall, in accordance with
				the Social Security Act and applicable HHS regulations, repay all recovered
				federal Medicaid funds to CMS.
(b)
				The Department shall retain the state Medicaid percentage of all recovered
				Medicaid funds as a state general fund reduction.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 16 - MEDICAID PROGRAM INTEGRITY › Section 16-26 - Delegation of Duties

Current through July 13, 2024
The Department may delegate any of its duties under this rule
				  to the Wyoming Attorney General, HHS, any other agency of the Federal, State or
				  local government, or a private entity which is capable of performing such
				  functions, provided that the Department shall retain the authority to impose
				  adverse actions, recover overpayments or take any other final action authorized
				  by this Chapter.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 17 - NURSING FACILITY RESIDENT TRUST ACCOUNTS › Section 17-1 - Authority

Current through July 13, 2024
This rule 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 17 - NURSING FACILITY RESIDENT TRUST ACCOUNTS › Section 17-2 - Purpose and Applicability

Current through July 13, 2024
(a) This Chapter
				has been adopted to establish the standards and procedures for all resident
				trust accounts maintained by nursing facilities.
(b) The Department may issue manuals,
				bulletins, or both to interpret the provisions of this Chapter. Such manuals
				and bulletins shall be consistent with and reflect the policies contained in
				this Chapter. The provisions contained in manuals or bulletins shall be
				subordinate to the provisions of this Chapter.
(c) 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 17 - NURSING FACILITY RESIDENT TRUST ACCOUNTS › Section 17-3 - Definitions

Current through July 13, 2024
Except as otherwise specified in the Rules and Regulations of
				  Wyoming Medicaid, Chapter 1, Definitions, the terminology used in this Chapter
				  is the standard terminology and has the standard meaning used in healthcare,
				  Medicaid, and Medicare.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 17 - NURSING FACILITY RESIDENT TRUST ACCOUNTS › Section 17-4 - Notice to Residents

Current through July 13, 2024
Notice of covered services. At the time of admission, the
				  nursing facility shall provide the resident and the resident's representative
				  with a written notice that contains the information specified in subsections
				  (a) through (g). Such notice shall also be given at least once every year after
				  admission, and within sixty (60) days after there is any change in the services
				  available to residents, the charges for such services or the services included
				  in the Medicaid reimbursement rate. The notice shall contain:
(a) An itemized statement of the services
				provided by the nursing facility as part of the nursing facility's Medicaid
				reimbursement rate;
(b) An itemized
				statement of the services provided by the nursing facility that are not covered
				by the nursing facility's Medicaid reimbursement rate or Medicare and that may
				be charged to the resident, including the charge for each such
				service;
(c) A statement that the
				client is not required to deposit personal funds in a resident trust account.
(i) Personal funds account. For purposes of
				this Chapter, personal funds are all funds which belong to a resident, from
				whatever source, including the resident's personal care allowance.
(ii) Resident trust account. For purposes of
				this Chapter, the resident trust account is an account maintained by a facility
				in which a facility resident's personal funds are deposited and held in trust
				by the facility for the use and benefit of the resident.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 17 - NURSING FACILITY RESIDENT TRUST ACCOUNTS › Section 17-5 - Charges to Residents

Current through July 13, 2024
(a) No charges for
				services included in per diem rate or covered by Medicare.
A nursing facility may charge a resident only for services
				  which are not included in the nursing facility's per diem rate for that
				  resident and which are not covered by Medicare.
(b) Charges to personal care allowance. A
				nursing facility may seek reimbursement from a resident's personal care
				allowance only for services directly related to the resident's personal needs,
				including, but not limited to:
(i) Commissary
				items, such as books, magazines and candy; or
(ii) Premiums on life insurance policies or
				burial expense policies.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 17 - NURSING FACILITY RESIDENT TRUST ACCOUNTS › Section 17-6 - Nursing Facility's Fiduciary Responsibilities

Current through July 13, 2024
(a) Upon
				written authorization from the resident, or any individual designated pursuant
				to Section  of this Chapter, the nursing
				facility shall accept responsibility for:
(i)
				Receiving personal funds;
(ii)
				Depositing personal funds in the resident's trust account;
(iii) Safeguarding the resident's personal
				funds; and
(iv) Managing the
				resident's trust account, including accounting for all personal funds received
				by the nursing facility.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 17 - NURSING FACILITY RESIDENT TRUST ACCOUNTS › Section 17-7 - Audits of Resident Trust Accounts

Current through July 13, 2024
(a) Audits are
				subject to the requirements of the Rules and Regulations of Wyoming Medicaid,
				Chapter 16, Medicaid Program Integrity.
(b) Repayment of missing funds. The nursing
				facility shall, within ten (10) days after receipt of notice of missing funds,
				replace such funds and provide a written accounting of such replacement to the
				Department, even if the nursing facility has requested reconsideration or
				requested an administrative hearing regarding the determination of missing
				funds. Missing funds are personal funds for which a facility is responsible,
				which are determined after an audit to be missing or otherwise unaccounted for.
				If the nursing facility does not replace the missing funds, the Department may
				recover such funds from the facility subject to the requirements of the Rules
				and Regulations of Wyoming Medicaid, Chapter 16, Medicaid Program
				Integrity.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 17 - NURSING FACILITY RESIDENT TRUST ACCOUNTS › Section 17-8 - Delegation of Duties

Current through July 13, 2024
The Department may delegate any of its duties under this rule
				  to the Wyoming Attorney General, HHS, any other agency of the Federal, State or
				  local government, or a private entity which is capable of performing such
				  functions, provided that the Department shall retain the authority to impose
				  sanctions, recover overpayments or take any other final action authorized by
				  this Chapter.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 17 - NURSING FACILITY RESIDENT TRUST ACCOUNTS › Section 17-9 - Interpretation of Chapter

Current through July 13, 2024
(a) The order in
				which the provisions of this Chapter appear is not to be construed to mean that
				any one provision is more or less important than any other provision.
(b) The text of this Chapter shall control
				the titles of its various provisions.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 17 - NURSING FACILITY RESIDENT TRUST ACCOUNTS › Section 17-10 - Superseding Effect

Current through July 13, 2024
This Chapter supersedes all prior rules or policy statements
				  issued by the Department, including manuals and/or bulletins, which are
				  inconsistent with this Chapter.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 18 - MEDICAID ELIGIBLITY › Section 18-1 - Authority

Current through July 13, 2024
This Chapter is promulgated pursuant to the Medical
				  Assistance and Services Act at Wyoming Statute (W.S.) §
									
										42-4-104(a)(iv).
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 18 - MEDICAID ELIGIBLITY › Section 18-2 - Purpose and Applicability

Current through July 13, 2024
(a) This Chapter has been adopted to describe
				an individual's rights and responsibilities associated with Medicaid
				eligibility, to establish uniform procedures and to define eligibility
				groups.
(b) The Department may
				issue manuals and bulletins to interpret the sections of this Chapter. Such
				manuals and bulletins shall be consistent with and reflect the rules contained
				in this Chapter. The provisions contained in manuals and bulletins shall be
				subordinate to the sections of this Chapter.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 18 - MEDICAID ELIGIBLITY › Section 18-3 - Definitions

Current through July 13, 2024
(a) Except as otherwise specified in Chapter
				1 of the Wyoming Medicaid Rules or as defined in this Section, the terminology
				used in this Chapter is the standard terminology and has the standard meaning
				used in health care, Medicaid, and Medicare.
(b) "Relative" means a parent, child,
				stepchild, grandparent, grandchild, brother, sister, stepbrother, stepsister,
				aunt, uncle, niece, nephew, whether by birth or adoption, and whether by whole
				or half-blood, of the individual or individual's current or former
				spouse.
(c) "Fiduciary" means an
				individual's attorney-in-fact, guardian, conservator, legal custodian,
				caretaker, trustee, attorney, accountant, or agent.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 18 - MEDICAID ELIGIBLITY › Section 18-4 - Application Process, Applicant Rights and Responsibilities

Current through July 13, 2024
(a) Application Process.
(i) Applicants shall submit an application in
				the manner and form prescribed by the Department. The application shall be
				completed, dated, and signed by the applicant or by any person who is assisting
				the applicant.
(ii) Applications
				shall be processed within the following time frames:
(A) Aged, Blind and Disabled programs:
(I) Forty-five (45) days from the date of
				application, or
(II) Sixty (60)
				days from the date of application when waiting on documentation from a third
				party to use in determining eligibility, or
(III) Ninety (90) days from the date of
				application when waiting for a disability determination to be completed by the
				Wyoming Department of Health or designee.
(B) Family and Children's programs:
(I) Forty-five (45) days from the date of
				application, or
(II) Sixty (60)
				days from the date of application when waiting on documentation from a third
				party to use in determining eligibility.
(iii) Applicants shall be notified in writing
				of the reasons for the approval, denial or closure, the specific regulation
				supporting the action, and an explanation of the right to request a hearing, as
				specified in
				42 C.F.R. §
											431.210 and W.S. §
										
											42-4-108.
(iv) Any individual who has been determined
				eligible by the Social Security Administration for Supplemental Security Income
				(SSI) is not required to complete an application.
(v) Applicants shall be allowed to receive
				retroactive Medicaid benefits not to exceed three (3) calendar months prior to
				the application if the individual received Medicaid covered services at any
				time during that period, and would have been eligible for Medicaid had they
				applied, unless restricted by other federal and state laws and
				regulations.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 18 - MEDICAID ELIGIBLITY › Section 18-5 - General Eligibility Requirements

Current through July 13, 2024
(a) In addition to meeting the requirements
				of this Chapter, applicants shall meet the following requirements to be
				eligible for Medicaid:
(i) Applicants shall
				be citizens or nationals of the United States, and shall provide a social
				security number and provide proof of identity. Pregnant women considered to be
				lawfully present satisfy the citizenship and alienage eligibility
				requirements.
(ii) Applicants shall
				be a Wyoming resident or meet the criteria, as specified in the Medicaid State
				Plan. An individual who intends to return to home property in another state,
				shall not be considered a Wyoming resident.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 18 - MEDICAID ELIGIBLITY › Section 18-7 - Presumptive Eligibility

Current through July 13, 2024
(a) Eligibility shall begin on the date on
				which a qualified provider or qualified hospital determines that an individual
				is eligible for presumptive eligibility and ends with the earlier of:
(i) The day on which Medicaid eligibility is
				determined; or
(ii) The last of day
				of the month following the month in which the determination of presumptive
				eligibility was made.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 18 - MEDICAID ELIGIBLITY › Section 18-8 - Aged, Blind or Disabled Eligibility

Current through July 13, 2024
(a) Eligibility Requirements for the Aged,
				Blind or Disabled.
(i) Age sixty-five (65) or
				over;
(ii) Legally blind as
				certified by an optical professional or the Social Security Administration
				(SSA); or
(iii) An individual who
				is determined disabled by the SSA or the Department.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 18 - MEDICAID ELIGIBLITY › Section 18-9 - Breast and Cervical Cancer Treatment Program

Current through July 13, 2024
(a) The Department's Public Health Division's
				Breast and Cervical Cancer Early Detection Program identifies applicants in
				need of treatment for either breast or cervical cancer. Financial eligibility
				is determined by the Department's Division of Healthcare Financing or
				designee.
(b) Eligibility
				Requirements.
(i) Countable family income is
				less than or equal to two hundred and fifty percent (250%) of the Federal
				Poverty Level.
(ii) Income shall be
				calculated using the modified adjusted gross income of the household, as
				specified in
				42 C.F.R.
				§
											435.603 and the State Plan.
(iii) Individuals shall be under the age of
				sixty-five (65).
(iv) Individuals
				shall not be eligible for Medicaid or have health insurance.
(v) Eligibility shall be reviewed by the
				Department for continued eligibility every twelve (12) months.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 18 - MEDICAID ELIGIBLITY › Section 18-10 - Employed Individuals with Disabilities Eligibility Group

Current through July 13, 2024
(a) Medicaid benefits are available to
				individuals with disabilities who work and pay a monthly premium for their
				healthcare coverage.
(b)
				Eligibility Requirements.
(i) Countable
				unearned income shall be less than or equal to three hundred percent (300%) of
				the Supplemental Security Income (SSI) payment standard.
(ii) Resource tests do not apply for this
				eligibility group.
(iii)
				Individuals shall be age sixteen (16) through sixty-four (64).
(iv) An individual shall be employed
				part-time or full-time during a specified payroll period. The individual can be
				considered employed when not working, but on temporary absence due to medical
				leave.
(v) The individual shall pay
				a monthly premium, as calculated according to W.S. §§
										
											42-4-115 and
				42-4-116.
(vi) If an individual otherwise meets the
				criteria for the Comprehensive, Support or Acquired Brain Injury Waiver, but
				does not meet the income or resource requirements, the individual may retain
				waiver services through the Employed Individuals with Disabilities
				program.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 18 - MEDICAID ELIGIBLITY › Section 18-11 - Medicare Savings Programs

Current through July 13, 2024
(a) Qualified Medicare Beneficiary (QMB).
				Medicaid shall assist individuals eligible for QMB with paying their Medicare
				premiums, cost sharing and deductibles, as specified in Sections
				1902(a)(10)(E)(i) and 1905(p)(1) of the Social Security Act. Individuals shall
				meet the following eligibility requirements:
(i) Entitled to Medicare.
(ii) Countable income shall be equal to or
				less than one hundred percent (100%) of the Federal Poverty Level
				(FPL).
(iii) Countable resources
				shall not exceed three (3) times the SSI resource limit, as adjusted annually
				by the increase in the consumer price index.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 18 - MEDICAID ELIGIBLITY › Section 18-12 - Emergency Services

Current through July 13, 2024
Applicants who are not citizens or nationals of the United
				  States, but otherwise meet the eligibility requirements of the State Plan, are
				  eligible for limited emergency services, as specified in
				  42 C.F.R. §
										440.255. Applicants who do not meet the
				  citizenship or alienage requirements shall not be eligible for emergency
				  services under the Nursing Home, Home and Community Based Services under a
				  waiver pursuant to Section 1915(c) of the Social Security Act, Hospice,
				  Presumptive Eligibility, Family Planning Waiver, EID, Breast and Cervical
				  Cancer, and Tuberculosis programs.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 18 - MEDICAID ELIGIBLITY › Section 18-13 - Delegation of Duties

Current through July 13, 2024
The Department may delegate any of its duties under this rule
				  to the Wyoming Attorney General, Health and Human Services, any other agency of
				  the federal, state or local government, or a private entity which is capable of
				  performing such functions, provided that the Department shall retain the
				  authority to impose sanctions, recover overpayments or take any other final
				  action authorized by this Chapter.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 19 - NURSING FACILITY PREADMISSION SCREENINGS › Section 19-1 - 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 19 - NURSING FACILITY PREADMISSION SCREENINGS › Section 19-2 - Purpose and Applicability

Current through July 13, 2024
(a) This Chapter
				establishes methods and standards for preadmission screening of clients and
				prospective clients of nursing facilities. The requirements of this Chapter
				apply to all clients and prospective clients, regardless of payment
				source.
(b) The Department may
				issue manuals, bulletins, or both, to interpret the provisions of this Chapter.
				Such manuals and bulletins shall be consistent with and reflect the policies
				contained in this Chapter. The provisions contained in manuals or bulletins
				shall be subordinate to the provisions of this Chapter.
(c) 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 19 - NURSING FACILITY PREADMISSION SCREENINGS › Section 19-3 - Definitions

Current through July 13, 2024
Except as otherwise specified in the Rules and Regulations of
				  Wyoming Medicaid, Chapter 1, Definitions, the terminology used in this Chapter
				  is the standard terminology and has the standard meaning used in healthcare,
				  Medicaid, and Medicare.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 19 - NURSING FACILITY PREADMISSION SCREENINGS › Section 19-4 - General Provisions

Current through July 13, 2024
This rule is intended to be read in conjunction with the
				  Rules and Regulations of Wyoming Medicaid, Chapter 22, Nursing Facility Long
				  Term Care/Home/Community Based Evaluation, and 42 C.F.R., Ch. IV, Subch. G,
				  Pt.483, Subpt. C.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 19 - NURSING FACILITY PREADMISSION SCREENINGS › Section 19-5 - Admission of Persons Diagnosed as Mentally Ill or with an Intellectual Disability or Related Condition

Current through July 13, 2024
(a) Mentally ill
				individuals. Except as otherwise provided by this Section, a nursing facility
				shall not admit any mentally ill individual unless:
(i) Prior to admission, the state mental
				health authority (SMHA) has determined, based on a physical and mental
				evaluation performed by a person or entity other than the state mental health
				authority, that the individual requires nursing facility services because of
				his or her physical and mental condition; and
(ii) If the individual requires nursing
				facility services, the SMHA has also determined whether the individual requires
				specialized services.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 19 - NURSING FACILITY PREADMISSION SCREENINGS › Section 19-6 - Level I Screening

Current through July 13, 2024
(a) Purpose. The
				Level I screening is performed by qualified staff of a nursing facility or
				hospital to determine whether an individual seeking admission to or residing in
				a facility needs further evaluation because of suspected mental illness, an
				intellectual disability or a related condition.
(b) Applicability. All individuals,
				regardless of payment source, who apply for admission to a facility on or after
				January 1, 1989, or who were clients in a facility on January 1, 1989, are
				subject to the requirements of this Section.
(c) Frequency of screening.
(i) Any individual who was a client in a
				facility before January 1, 1989, must be screened on or before April 1,
				1990.
(ii) Any individual seeking
				admission to a facility as a new admission on or after January 1, 1989, must be
				screened before admission.
(iii) If
				the screening does not result in a referral to Level II, the individual need
				not be screened again unless there is a significant change in the individual's
				condition that indicates that a Level II screening is advisable.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 19 - NURSING FACILITY PREADMISSION SCREENINGS › Section 19-7 - Level II Screening

Current through July 13, 2024
(a) Purpose. To
				determine whether an individual with a mental illness has an intellectual
				disability or related condition which requires, because of the individual's
				physical and mental condition, the level of services provided by a nursing
				facility and whether the individual requires specialized services.
(b) Applicability. All individuals who apply
				for admission to a facility on or after January 1, 1989, or who were clients in
				a facility on January 1, 1989, are subject to the requirements of this Section
				if the Level I screening indicates the possibility of mental illness,
				intellectual disability or related condition. No facility shall admit any
				individual for whom the Level I screening indicates a reason to refer the
				individual for a Level II screening until the Level II screening is completed
				and a determination of appropriate placement rendered.
(c) Change in condition. If there has been a
				previous Level II and the resident has a change in physical or mental
				functioning, a new Level II must be requested promptly by the nursing facility.
				This will be done by completing a new Level I form and submitting it through
				established procedures. The facility must indicate on the Level I form that a
				new Level II is being requested because a significant change in the person's
				physical or mental functioning.
(d)
				Failure to timely comply with Professional Activities Survey (PAS)
				requirements.
(i) PAS. Medicaid reimbursement
				shall be disallowed for nursing facility services furnished to a client before
				the Level II screening is completed and a determination of appropriate
				placement in a nursing facility is made.
(ii) Non-Medicaid individuals. For failure to
				timely comply with PAS requirements for non-Medicaid eligible individuals, the
				Department may impose any of the remedies specified in the Rules and
				Regulations of Wyoming Medicaid, Chapter 5, Long Term Care Facility Remedies,
				Terminations, using the procedures specified in Chapter 5.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 19 - NURSING FACILITY PREADMISSION SCREENINGS › Section 19-8 - Medicaid Reimbursement

Current through July 13, 2024
(a) Completion of
				screening. No facility shall receive Medicaid reimbursement for nursing
				facility services furnished to a client until:
(i) The completion of the Level I screening
				which indicates that there is no need for Level II screening or, if the Level I
				screening indicates the need for Level II screening, the completion of the
				Level II screening and a determination that nursing facility services are
				appropriate; and
(ii) The
				completion of the evaluation of medical necessity pursuant to the Rules and
				Regulations of Wyoming Medicaid, Chapter 22, Nursing Facility Long Term
				Care/Home/Community Based Evaluation, which indicates that nursing facility
				services are medically necessary.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 19 - NURSING FACILITY PREADMISSION SCREENINGS › Section 19-9 - Recovery of Overpayments

Current through July 13, 2024
The Department shall recover overpayments pursuant to the
				  provisions of the Rules and Regulations of Wyoming Medicaid, Chapter 16,
				  Medicaid Program Integrity.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 19 - NURSING FACILITY PREADMISSION SCREENINGS › Section 19-10 - Reconsideration

Current through July 13, 2024
A provider may request reconsideration of the decision to
				  recover overpayments pursuant to the Rules and Regulations of Wyoming Medicaid,
				  Chapter 16, Medicaid Program Integrity.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 19 - NURSING FACILITY PREADMISSION SCREENINGS › Section 19-11 - Administrative Hearing

Current through July 13, 2024
(a) A provider may
				request an administrative hearing regarding the final decision pursuant to the
				Rules and Regulations of Wyoming Medicaid, Chapter 4, Administrative Hearings,
				of these rules.
(b) An applicant or
				client may request an administrative hearing pursuant to the Rules and
				Regulations of Wyoming Medicaid, Chapter 4, Administrative Hearings, regarding
				the Level II determination of appropriate placement.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 19 - NURSING FACILITY PREADMISSION SCREENINGS › Section 19-12 - Delegation of Duties

Current through July 13, 2024
The Department may delegate any of its duties under this rule
				  to the Wyoming Attorney General, HHS, any other agency of the Federal, State or
				  local government, or a private entity which is capable of performing such
				  functions, provided that the Department shall retain the authority to impose
				  sanctions, recover overpayments or take any other final action authorized by
				  this Chapter.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 19 - NURSING FACILITY PREADMISSION SCREENINGS › Section 19-13 - Interpretation of Chapter

Current through July 13, 2024
(a) The order in
				which the provisions of this Chapter appear is not to be construed to mean that
				any one provision is more or less important than any other
provision.
(b) The text of this Chapter shall control
				the titles of its various provisions.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 19 - NURSING FACILITY PREADMISSION SCREENINGS › Section 19-14 - Superseding Effect

Current through July 13, 2024
This Chapter supersedes all prior rules or policy statements
				  issued by the Department, including manuals and bulletins, which are
				  inconsistent with this Chapter.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 20 - REIMBURSEMENT OF INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES (ICFs/IID) › Section 20-1 - Authority

Current through July 13, 2024
This rule is promulgated by the Department of Health pursuant
				  to the Medical Assistance and Services Act at W.S. §§
									
										42-4-101 through
				  42-4-306.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 20 - REIMBURSEMENT OF INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES (ICFs/IID) › Section 20-2 - Applicability

Current through July 13, 2024
This rule shall apply to and govern the reimbursement of the
				  Wyoming Life Resource Center State Operated Facility and other
				  ICFs/IID.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 20 - REIMBURSEMENT OF INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES (ICFs/IID) › Section 20-3 - General Terms

Current through July 13, 2024
These rules are intended to implement and be read in
				  conjunction with the provisions of W.S. §§
									
										42-4-101 through
				  42-4-306.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 20 - REIMBURSEMENT OF INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES (ICFs/IID) › Section 20-4 - Definitions

Current through July 13, 2024
(a) "Certified." Approved by the Department
				to provide ICF/IID services.
(b)
				"Excess payments." Medicaid funds received by a provider:
(i) That exceed the provider's per diem
				rate;
(ii) Pursuant to a per diem
				rate which is subsequently determined to be erroneous or based on erroneous
				information; or
(iii) Pursuant to
				an interim payment rate that is based on projected costs which exceed the
				facility's actual costs for the interim payment rate period.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 20 - REIMBURSEMENT OF INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES (ICFs/IID) › Section 20-5 - General methodology

Current through July 13, 2024
(a) ICFs/IID shall be reimbursed using a per
				diem rate calculated in accordance with the methodology established below. In
				addition, ICFs/IID shall be subject to the rules in Chapter 7, Wyoming Nursing
				Home Reimbursement System, except as otherwise specified by this rule. ICFs/IID
				shall not be subject to the Chapter 7 rate and price setting Sections
				7, 13(d), 14, 15, 16, 17(c), 18, and
				19.
(b) Calculation of per diem
				rates for ICFs/IID. The per diem rate for ICFs/IID shall be calculated
				independently from the calculation of rates for facilities as defined in
				Chapter 7. The provider's per diem rate shall be determined utilizing either a
				desk reviewed or audited cost report. Costs shall not be subject to any form of
				cap or maximum rate for the Wyoming Life Resource Center.
(i) Effective date. The rates calculated each
				July 1 shall remain in effect until the following July 1.
(ii) Per diem rates are established
				prospectively and shall remain in effect from the rate effective date until
				re-determined pursuant to this rule.
(iii) Applicable cost report data. The data
				used in establishing the rate calculation is from the cost reports which ended
				two (2) calendar years ago (for example, cost reports ending during the period
				from January 1, 2013 to December 31, 2013, shall be used to set rates effective
				July 1, 2015).
(iv) Cost reports
				submitted by ICFs/IID shall not be used in any way to calculate per diem rates
				for facilities as defined in Chapter 7.
(v) Rates shall be established by inflating
				adjusted / reviewed costs from the midpoint of the provider's cost reporting
				year to the midpoint of the rate year. Inflated costs shall be divided by total
				patient days to arrive at the allowed per diem rate.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 20 - REIMBURSEMENT OF INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES (ICFs/IID) › Section 20-6 - Incorporation of Chapter XVII

Current through July 13, 2024
ICFs/IID are subject to the requirements of Chapter 17,
				  Nursing Facility Resident Trust Accounts.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 20 - REIMBURSEMENT OF INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES (ICFs/IID) › Section 20-7 - Superseding Effect

Current through July 13, 2024
This chapter supersedes all prior rules or policy statements
				  issued by the Department, including manuals and/or bulletins, which are
				  inconsistent with this Chapter.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 20 - REIMBURSEMENT OF INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES (ICFs/IID) › Section 20-8 - Severability

Current through July 13, 2024
If any portion of these rules is found to be invalid or
				  unenforceable, the remainder shall continue in effect.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 20 - REIMBURSEMENT OF INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES (ICFs/IID) › Section 20-9 - Incorporation by Reference

Current through July 13, 2024
(a) For any code, standard, rule or
				regulation incorporated by reference in these rules:
(i) The Department of Health has determined
				that incorporation of the full text in these rules would be cumbersome or
				inefficient given the length or nature of the rules;
(ii) The incorporation by reference does not
				include any later amendments or editions of the incorporated matter beyond the
				applicable date identified in subsection (b) of this section; and
(iii) The incorporated code, standard rule,
				or regulation is maintained at the Department of Health and is available for
				public inspection and copying at cost at the same location.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 22 - DETERMINATION OF NURSING FACILITY LEVEL OF CARE › Section 22-1 - Authority

Current through July 13, 2024
This Chapter is promulgated by the Department of Health
				  pursuant to the Wyoming Medical Assistance and Services Act at Wyoming
				  Statutes
										42-4-104(a)(iv).
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 22 - DETERMINATION OF NURSING FACILITY LEVEL OF CARE › Section 22-2 - Purpose and Applicability

Current through July 13, 2024
(a) The methods and standards established in
				this Chapter shall be used to determine whether an individual requires, or
				continues to require the level of care provided, in a nursing facility or in
				consideration of eligibility for applicable home and community-based waiver
				programs.
(b) The Department may
				issue manuals and bulletins to interpret the provisions of this Chapter. Such
				manuals and bulletins shall be consistent with and reflect the policies
				contained in this Chapter. The provisions contained in manuals or bulletins
				shall clarify information provided in this rule but shall not override or
				supersede it.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 22 - DETERMINATION OF NURSING FACILITY LEVEL OF CARE › Section 22-3 - Definitions

Current through July 13, 2024
Except as otherwise specified in Chapter 1 or as defined
				  herein, the terminology used in this Chapter is the standard terminology and
				  has the standard meaning used in health care, Medicaid, and Medicare.
(a) "Nursing Facility Level of Care
				Determination." A determination as to whether an individual requires or
				continues to require the level of care provided in a nursing
				facility.
(b) "Level of Care
				Assessment." An assessment of an individual's current functional status used by
				the Department in making nursing facility level of care
				determinations.
(c) "Level of Care
				Assessor." A registered nurse licensed to practice in the State of Wyoming and
				qualified by the Department or its agent as having successfully completed all
				requisite education and training to conduct a level of care
				assessment.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 22 - DETERMINATION OF NURSING FACILITY LEVEL OF CARE › Section 22-4 - General Provisions

Current through July 13, 2024
(a) A determination indicating a need for
				nursing facility level of care shall not constitute a determination of
				eligibility or a guarantee of reimbursement for Wyoming Medicaid services.
				Individuals shall meet any additional eligibility criteria for the applicable
				Wyoming Medicaid services and programs.
(b) The level of care assessment conducted
				pursuant to this Chapter is not intended to serve as an instrument for the
				identification, diagnosis, or treatment of any disease or medical
				condition.
(c) The Department is
				the sole entity authorized to make nursing facility level of care
				determinations for the purposes established by this Chapter.
(d) The Department shall establish the
				procedures, instruments, methods, and criteria by which a level of care
				assessment is conducted.
(i) The Department
				shall make nursing facility level of care determinations based solely on the
				results of a level of care assessment conducted by a qualified level of care
				assessor.
(ii) The Department shall
				make nursing facility level of care determinations and provide notification in
				accordance with its established timelines and procedures.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 22 - DETERMINATION OF NURSING FACILITY LEVEL OF CARE › Section 22-5 - Requests for Determination of Nursing Facility Level of Care

Current through July 13, 2024
(a) Any individual may request a nursing
				facility level of care determination on his or her own behalf.
(b) A guardian or legal representative may
				request a nursing facility level of care determination on behalf of an
				individual for whom legal decision-making authority has been
				conferred.
(c) Employees of a
				nursing facility, hospital, or any other such healthcare or social services
				provider may request a nursing facility level of care determination on behalf
				of any individual for whom that organization has the responsibility for the
				provision or coordination of healthcare services.
(d) The Department shall approve only those
				requests for a nursing facility level of care determination which meet all of
				the following criteria:
(i) The request is
				complete and is submitted in accordance with the Department's established
				procedures;
(ii) The individual to
				be assessed is a resident of, or intends to reside in, the State of
				Wyoming;
(iii) The individual to be
				assessed demonstrates a reasonable indication of need for long-term care
				services as determined by any initial screening criteria established by the
				Department;
(iv) The individual to
				be assessed is currently receiving, or has expressed interest in, a long-term
				care service or program which requires a nursing facility level of care
				determination; and
(v) The
				individual to be assessed is a current Wyoming Medicaid recipient, has
				submitted an application for Wyoming Medicaid, or has been identified by a
				Preadmission Screening and Resident Review (PASRR) Level I Screening to require
				a PASRR Level II screening pursuant to Chapter 19.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 22 - DETERMINATION OF NURSING FACILITY LEVEL OF CARE › Section 22-6 - Requests for Reconsideration and Administrative Hearings

Current through July 13, 2024
(a) The individual for whom the determination
				was made, or his or her guardian or legal representative, if applicable, may
				request reconsideration of the Department's nursing facility level of care
				determination.
(i) Reconsideration requests
				are an opportunity for alternative dispute resolution, are not a prerequisite
				to request an administrative hearing, and shall not impede the individual's
				right to request an administrative hearing in accordance with Chapter
				4.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 24 - WYOMING HOSPITAL REIMBURSEMENT SYSTEM › Section 24-1 - Authority

Current through July 13, 2024
This rule 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 24 - WYOMING HOSPITAL REIMBURSEMENT SYSTEM › Section 24-2 - Purpose and Applicability

Current through July 13, 2024
This rule shall apply to and govern the reimbursement of
				  inpatient and outpatient hospital services provided on or after July , 1993.
				  Hospital services are also subject to the provisions of Chapters III, VIII, and
				  IX of these rules, except as otherwise specified in this
				  Chapter.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 24 - WYOMING HOSPITAL REIMBURSEMENT SYSTEM › Section 24-3 - General provisions

Current through July 13, 2024
(a) Terminology.
				Except as otherwise specified, the terminology used in this rule is the
				standard terminology and has the standard meaning used in accounting, health
				care, Medicaid and Medicare.
(b)
				General methodology. The Department reimburses providers of inpatient and
				outpatient hospital services using Medicare's retrospective reasonable most
				reimbursement principles, subject to the limits established by Section 1886(b)
				of the Social Security Act, except as otherwise specified by this
				Chapter.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 24 - WYOMING HOSPITAL REIMBURSEMENT SYSTEM › Section 24-4 - Definitions

Current through July 13, 2024
(a) "Admission". The act by which an
				individual is admitted to a hospital as an inpatient or an outpatient.
				"Admission" does not include a new born child or an individual that is
				transferred from one unit of a hospital to another unit in the hospital or to a
				distinct part hospital unit.
(b)
				"Allowable costs". Medicare allowable costs, except as otherwise specified by
				this Chapter.
(c) "Base year". A
				hospital's first 12 month cost reporting period ending on or after September
				30, 1982 and before September 30, 1983.
(d) "Chapter I". Chapter I, Rules for
				Medicaid Administrative Hearings, of the Wyoming Medic-aid rules.
(e) "Claim". A request by a provider for
				Medicaid payment for services provided to a recipient.
(f) "Cost report". An itemized statement of a
				hospital's costs for its most recently completed fiscal year, including an
				audited or unaudited financial statement, prepared in accordance with GAAP and
				the instructions of the Department. A cost report must include the information
				and be prepared in the form specified by the Department and the intermediary,
				and must be submitted in hardcopy and on computer disc using software
				designated by the Department. "Cost report" includes any supplemental request
				by the Department for additional information relating to the hospitals costs
				and the hospitals efforts to achieve efficiencies or other cost
				savings.
(g) "Covered service". A
				health service or supply eligible for Medicaid reimbursement pursuant to the
				rules and policies of the Department. "Covered service" does not include
				nursing facility services.
(h)
				"Credit balance". Medicaid funds received by a hospital that are owed to the
				Department for any reason.
(i)
				"Department". The Wyoming Department of Health, its designee, agent or
				successor.
(j) "Desk review". A
				review by the Department of a hospitals cost report to determine:
(i) if the cost report has been prepared and
				submitted in compliance with this rule;
(ii) that costs have been properly allocated;
				and
(iii) that costs are
				allowable.