35-24-109. Limited hearing on application; issues identified prior to hearing; procedure; evidence; decision.
(a) If a contested case hearing is not required pursuant to W.S. 35-24-107(b) and in lieu of W.S. 35-24-108, the director may prior to rendering a decision on any application, order a limited hearing. A copy of the order shall be mailed to the applicant and to all persons who have submitted comments or requested to be kept informed of the proceedings involving the application. The order shall state the date, time and location of the limited hearing and shall identify specific issues to be addressed at the limited hearing, which may include the feasibility and desirability of one (1) or more alternatives to the proposed arrangement. The order shall require the applicant to submit written evidence in the form of affidavits and supporting documents, addressing the issues identified within twenty (20) days after the date of the order. The order shall also state that any person may arrange to receive a copy of the written evidence from the director, at the person's expense, and may provide written comments on the evidence within forty (40) days after the date of the order. Any person providing written comments pursuant to this subsection shall provide a copy of the comments to the applicant.
(b) The limited hearing shall be held before the director or a department staff member designated by the director. The director or his designee shall question the applicant concerning the evidence submitted by the applicant. The questions may address relevant issues identified in the comments submitted in response to the written evidence or identified by the department of health staff or discovered through publicly available department of health data. At the conclusion of the applicant's responses to the questions, any person who submitted comments about the applicant's written evidence may make a statement addressing the applicant's responses to the questions. The director or his designee may ask questions of any person making a statement. At the conclusion of all statements, the applicant may make a closing statement.
(c) The director's decision after a limited hearing shall to the extent each is relevant, be based upon the application, the comments, the applicant's response to the comments, the applicant's written evidence, the comments in response to the written evidence and the information presented at the limited hearing. In making the decision, the director may rely on publicly available department of health data.
35-24-110. Contested case hearing on application; procedure specified; recommendations and final decisions.
(a) If required by W.S. 35-24-107, the director shall order a contested case hearing. The director shall publish notice of the time, date and location of the hearing in a newspaper of general circulation at least a week prior to the hearing.
(b) The hearing shall be conducted in an impartial manner pursuant to the Wyoming Administrative Procedure Act, applicable provisions of the Wyoming Rules of Civil Procedure and any rules for the conduct of contested cases adopted by the director of the office of administrative hearings pursuant to W.S. 9-2-2203. The hearing shall be conducted by a hearing officer. All factual issues relevant to a decision shall be presented in the contested case. The attorney general may appear as a party. Additional aggrieved parties may appear to the extent permitted under W.S. 16-3-107. The record in the contested case includes the application, the comments, the applicant's response to the comments and any other evidence that is part of the record under the Wyoming Administrative Procedure Act.
(c) The director shall issue a final decision within thirty (30) days following receipt of recommendations of the hearing officer.
(d) All parties appearing in a contested case shall be provided a copy of the hearing officer's recommendation and the director's final decision.
35-24-111. Criteria for approving application; factors enumerated.
(a) The director shall not approve an application unless he determines the arrangement is more likely to result in a better overall promotion of the quality of health care, access to health care, a lower cost for health care and the increased availability of a comprehensive health care system in the state, than would otherwise occur under existing market conditions or conditions likely to develop without an exemption from state and federal antitrust law. If a proposed arrangement appears likely to improve certain criteria at the expense of other criteria, the director shall not approve the application unless he determines improvements outweigh the negative impacts and the proposed arrangement, taken as a whole, is likely to substantially further the purposes of this chapter.
(b) In making a determination about cost, access, quality and the promotion of a comprehensive health care system in the state, the director may to the extent applicable, require the applicant to demonstrate or provide information for purposes of considering:
(i) If the proposal includes provisions for cost containment;
(ii) Market structure, including:
(A) Actual and potential sellers and buyers or providers and purchasers;
(B) Actual and potential consumers;
(C) Geographic market area; and
(D) Entry conditions.
(iii) Current market conditions;
(iv) The historical behavior of the market;
(v) Performance of other similar arrangements;
(vi) If the proposal unnecessarily restrains competition or restrains competition in ways not reasonably related to the purposes of this chapter; and
(vii) The financial condition of the applicant.
(c) The analysis of cost by the director shall consider the individual consumer of health care and if a proposed arrangement will result in cost-efficiencies in the services provided by the applicant. Cost-efficiencies to be realized by providers, group purchasers or other participants in the health care system also are relevant and shall be considered to the extent any efficiencies are likely to directly or indirectly benefit the consumer. If an application is submitted by providers primarily paid by third party payors or persons unaffiliated with the applicant, it is sufficient for the applicant to show that cost savings are likely to be passed on to the unaffiliated third party payors or persons and the applicants shall not be required to show that third party payors with whom the applicants are not affiliated will pass on cost savings to individuals receiving coverage through the third party payors. To the extent relevant and ascertainable, cost analysis may also include the impact on overall employer premiums for health insurance. In making determinations as to costs, the director shall determine the extent to which:
(i) The cost savings likely to result to the applicant;
(ii) The extent to which cost savings are likely to be passed on to the consumer and in what form;
(iii) The extent to which overall employer premium costs for health insurance will be decreased;
(iv) The extent to which the proposed arrangement is likely to result in cost shifting by the applicant onto other payors or purchasers of other products or services;
(v) The extent to which any cost shifting by the applicant is likely to be followed by other persons in the market;
(vi) The extent to which the proposed arrangement reduces overall systemic cost shifting;
(vii) The current and anticipated supply and demand for any products or services at issue;
(viii) The representations and guarantees of the applicant and their enforceability;
(ix) Effectiveness of regulation by the director;
(x) Inferences to be drawn from market structure;
(xi) The cost of regulation, both for the state and for the applicant; and
(xii) Any other factors showing that the proposed arrangement is or is not likely to reduce costs.
(d) In making determinations as to access, the director shall determine the extent to which the:
(i) Utilization of needed health care services or products by the intended targeted population is likely to increase or decrease. When a proposed arrangement is likely to increase access in one (1) geographic area by lowering prices or otherwise expanding supply, but limits access in another geographic area by removing service capabilities from that second area, the director shall require the applicant to articulate the criteria employed to balance these effects;
(ii) Proposed arrangement is likely to make available a new and needed service or product to a certain geographic area;
(iii) Proposed arrangement is likely to otherwise make health care services or products more financially or geographically available to consumers, particularly persons in historically underserved populations including indigent persons and unserved geographic areas; and
(iv) Proposed arrangement is likely to result in a wide distribution of appropriate health care services throughout the state.
(e) If the director determines that the proposed arrangement is likely to increase access and bases that determination on a projected increase in utilization, the director shall require the applicant to demonstrate that the increased utilization does not result in overutilization.
(f) In making determinations as to quality, the director shall determine the extent to which the proposed arrangement is likely to:
(i) Decrease morbidity and mortality;
(ii) Result in faster convalescence;
(iii) Result in fewer hospital days;
(iv) Permit providers to attain needed experience or frequency of treatment likely to lead to better outcomes;
(v) Result in more effective or efficient provider credentialing and licensing;
(vi) Result in increased or more effective use of clinical practice guidelines, quality assurance measures such as continued quality improvement and other outcome measurements;
(vii) Increase patient satisfaction; and
(viii) Have any other features likely to improve or reduce the quality of health care.
(g) Notwithstanding subsection (f) of this section, in evaluating if a proposed arrangement improves or reduces the quality of health care, the director shall preserve the confidentiality of quality management functions involving health care facilities and peer review activities involving professional standard review organizations as set forth in W.S. 35-2-910 and 35-17-101 through 35-17-106.
(h) In making determinations as to whether a proposed arrangement contributes to the promotion of a comprehensive health care system in the state, the director shall determine the extent to which the arrangement is likely to:
(i) Promote the development of and access to a wide variety of health care services and specialties in the state;
(ii) Minimize cost-shifting in which more lucrative patient populations and specialties are served at the expense of other patients and specialties, resulting in fewer services available in the state; and
(iii) Promote access to appropriate health care services in locations throughout the state.
35-24-112. Final decision; conditions for approval; findings; ongoing supervision and reporting; renewal fees.
(a) The director shall issue a written decision approving or disapproving the application.
(b) The director may condition approval on a modification of all or part of the proposed arrangement to eliminate any restriction on competition that is not reasonably related to the goals of reducing cost or improving access or quality. The director may also establish conditions for approval that are reasonably necessary to protect against abuses of private economic power and to ensure that the arrangement is appropriately supervised and regulated by the state.
(c) The decision by the director approving or disapproving an application shall include specific findings of fact concerning cost, access and quality criteria and shall identify one (1) or more of these criteria as the basis for the decision.
(d) The decision to approve an application shall require periodic submission of specific data by the applicant relating to cost, access and quality and to the extent feasible, the applicant shall identify objective standards of cost, access and quality by which the success of the arrangement will be measured. If the director determines that the scope of a particular proposed arrangement is such that the arrangement is certain to have neither a positive or negative impact on any one (1) of the criteria, the director may not require the submission of data or establish an objective standard relating to that criteria. An applicant shall submit a renewal fee together with information required under this subsection, in an amount determined by the department subject to limitations imposed under W.S. 35-24-104(d). Revenues from fees collected shall be deposited into the account established under W.S. 35-24-104(d).
After the director has rendered a decision under W.S. 35-24-112 and in accordance with W.S. 16-3-114, the applicant or any other aggrieved party may request judicial review of the director's decision by filing a petition for review within thirty (30) days in accordance with the Wyoming Administrative Procedure Act. A determination under W.S. 35-24-107(a) shall not be raised as an issue on appeal.
35-24-114. Ongoing supervision following application
approval; procedures; solicitation of public comment on arrangement impacts.
(a) The director shall appropriately supervise, monitor and regulate approved arrangements consistent with subsection
(b) of this section.
(b) The decision approving the application shall specify a time schedule for the submission of data by the applicant, which shall be at least once a year and shall identify the data required to be submitted. The director may at any time require the submission of additional data or alter the time schedule. Upon review of the data submitted, the director shall notify the applicant on compliance of the arrangement with the initial decision or subsequent orders. If the arrangement is not in compliance, the director shall identify those respects in which the arrangement does not conform to the decision.
(c) An applicant receiving notification that an arrangement is not in compliance may respond with additional data within thirty (30) days. The response may include a proposal and time schedule by which the applicant will bring the arrangement into compliance with the initial decision or subsequent orders. If the arrangement is not in compliance and the director and the applicant cannot agree to the terms of bringing the arrangement into compliance, the matter shall be set for hearing. The hearing shall be conducted as a contested case in the manner prescribed under W.S. 35-24-110. The hearing officer shall issue a written recommendation to the director who shall issue a final decision within thirty (30) days following issuance of the recommendation. A copy of the recommendation and final decision shall be provided to all parties to the contested case hearing. A final decision by the director is subject to judicial review in accordance with W.S. 16-3-114.
(d) The director shall publish notice two (2) years after the date the initial application is approved and at two (2) year intervals thereafter, soliciting comments from the public concerning the impact the arrangement has had on cost, access and quality. The director may request additional oral or written information from the applicant or from any other source.
35-24-115. Revocation of approval; conditions; notice;
public comment; hearing; revocation alternatives specified; liability of applicant.
(a) Subject to subsection (d) of this section, the director shall revoke his initial approval of an application if the arrangement:
(i) Is not in substantial compliance with the terms of the application;
(ii) Is not in substantial compliance with the conditions of approval;
(iii) Has not and is not likely to substantially achieve improvements in cost, access or quality or the promotion of a comprehensive health care system in the state as identified in the initial decision as the basis for approval of the arrangement; or
(iv) Is not promoting reductions in cost and improvements in access and quality to the extent competition would do so due to changing conditions in the marketplace. Revocation under this paragraph shall be identified in writing by the director together with reasons therefor.
(b) The director shall initiate a proceeding to revoke approval by providing written notice to the applicant describing in detail the basis for the proposed revocation. Notice of the proceeding shall be published and provided to all interested parties in the manner and time specified under W.S. 35-24-104(b), which shall request the submission of comments to the director.
(c) A proceeding to revoke an approval shall be conducted as a contested case proceeding upon the written request of the applicant. The attorney general may appear as a party. The contested hearing shall be conducted in the manner prescribed by W.S. 35-24-110. Decisions of the director in a proceeding to revoke approval are subject to judicial review in accordance with W.S. 16-3-114.
(d) In deciding whether to revoke an approval, the director shall consider the hardship the revocation may impose on the applicant and any potential disruption of the market as a whole. The director shall also consider based upon a demonstration by the applicant, if the arrangement can be modified, restructured or regulated in a manner to remedy the problem upon which the revocation proceeding is based. Before approving an alternative to revocation that involves modifying or restructuring an arrangement, the director shall publish notice stating that any person may comment on the proposed modification or restructuring within twenty (20) days after publication of the notice. The director shall not approve any modification or restructuring until the comment period has concluded. An approved modified or restructured arrangement is subject to appropriate supervision in the manner provided under W.S. 35-24-114.
(e) An applicant that has had its approval revoked is not required to terminate the arrangement. The applicant cannot be held liable under state or federal antitrust law for acts that occurred while the approval was in effect, except to the extent the applicant failed to substantially comply with terms of its application or failed to substantially comply with terms of the approval. The applicant is subject to state and federal antitrust law after the revocation becomes effective and may be held liable for acts that occur after the revocation.
Nothing in this chapter shall relieve an applicant or recipient of an exception under this chapter from applicable provisions of the Wyoming Insurance Code.
35-25-101. Uninsured child health insurance program.
There is created a child health insurance program for families with a gross monthly income at or below one hundred eighty-five percent (185%) of the federal poverty level, until July 1, 2005, and thereafter, for families with a gross monthly income at or below two hundred percent (200%) of the federal poverty level.
(a) As used in this act:
(i) "Child" means a person who has not yet reached the nineteenth anniversary of his birth;
(ii) "Department" means the department of health;
(iii) "Federal poverty level" means the federal poverty guideline updated annually in the federal register by the United States department of health and human services under the authority of section 673(2) of the Omnibus Budget Reconciliation Act of 1981;
(iv) "Private health insurance" means an individual insurance policy or contract for the purpose of paying for or reimbursing the cost of dental, hospital and medical care;
(v) "State plan" means the state plan required by 42 U.S.C. 1397aa et seq. to be submitted by the state to the United States secretary of health and human services to receive federal funding for a child health insurance program;
(vi) "This act" means W.S. 35-25-101 through 35-25-108.
35-25-103. Child health insurance program eligibility; services by department or private health insurance.
(a) Subject to approval of the state plan by the United States secretary of health and human services, and subject to available state and federal funding the department shall provide a health insurance plan for an eligible child whose monthly gross family income is not more than two hundred percent (200%) of the federal poverty level. A child who is determined eligible to receive benefits under this section shall remain eligible for twelve (12) months as long as the child resides in the state of Wyoming and has not yet attained nineteen (19) years of age. A child's eligibility to receive benefits under this act shall be redetermined on an annual basis. A simplified application process, which includes minimum eligibility requirements, shall be provided throughout the state at various public and private establishments approved by the department of health. To be determined eligible to receive benefits under this section, a child shall not be eligible under the Wyoming Medical Assistance and Services Act, shall not have been covered under another health insurance plan for a minimum of one (1) month prior to application for coverage under this act or, upon birth, the child would not otherwise be covered by a public or private health insurance plan. Eligibility under this section shall be determined by the department of health or its designee.
(b) The child health insurance plan required by subsection
(a) of this section shall be provided either through a private health insurance company licensed by the insurance commissioner to write insurance in Wyoming or by the department of health's division responsible for administering the Medicaid program. The department's division shall be used to provide the insurance plan only if it can provide the plan at a lower cost than can a qualified private insurance company or if use of the division will otherwise accrue more benefits to the state than will use of a private insurance company. If the child health insurance plan required by subsection (a) of this section is provided through the department's division, the department shall competitively procure the contract at least once every five (5) years. In awarding the contract the department shall compare the cost of operating the program through a private insurance company to a forecasted state administered alternative.
(c) A medical provider who accepts payment for services provided under this section shall not charge or attempt to collect payments in excess of a rate schedule established by the department or in excess of rates negotiated with a private health insurance company who is offering child health insurance pursuant to this act.
(a) A child eligible for services under this act shall receive benefits developed by the department as allowed by 42 U.S.C. 1397cc et seq. and that include:
(i) Cost sharing factors, not to exceed the maximum allowable under 42 U.S.C. 1397aa et seq.;
(ii) Exclusions and limitations;
(iii) Inpatient and outpatient hospital services;
(iv) Physician services;
(v) Laboratory and x-ray services;
(vi) Well-baby and well-child care including age appropriate immunizations;
(vii) Prescription drug coverage;
(viii) Vision coverage;
(ix) Dental coverage including preventive and basic services; and
(x) Provision of all services through managed care pursuant to 42 U.S.C. 1397cc(f)(3). This paragraph shall be effective only if the child insurance program under this act is provided through a private insurance company licensed by the insurance commissioner to write insurance in Wyoming.
35-25-106. Private health insurance plan request for proposals.
(a) If the child health insurance plan required by W.S. 35-25-103 is provided through a private health insurance company, the department shall issue a request for proposals from qualified insurers not less than once every five (5) years, in addition to the requirements set forth in W.S. 35-25-103(b). The department shall award the contract for this service to an insurer based on price, the provision of required services and other factors listed in the department's request for proposals. A contract for health insurance awarded under this section shall contain provisions with respect to exclusions from coverage for preexisting conditions that are no more restrictive than those described in 42 U.S.C. 1397bb(b)(1)(B)(ii). The contract shall include provisions for changes in terms and conditions and for rebidding in case major changes are needed. The department shall have the right to rebid the contract after two (2) years.
(b) Biennially, the department may allow a contractor providing child health insurance pursuant to subsection (a) of this section to adjust the price charged for the coverage, but if the price is increased, the department may, after public notice, rebid the contract or the department may administer the program pursuant to W.S. 35-25-103.
(c) Repealed by Laws 2020, ch. 10, § 2.
recommendations; required action to limit expenditures to budget available.
(a) The department shall project monthly expenditures under this act each month through the end of the biennium based upon the level of activity for the previous months and the trend in expenditures compared to previous expenditures. If the projections indicate that expenditures may exceed the federal and state funds available under this act, the department, may, by rule and regulation and subject to availability of funds, limit participation in the program under this section as follows:
(i) The department may impose a partial or total moratorium on new enrollments in the programs under this act until funds are available to meet the needs of new enrollees;
(ii) For current recipients of benefits under this act, priority for the continuation of funding shall be given to those families with the lowest incomes.
(b) In the last six (6) months of the biennium, the department shall include a projection of expenditures for the next biennium based on the spending for the current biennium unless the legislature provides for a different level of funding for the next biennium.
(c) The funding for the child health insurance program shall be deemed to be included within the division of health care financing line item within the department of health budget unless a separate line item is provided in the budget bill. General fund expenditures for the child health program shall not exceed the amount needed to match federal funds without explicit authorization enacted in the budget bill.
35-25-108. Implementation; duties; restrictions on the department of health.
(a) The department shall:
(i) Administer this act within the fiscal constraints of 42 U.S.C. 1397aa et seq. and subsequent federal enactments governing this program and the state budget as enacted by the legislature;
(ii) Develop a state plan for child health insurance to qualified recipients under this act and otherwise provide for the effective administration of this act;
(iii) Maintain records on the administration of this act and report to the federal government as required by federal law and regulation;
(iv) Adopt, amend and rescind rules and regulations on the administration of this act following notice and public hearing in accordance with the Wyoming Administrative Procedure Act;
(v) Establish indicators for measuring access, process, quality and outcomes effectiveness in improving children's health.
(b) The department shall not implement:
(i) The program under this act until a state plan has been approved by the United States secretary of health and human services or, for any modified plan, until the modified plan has been approved if the modifications require the approval of the United States secretary of health and human services; and
(ii) Any state plan that does not conform to the requirements of this act.
(a) As used in this act:
(i) "CDC" means the federal center for disease prevention and control;
(ii) "County cancer resource coordinator program" means a program undertaken through a private organization, county hospital, hospital district hospital or city or county health department which provides local level education, outreach, patient navigation services, community planning and data collection in order to lessen the impact of cancer on Wyoming people;
(iii) "Department" means the department of health;
(iv) "Evidence based" means relying on scientifically valid evidence. Scientifically valid evidence relies on studies and experiments including systematic reviews of multiple randomized controlled trials or epidemiological studies, one (1) or more randomized controlled trials, one (1) or more epidemiological studies and the recommendations of nationally and internationally recognized groups of experts in the field;
(v) "Medicaid" means the joint federal and state program of health care financing for the poor authorized by Title XIX of the federal Social Security Act and title 42 of the Wyoming statutes;
(vi) "Statewide comprehensive cancer control steering committee" means a committee whose mission is defined by the 2006-2010 Wyoming cancer control plan and which provides advice and guidance to the Wyoming comprehensive cancer control program. The committee is a private entity whose members include government employees;
(vii) "This act" means W.S. 35-25-201 through 35-25-206.
(a) The department shall develop a comprehensive cancer control plan. The department shall begin with the plan and recommendations in the Wyoming cancer control plan published in October 2005 by the Wyoming comprehensive cancer control consortium. The goals shall be to reduce the numbers of people affected by cancer with improved prevention and education and, for those individuals who are diagnosed with cancer, the goal shall be to provide diagnostic, therapeutic and palliative interventions that are evidence based, scientifically proven best of care. The comprehensive cancer control plan may include:
(i) Cancer prevention and education for both the public, health care professionals and institutions;
(ii) Evidence based early detection, screening, diagnosis and treatment;
(iii) Research and data collection;
(iv) Palliative care including pain management and other steps to improve the quality of life of probably terminal cancer patients;
(v) Rehabilitation of cancer victims; and
(vi) Programs to assist cancer survivors in returning to normal life.
(b) In financing and implementing the program established pursuant to subsection (a) of this section the department shall consider the use of the Medicaid program. This section does not constitute authorization to expand the services and eligibilities of the Medicaid program which requires specific legislative authorization. The department may recommend such authorization where appropriate.
(c) The department may contract with one (1) or more third parties to develop and implement the plans authorized by this section. Any contract awarded under this section shall be awarded on the basis of competitive bids and shall include specific requirements relating to outcome based evaluation.
(d) Subject to the restriction of subsection (b) of this section, the department may accept state, federal, local and nongovernmental funds for developing and implementing the plans established pursuant to this section.
(e) The department may solicit proposals for grants under this section by publication of a request for proposals. Grant recipients under this section may include local governments, private nonprofit organizations, schools and other organizations as appropriate. Any grants to organizations not political subdivisions of the state of Wyoming or under the absolute control of the state shall be subject to any restriction necessary to comply with Article 16, Section 6 of the Wyoming Constitution. Any request for proposals used during the competitive grant process shall include specific requirements relating to outcome based evaluation of the grant recipient's performance.
(f) The department shall collaborate and coordinate with public and private entities including state and local governments and the CDC to assure maximum effective use of resources, people and money. The department shall take advice, as appropriate, from the statewide comprehensive cancer control steering committee.
(g) Considering funds available and the purposes for which those funds are made available, the department shall give emphasis to the following cancer control and prevention programs:
(i) The county cancer resource coordinator program. This program shall be a pilot program in two (2) sites, one (1) urban and one (1) rural. Each program shall cover at least one (1) county and may cover several counties. The program may be expanded to additional sites if sufficient funds become available;
(ii) Public education relating to cancer prevention and awareness for all cancers;
(iii) Early detection of cancer including those cancers identified in the state cancer control plan and specifically including the Wyoming colorectal cancer early detection and prevention program;
(iv) Programs and public education which promote the reduction of risk factors to reduce cancer and other chronic diseases within the state; and
(v) Programs and public education which enhance treatment and quality of care of those impacted by cancer within the state.
(h) The department may propose cancer control as a specific line item in its biennial budget.
(j) The department shall, in accordance with the Wyoming Administrative Procedure Act, promulgate rules and regulations as appropriate to implement this act.
(k) The department shall report on its activities, program outcomes, conclusions and goals for the next two (2) years under this act to the joint labor, health and social services interim committee. The report shall be due on October 1 of every odd numbered year.
35-25-204. Wyoming colorectal cancer early detection and prevention program.
(a) Subject to the availability of appropriations, the department shall undertake a colorectal cancer screening and prevention program for those who qualify as specified in subsection (c) of this section.
(b) Initially the screening and prevention program funded under this program shall consist of colonoscopies which shall consist of both the examination of the colon and rectum and the removal and pathological examination of polyps in accordance with the normal standards of care for colonoscopies. After July 1, 2008, the department may, by rule and regulation, authorize other forms of screening to participate in the program provided these other forms of screening are evidence based and are shown by the evidence to be as effective or as cost effective as traditional colonoscopies.
(c) Starting July 1, 2007 Wyoming residents with incomes at or below two hundred and fifty percent (250%) of the federal poverty level shall be eligible to participate in this program and this shall remain the standard if the biennial budget bill does not establish a different standard and unless a different standard is established pursuant to subsection (d) of this section.
(d) Eligibility for the program set forth in this section shall be limited to individuals who are Wyoming residents and have been so for at least one (1) year immediately prior to screening. The eligibility shall be for one (1) colonoscopy every ten (10) years, counting any done before the effective date of this act or before the individual became a Wyoming resident. However, the department on a case-by-case basis may authorize follow-up screening when medically indicated based on national evidence based guidelines. Eligibility shall be restricted to individuals who meet appropriate age requirements in accordance with national evidence based recommendations and are uninsured or underinsured. For persons who are underinsured, the program shall only pay expenses not covered by insurance. In the event that analysis shows spending in the program will exceed the budget available, the department shall institute a waiting list.
(e) The department shall provide reimbursement for an eligible person's colonoscopy at the rate paid under the Wyoming Medical Assistance and Services Act for colonoscopies, including polyp removal. The person receiving services under this subsection shall pay all other costs of the colonoscopy. When the funds appropriated for this program are expended, the department shall cease payments under this section.
(f) The department shall develop an internet based application process for determining individual eligibility. The result of a successful application may be a voucher that the individual may present to a provider the department has contracted with or may be an online statement of eligibility that the providers can access or both. The department may use city or county health departments, other public health offices, providers, advocacy groups and any other appropriate governmental or private entities to assist individuals in completing the application process.
(a) The breast and cervical cancer program within the department is authorized to obtain private and federal grant funds and to seek appropriations for:
(i) Education, outreach and breast and cervical cancer screenings for those unable to afford them;
(ii) Continuation of the existing pilot outreach program for the medically underserved population in the Big Horn Basin and expansion of that program to other areas of the state; and
(iii) Implementation of the program known as the native sisters program for outreach to members of the Eastern Shoshone and Northern Arapaho tribes, provided that any grants or contracts entered into pursuant to this paragraph shall contain any restrictions necessary to comply with Article 16, Section 6 of the Wyoming Constitution.
(a) The department may establish an acute and chronic pain management advisory committee consisting of the following members:
(i) One (1) employee of the department appointed by the director who will serve as the chairman of the committee;
(ii) One (1) member appointed by the board of medicine;
(iii) One (1) member appointed by the board of nursing;
(iv) One (1) member appointed by the board of pharmacy; and
(v) One (1) member of the public who has experience in pain management appointed by the director.
(b) The members of the pain management advisory committee shall serve at the pleasure of the director of the department and shall meet at least two (2) times each year. The travel expenses of the members of the pain management committee as described in subsection (a) of this section shall be paid by their respective departments or boards. The department shall pay the per diem and travel expenses of the member of the public appointed pursuant to paragraph (v) of subsection (a) of this section and shall provide administrative support for the operation of the committee.
(c) The committee shall perform the following functions:
(i) Research issues associated with acute and chronic pain management including those issues assigned to the committee by the director of the department;
(ii) Offer recommendations to the director of the department, other state agencies and licensing boards of health care professionals regarding policies and programs that would manage acute and chronic pain more effectively or efficiently; and
(iii) Make recommendations regarding legislation to the director of the department.
35-25-301. Diabetes care planning; reports to the legislature.
(a) The department of health shall develop a plan to reduce the incidence of diabetes in Wyoming, improve diabetes care, and control complications associated with diabetes. The plan shall include identification of goals and benchmarks. The department shall submit the plan to the joint labor, health and social services interim committee by October 1, 2014.
(b) The department of health shall track for statistical and trending analysis the following:
(i) The prevalence of all types of diabetes in the state and the financial impact that diabetes is having on the state. Items included in this assessment shall include the number of individuals with diabetes, the number of individuals with diabetes and family members impacted by prevention and diabetes control programs implemented by the department, the financial toll or impact diabetes and its complications place on the Medicaid program and the financial toll or impact diabetes and its complications place on the Medicaid program in comparison to other chronic diseases and conditions;
(ii) An assessment of the benefits of implemented programs and activities aimed at controlling diabetes and preventing the disease;
(iii) A description of the level of coordination existing between the department, other agencies and Eastern Shoshone and Northern Arapaho tribes on activities, programmatic activities and messaging on managing, treating or preventing all forms of diabetes and its complications;
(iv) Detailed action plans for battling diabetes with a range of actionable items for consideration by the legislature. The plans shall identify proposed action steps to reduce the impact of diabetes, prediabetes and related diabetes complications. The plan shall also identify expected outcomes of the action steps proposed in the following biennium while also establishing benchmarks for controlling and preventing relevant forms of diabetes; and
(v) The impact of gestational diabetes on the Medicaid population, including an analysis of cost implications, the number of pregnant women screened and diagnosed and patient outcome measures and recommended strategies to reduce the impact of the condition and to improve outcomes for this population;
(vi) The development of a detailed budget blueprint identifying needs, costs and resources required to implement the plan developed pursuant to this section. The blueprint shall include a budget range for all options presented in the plan for consideration by the legislature.
(a) The department of health, the attorney general's office division of victim services or the department of health and attorney general's office division of victim services together shall develop a community education program regarding female genital mutilation. The program shall include:
(i) Education, prevention and outreach materials regarding the health risks and emotional trauma inflicted by the practice of female genital mutilation;
(ii) Ways to develop and disseminate information regarding recognizing the risk factors associated with female genital mutilation;
(iii) Training materials for law enforcement, teachers and others who are mandated reporters under W.S. 14-3-205(a), encompassing:
(A) Risk factors associated with female genital mutilation;
(B) Signs that an individual may be a victim of female genital mutilation;
(C) Best practices for responses to victims of female genital mutilation; and
(D) The criminal penalties associated with the facilitation or commission of female genital mutilation.
(b) Law enforcement, teachers and others who are mandated reporters under W.S. 14-3-205(a) shall incorporate the training under this section into their professional development programs and shall provide the training to employees and volunteers. To assist state and local entities in disseminating the education program under this section, the department of health, the attorney general's office division of victim services or the department of health and attorney general's office division of victim services together shall provide necessary training programs and technical assistance as requested.
(a) As used in this article:
(i) "988" or "988 system" means the universal telephone number for the national suicide prevention and mental health crisis hotline system within the United States, operating through the national suicide prevention lifeline or its successor, maintained by the assistant secretary for mental health and substance abuse under 42 U.S.C. § 290bb-36c;
(ii) "Administrator" means the administrator of the 988 system;
(iii) "Contact" means a communication with the 988 system including a call, text or chat;
(iv) "Crisis center" or "crisis hotline center" means a center designated by the state to respond to statewide or regional 988 contacts;
(v) "Crisis facility" means a behavioral health center as defined by W.S. 35-1-613(a)(xvi), other provider under W.S. 35-1-611 through 35-1-627 or an equivalently staffed and equipped student health service;
(vi) "Department" means the department of health;
(vii) "Mobile crisis team" means a team providing services outside of a hospital or facility setting:
(A) That includes not less than one (1) behavioral health care professional who is capable of conducting an assessment of a person having a behavioral health crisis, in accordance with the professional’s permitted scope of practice under state law, and other professionals or paraprofessionals with appropriate expertise in behavioral health or mental health crisis response, including nurses, social workers, peer support specialists and others;
(B) Whose members are trained in trauma-informed care, de-escalation strategies and harm reduction;
(C) That is able to respond in a timely manner and, where appropriate, provide screening, assessment, health services, stabilization, de-escalation and referrals to health, social and other services and supports as needed;
(D) That maintains relationships with relevant community partners, including medical and behavioral health providers, primary care providers, community health centers and crisis centers; and
(E) That maintains the privacy and confidentiality of patient information consistent with federal and state requirements.
35-25-502. Crisis center designation; powers and duties of the department; rulemaking; report.
(a) Not later than July 1, 2023, the department shall designate one (1) or more crisis centers to provide crisis intervention services and crisis care coordination to persons accessing the 988 system from anywhere in Wyoming, twenty-four (24) hours per day and seven (7) days per week.
(b) A crisis center designated under this section shall:
(i) Have an agreement with the national suicide prevention lifeline or its successor for participation within the 988 system;
(ii) Meet all requirements and best practices guidelines of the national suicide prevention lifeline;
(iii) Provide data and reports and participate in evaluations and quality improvement activities as required by the administrator;
(iv) Have authority to deploy crisis services, including mobile crisis teams and coordinate access to crisis services or other local resources as appropriate, consistent with guidelines or best practices established by the national suicide prevention lifeline;
(v) Meet requirements established by the national suicide prevention lifeline for serving at-risk and specialized populations identified by the substance abuse and mental health services including those with co-occurring substance use by providing linguistically and culturally competent care including training and policies for transferring a 988 contact to an appropriate specialized center or subnetwork within the national suicide prevention lifeline network;
(vi) Provide follow-up services to persons accessing the 988 system consistent with policies and guidelines of the national suicide prevention lifeline.
(c) The department shall:
(i) Implement and provide oversight of the 988 system as provided in this article;
(ii) Promulgate rules to allow appropriate information sharing between and across crisis and emergency response systems for the purpose of real-time crisis care coordination including deployment of linked crisis services specific to the crisis response;
(iii) Coordinate active collaborations, including facilitating formal agreements and establishing appropriate information sharing procedures, between any crisis center designated under this section and appropriate community partners including mental health and substance abuse disorder treatment providers, primary care providers, community mental health centers, community behavioral health centers, mobile crisis teams, hospitals, inpatient psychiatric facilities and crisis facilities;
(iv) In consultation with the national suicide prevention lifeline, veteran's crisis line and other networks approved by the substance abuse and mental health services administration, ensure consistent public messaging about the 988 system;
(v) Provide an annual report on the usage of and services provided by the 988 system to the joint labor, health and social services interim committee and the substance abuse and mental health services administration;
(vi) Review its practices under this article not less than every four (4) years to ensure that the services provided are and remain best evidence-based practices for suicide prevention.
(a) The department may provide onsite response services to address 988 system contact through state or locally funded mobile crisis teams. A mobile crisis team under this section shall:
(i) Be designed in partnership with community members;
(ii) To the extent practical, be staffed by personnel that reflect the demographics of the community to be served;
(iii) Collect any data required by the substance abuse and mental health services administration and consistent with any requirements of the department.
(a) The department may provide payment for the provision of crisis services of a contact to the 988 system if:
(i) The person is not insured or the service is not covered by the person's health coverage; and
(ii) The service is not covered by another entity including municipal or county programs or funding.
(b) The department may explore options for appropriate coding of and payment for crisis services through the Medicaid program.
The governor shall create an advisory body or designate an existing advisory body to provide guidance to the department, gather feedback and make recommendations regarding the planning and implementation of the 988 system under this article. The advisory body may include representatives of a designated crisis center, 911 call center, law enforcement, hospital emergency department, individuals or family members of individuals with lived experience with suicide prevention or behavioral health crisis service usage and behavioral health crisis service providers and may include members of the judicial branch appointed by the chief justice of the supreme court.
35-25-506. 988 system trust fund; reserve account spending policy.
(a) The 988 system trust fund account is created. The trust account shall consist of those funds designated to the account by law and all monies collected from federal grants and other appropriations, contributions, grants, gifts, bequests and donations to the trust fund account. The trust fund account is specifically empowered to accept grants, gifts, transfers, bequests and donations. Funds deposited within the trust fund account are intended to be inviolate and constitute a permanent and perpetual trust fund which shall be invested by the state treasurer as authorized by law and in a manner to obtain the highest return possible consistent with preservation of the trust account corpus.
(b) During each fiscal year beginning July 1, 2024, the earnings from the 988 system trust fund account are appropriated to the department for expenditure as provided in subsection (d) of this section in an amount equal to five percent (5%) of the previous five (5) year average market value of the 988 system trust fund account, calculated from the first day of the fiscal year. For purposes of making the calculation under this subsection, until the 988 system trust fund account has existed for five (5) years, the average market value of the trust fund shall be the average market value during the years that the trust fund has existed. The calculation required by this subsection shall constitute the spending policy for the 988 system trust fund account.
(c) Earnings from the 988 system trust fund account in excess of the spending policy amount established by subsection
(b) of this section in any fiscal year shall be deposited by the state treasurer to the 988 system trust fund reserve account, which is hereby created. Except for monies appropriated to the department and monies deposited back to the 988 system trust fund pursuant to this subsection, funds deposited in the reserve account are intended to be inviolate and constitute a permanent and perpetual trust fund which shall be invested by the state treasurer as authorized by law. Interest and other earnings on funds within the reserve account shall be credited to the reserve account. Beginning July 1, 2024 for fiscal year 2023 and each fiscal year thereafter, the state treasurer shall transfer unobligated funds from the reserve account to the 988 system trust fund account as necessary to ensure that an amount equal to the spending policy amount established in subsection (b) of this section is available to the department, pursuant to subsection (b) of this section, for expenditure during the fiscal year. As soon as possible after the end of each fiscal year, revenues in this account in excess of four hundred twenty percent (420%) of the spending policy amount in subsection (b) of this section shall be credited to the 988 system trust fund account.
(d) Funds available to the department shall be prioritized to the extent practicable to first fund those services representing the best evidence-based practices for the prevention of suicide, which may include the following:
(i) Creating and maintaining a statewide 988 system pursuant to this article and in accordance with the National Suicide Hotline Designation Act of 2020 and the federal communication commission's rules adopted July 16, 2020 and in accordance with national guidelines for crisis care;
(ii) Supporting or enhancing the 988 system including providing for state designated crisis centers as provided in W.S. 35-25-502, providing for mobile crisis teams as provided in W.S. 35-25-503 and providing payment for crisis services as provided in W.S. 35-25-504;
(iii) Taking other actions necessary related to the administration of the 988 system as provided by this article;
(iv) Providing other goods or services, including health care services, that do not infringe on fundamental individual liberties and that, according to best evidence-based practices, are likely to lead to the prevention of suicide.
35-25-507. Immunity for telecommunications providers.
(a) A telecommunications provider shall not be liable to any person for any damages caused by any act or omission relating to the origination, transmission or termination of a contact with the 988 system unless the act or omission constitutes willful or wanton misconduct or gross negligence.
(b) As used in this section, "telecommunications provider" means any person that provides commercial landline telephone service, mobile telephone service or internet protocol enabled voice service and includes any agent or employee of the service provider.
The information obtained through the 988 system shall be considered a public record under W.S. 16-4-201(a)(v) and access to the information may be denied according to law.
(a) As used in this article:
(i) "Department" means the department of health;
(ii) "Eligible adult" means a Wyoming resident not less than eighteen (18) years of age who has been diagnosed by a physician or audiologist with a profound hearing impairment that requires hearing aids and who has a monthly modified adjusted gross family income at or below two hundred percent (200%) of the federal poverty level;
(iii) "Federal poverty level" means the federal poverty guideline updated annually in the federal register by the United States department of health and human services under the authority of section 673(2) of the Omnibus Budget Reconciliation Act of 1981;
(iv) "Hearing aid" means as defined by W.S. 33-35-102(a)(ii).
(a) Subject to available state funding, the department shall provide hearing aids for eligible adults. Eligibility under this section shall be determined by the department or its designee. To be determined eligible to receive hearing aids under this section, a person shall not be eligible to receive hearing aids through private insurance, Medicaid, Medicare or any other available third-party payor. Recipients shall not receive more than one (1) set of hearing aids under this article in any five (5) year period.
(b) An adult eligible for services under this article shall receive:
(i) Up to one (1) hearing aid per ear at a cost of not more than the rate paid for hearing aids under the Wyoming Medical Assistance and Services Act and including hearing aid insurance for loss or damage;
(ii) A hearing aid fitting at a cost of not more than the rate paid under the Wyoming Medical Assistance and Services Act; and
(iii) An initial set of ear molds at a cost of not more than the rate paid under the Wyoming Medical Assistance and Services Act.