Wyoming · 42 · statute
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sha256 16714fed41850ff82fcf9e9e789791894310fe3ade88371b7c7802946982e0b9
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Not later than November 30 of 2017, 2018 and 2020 the department shall report to the governor and the joint labor, health and social services interim committee on the effectiveness of the eligibility verification system and the number of cases referred under W.S. 42-10-105 including information on the outcome of the cases, if available, and on the cost to the department of the system.
Propose a changeThe department shall promulgate rules necessary to implement this chapter.
Propose a change(a) Except as required under federal law, self-attestation shall not be accepted for any of the following eligibility factors without verification prior to enrollment in the medicaid program: (i) Income in excess of zero dollars ($0.00); (ii) Residency; (iii) Identity; (iv) Except for any presumptive eligibility period, citizenship or immigration status. (b) The department shall not rely on self-attestation to establish any medicaid eligibility factor unless expressly required by federal law.
Propose a changemultistate enrollment; monthly death record checks. Note: this section is effective as of 1/1/2027. (a) As used in this section, "address change information" means postal change of address data, state address change databases or comparable systems. (b) On not less than a monthly basis, the department of health shall review address change information to identify potential changes in residency for medicaid recipients. (c) The department of health shall conduct monthly cross checks of address change information against enrollment records and shall initiate an eligibility redetermination when a change in residency is indicated. (d) The department of health shall submit enrollment information to any national database used to identify persons enrolled in medicaid in multiple states. Implementation of this subsection shall occur no later than October 1, 2029. (e) Not later than August 31 of each year, the department of health shall submit a public report to the joint labor, health and social services interim committee of the Wyoming legislature, including: (i) The number of persons flagged through address change information or out of state benefit activity; (ii) The number of persons removed from the medicaid program due to enrollment in multiple states; (iii) The estimated fiscal impact of this section. (f) On not less than a monthly basis, the department of health shall receive and review information from the vital statistics services and the social security administration master death file to identify any deceased persons enrolled in the medicaid program. Upon confirmation of death, the department shall promptly remove the deceased person from the program.
Propose a change(a) As used in this section: (i) "Retroactive eligibility" means coverage for services furnished prior to the month of application as authorized by 42 U.S.C. § 1396a(a)(34); (ii) "Medicaid eligible population" means persons eligible for medicaid under state or federal law. (b) Retroactive medicaid eligibility shall not extend more than two (2) months prior to the month in which a completed medicaid application is submitted. (c) This limitation applies only to initial applications and shall not affect ongoing eligibility. (d) The department of health shall adopt rules necessary to implement this section. (e) Not later than August 1 of each year, the department of health shall submit a report to the joint labor, health and social services interim committee of the Wyoming legislature, including: (i) The number of medicaid applications processed; (ii) The number of applicants denied retroactive eligibility under this section; and (iii) The estimated fiscal impact of the limitation. (f) This section shall be implemented not later than January 1, 2027.
Propose a change(a) The department of family services shall not seek, apply for, accept or renew any waiver of work requirements under 7 U.S.C. § 2015(o)(4) without first obtaining specific authorization from the legislature. Such authorization shall be provided in a duly enacted statute. (b) The department of family services shall not exercise the state's option to provide any exemptions from the work requirement under 7 U.S.C. § 2015(o)(6)(F), except for family caregivers as defined in section 2 of the Recognize, Assist, Include, Support and Engage Family Caregivers Act of 2017.
Propose a changeThis chapter shall be known and may be cited as the "Wyoming Private Ground Ambulance Service Provider Assessment Act."
Propose a change(a) As used in this chapter: (i) "Account" means the private ground ambulance service provider assessment account created by W.S. 42-11-103; (ii) "Ambulance" has the same meaning as defined in W.S. 33-36-102(a)(i)(A) and (B); (iii) "Department" means the department of health; (iv) "Fiscal year" means the twelve (12) month period beginning October 1 and ending September 30; (v) "Private ground ambulance service provider" means any person operating a licensed ambulance service designed to operate on the ground, which is not owned or operated by the state or any city, town, county, special district or other political subdivision of the state or local government; (vi) "License" and "licensed" means an ambulance business license issued under W.S. 33-36-104 that is not expired and has not been revoked or suspended; (vii) "Medicaid" means the medical assistance program established by title XIX of the federal Social Security Act and administered in this state by the department pursuant to the Wyoming Medical Assistance and Services Act; (viii) "Net patient revenue" means all amounts received by a private ground ambulance service provider licensed under W.S. 33-36-104 for the provision of licensed, ground ambulance services in the state of Wyoming. The department shall establish a procedure for determining net patient revenue for purposes of the assessment provided under W.S. 42-11-104; (ix) "Quarterly adjustment payment" means the quarterly payments made to private ground ambulance service providers that the department may establish and distribute pursuant to W.S. 42-11-106; (x) "Rate enhancement" means Medicaid reimbursement rate increases to private ground ambulance service providers, as determined by the department and approved by the Centers for Medicare and Medicaid Services; (xi) "Upper payment limit" means a limitation on aggregate Medicaid payments to private ground ambulance service providers, or another applicable class of Medicaid payees, as established by the Centers for Medicare and Medicaid Services; (xii) "Upper payment limit gap" means the amount calculated annually by the department constituting the difference between the applicable upper payment limit and Medicaid payments made subject to that limit in a fiscal year, excluding any payments authorized by this chapter.
Propose a change(a) The private ground ambulance service provider assessment account is created. (b) The state treasurer shall invest amounts deposited in the account in accordance with law and all investment earnings shall be credited back to the account. Funds in the account are continuously appropriated to the department for the purposes specified in this section. (c) The account shall consist of: (i) Amounts collected or received by the department from private ground ambulance service provider assessments under this chapter; (ii) All federal matching funds received by the department as a result of expenditures made by the department pursuant to this chapter. (d) The account shall be used exclusively for the following purposes: (i) To pay administrative expenses incurred by the department or its agent in performing the activities authorized by this chapter, provided that these expenses shall not exceed a total of three percent (3%) of the aggregate assessment funds collected in the fiscal year; (ii) To secure federal matching funds available through the state Medicaid plan as approved pursuant to W.S. 42-11-108, which shall be used to make quarterly adjustment payments or to provide rate enhancements to private ground ambulance service providers as provided by this chapter; (iii) To repay to the federal government any excess payments received or made to private ground ambulance service providers if the state plan, after approval by the Centers for Medicare and Medicaid Services, is subsequently disapproved for any reason and after the state has exhausted all appeals. Private ground ambulance service providers shall refund any excess payments to the assessment account. If a private ground ambulance service provider is unable to refund payments as provided in this paragraph, the department shall develop a payment plan to recoup deficient payments and accordingly deduct amounts from future Medicaid payments. The department shall refund the federal government for the federal portion of those overpayments; (iv) To refund assessments paid by private ground ambulance service providers for payments which were earned but not paid by the department, but only after the payments authorized by paragraphs (i) and (iii) of this subsection have been made.
Propose a change(a) Each private ground ambulance service provider shall pay a private ground ambulance service provider assessment to the department in accordance with this section. (b) The assessment due under this section shall be imposed each fiscal year in an amount calculated as a uniform percentage of each private ground ambulance service provider's net patient revenue. The assessment rate shall be determined by the department on a prospective basis and shall be based on the percentage of private ground ambulance service provider net patient revenue necessary to generate an amount not to exceed the nonfederal portion of the upper payment limit gap plus the fee authorized by W.S. 42-11-103(d)(i). If a rate enhancement is paid to private ground ambulance service providers pursuant to this chapter, the assessment rate shall include a uniform percentage of each private ground ambulance service provider's net patient revenue necessary to generate the nonfederal portion of all enhanced rates paid under this chapter plus the fee authorized by W.S. 42-11-103(d)(i). In no event shall assessments or the assessment rate exceed the indirect guarantee threshold amount established by 42 C.F.R. 433.68(f)(3)(i) or other federal law. (c) Unless otherwise determined by the department, the department shall collect and each private ground ambulance service provider shall pay the assessment required by this section on a quarterly basis, each payment constituting twenty-five percent (25%) of the annual assessment determined by the department. The initial payment shall be due not later than forty-five (45) days after the state plan has been approved by the Centers for Medicare and Medicaid Services unless a later date is set by the department. Subsequent payments are due not later than forty-five (45) days after the end of each calendar quarter unless a later date is set by the department. (d) If a private ground ambulance service provider ceases to operate as an ambulance service or for any reason ceases to be subject to the assessment imposed under this chapter, the assessment for the fiscal year in which the cessation occurs shall be adjusted by multiplying the annual assessment by a fraction, the numerator of which is the number of days in the year during which the private ground ambulance service provider is subject to the assessment and the denominator of which is three hundred sixty-five (365). Immediately upon ceasing to operate as an ambulance service provider, or otherwise ceasing to be subject to this chapter, the private ground ambulance provider shall pay the assessment for each quarter as adjusted, to the extent not previously paid.
Propose a change(a) If a private ground ambulance service provider fails to pay an assessment due under this chapter, there shall be added to the assessment a penalty equal to five percent (5%) of the amount of the assessment that was not paid when due. The penalty under this section may be waived by the department for good cause. Any payments made after a penalty is assessed under this section shall be credited first to unpaid assessment amounts rather than to penalty amounts, beginning with the most delinquent installment. (b) In addition to the penalty under subsection (a) of this section, the department may implement any of the following remedies for failure of a private ground ambulance service provider to pay its assessment when due under this chapter: (i) Withhold any Medicaid payments, including any quarterly adjustment payments or rate enhancements, until the assessment is paid; (ii) Develop a plan that requires the private ground ambulance service provider to pay any delinquent assessment in installments; (iii) Suspend or revoke the private ground ambulance service provider's license.
Propose a change(a) Subject to W.S. 42-11-107, the initiation of assessments under W.S. 42-11-104(c) and the federal approval authorized in W.S. 42-11-108, the department shall make quarterly adjustment payments to or implement rate enhancements for private ground ambulance service providers as set forth in this section. (b) Each private ground ambulance service provider that pays assessments under this chapter and meets the eligibility standards set by subsection (c) of this section shall be eligible to receive quarterly adjustment payments as provided in this section. The department shall distribute quarterly adjustment payments in amounts up to but not to exceed the applicable upper payment limit gap. The department shall establish a uniform methodology by which to distribute payments in compliance with applicable federal and state Medicaid laws and regulations. (c) Unless otherwise prohibited by federal law, only private ground ambulance service providers who meet all of the following requirements shall be eligible to receive a quarterly adjustment payment authorized in subsection (b) of this section: (i) Private ground ambulance service providers who provide ground ambulance services to Medicaid beneficiaries; (ii) Private ground ambulance service providers who provide ground ambulance services to Medicare beneficiaries; (iii) Private ground ambulance service providers who accept as full payment for ground ambulance services any payments made under Wyoming's worker's compensation system; and (iv) Private ground ambulance service providers who: (A) Are network providers for all insurers offering private health benefit plans in this state who maintain not less than a twenty percent (20%) share of the state's individual or small group health insurance market; or (B) Have made a bonafide and reasonable offer to become a network provider to all of the insurers identified in subparagraph (A) of this paragraph by offering to accept as network provider reimbursement not more than double the Medicaid reimbursement rate for relevant medical services. The offer required by this subparagraph may be higher to the extent the private ground ambulance service provider demonstrates to the department that the actual cost of providing relevant medical services plus six percent (6%) of the actual cost is an amount higher than double the Medicaid reimbursement rate for the relevant medical services. (d) To the extent rate enhancements are approved by the Centers for Medicare and Medicaid Services and subject to the collection of assessments under W.S. 42-11-104(b), the department shall provide rate enhancement payments to private ground ambulance service providers consistent with applicable federal and state requirements. (e) Quarterly payments or rate enhancements shall not be used to offset any other payment by Medicaid for ground ambulance services to Medicaid beneficiaries, including without limitation any fee-for-service, per diem, adjustment or cost settlement payments. (f) No private ground ambulance service provider is guaranteed, expressly or otherwise, that quarterly adjustment payments or rate enhancements will equal or exceed the amount of private ground ambulance service provider assessments due under this chapter. (g) Monies made available by this chapter shall not be used to replace other general revenues appropriated and funded by the legislature or other revenues used to support Medicaid.
Propose a change(a) The assessments imposed by this chapter shall be discontinued or not allowed if: (i) The state plan amendment or other agreement with the Centers for Medicare and Medicaid Services reflecting the payments authorized by this chapter is not approved by the Centers for Medicare and Medicaid Services. The department may modify the payment or qualification provisions as necessary to obtain the Centers for Medicare and Medicaid Services approval if the changes do not exceed the authority and purposes of this chapter; (ii) Federal financial participation to match assessments under this chapter becomes unavailable under federal law. In this event, the department shall terminate the imposition of assessments beginning on the date the federal statutory, regulatory or interpretive change takes effect. (b) If the collection of assessments is discontinued as provided in this section, payments or rate enhancements under this chapter shall be discontinued and, after payment of all amounts under W.S. 42-11-103(d)(i) and (iii), any assessments remaining in the account shall be returned to the private ground ambulance service providers from which the assessments were collected on the same basis as they were collected. (c) If the department is collecting assessments for both quarterly adjustment payments and rate enhancements and both collections are not discontinued, the department shall continue to maintain the account as required by this chapter for the type of assessment that continues to be collected.
Propose a change(a) The department shall seek necessary federal approval in the form of state plan amendments or otherwise in order to implement the provisions of this chapter. The department shall be deemed to satisfy this requirement by seeking approval for the operation of an upper payment limit program that provides for quarterly adjustment payments, by seeking approval for rate enhancements, or both. While seeking federal approval under this subsection, the department may modify payment or qualification provisions as necessary to obtain the Centers for Medicare and Medicaid Services approval if the changes do not exceed the authority and purposes of this chapter. (b) The department shall adopt rules and regulations necessary to implement the provisions of this chapter.
Propose a changeIf a person conducts, operates or maintains more than one (1) private ground ambulance service provider licensed by the department, the person shall pay the assessment for each private ground ambulance service provider separately. CHAPTER 12 -CITIZENS AND QUALIFIED ALIENS STATUS VERIFICATION FOR WELFARE
Propose a changepublic assistance. Note: this section is effective as of 1/1/2027. (a) Unless required by federal law, no person who is not a United States citizen or national of the United States shall be eligible to receive food assistance through the supplemental nutrition assistance program, unless that individual meets the definition of a qualified alien pursuant to 8 U.S.C. § 1641(b). (b) No person who is not a United States citizen or national of the United States shall be eligible to receive medical assistance through medicaid, unless that person meets the definition of an eligible alien pursuant to 42 U.S.C. § 1396b(v) and meets the definition of a qualified alien pursuant to 8 U.S.C. § 1641(b). (c) No person who is not a United States citizen or national of the United States shall be eligible to receive assistance through the personal opportunities with employment responsibilities (POWER) program, unless that person meets the definition of a qualified alien pursuant to 8 U.S.C. § 1641(b).
Propose a change(a) The department of family services shall be required to verify that a person is eligible to participate in the supplemental nutrition assistance program during enrollment and eligibility recertification by verifying citizenship or eligible alien status by using the United States citizenship and immigration services' systematic alien verification for entitlements (SAVE) online service or requiring the person to provide an acceptable form of proof of citizenship or eligible alien status, including but not limited to certified birth certificates, United States passports and United States customs and immigration services documentation. (b) The department of health shall be required to verify that a person is eligible for medicaid during enrollment and eligibility redetermination by verifying citizenship or eligible alien status using the SAVE online service or requiring the person to provide an acceptable form of proof of citizenship or eligible alien status, including but not limited to, certified birth certificates, United States passports and United States customs and immigration services documentation. (c) The department of family services or other applicable agency shall be required to verify that a person is eligible for the POWER program during enrollment and eligibility redetermination by verifying citizenship or eligible alien status using the SAVE online service or requiring the person to provide an acceptable form of proof of citizenship or eligible alien status, including but not limited to, certified birth certificates, United States passports and United States customs and immigration services documentation. (d) The department of family services shall submit to the United States department of agriculture information concerning any assistance unit member for whom it is unable to verify eligible alien status. (e) The department of health shall submit to the United States department of health and human services information concerning any person member for whom it is unable to verify eligible alien status.
Propose a changeNote: this section is effective as of 1/1/2027. The department of health and department of family services shall submit to the appropriate law enforcement authorities, including but not limited to the United States department of homeland security, information concerning any household member or assistance unit member who it is determined by the applicable department while applying the requirements of this title to be an unlawfully present alien, regardless of whether such household member or assistance unit member is applying to participate in a public assistance program, including but not limited to, the supplemental nutrition assistance program or medicaid.
Propose a changedetermination of benefits under the supplemental nutrition assistance program. Note: this section is effective as of 1/1/2027. The entire income and financial resources of any individual rendered ineligible for participation in the supplemental nutrition assistance program under 7 U.S.C. § 2015(f) shall be considered in determining the eligibility and benefit allotment of the household of which such individual is a member.
Propose a changeapplying for medicaid. Note: this section is effective as of 1/1/2027. (a) The department of health shall adhere to the following requirements regarding the reasonable opportunity period for verification of United States citizenship or eligible alien status for medicaid: (i) When an applicant's status cannot be verified through available data sources, the department shall provide only a single reasonable opportunity period, consistent with the minimum period required under federal law, for the applicant to provide verification; (ii) Medicaid coverage may only be provided provisionally during the reasonable opportunity period; (iii) Failure to submit acceptable documentation within the reasonable opportunity period required under federal law shall result in denial or termination of medicaid eligibility, subject to required notice; (iv) No additional reasonable opportunity period shall be granted to any applicant for medicaid who has previously been denied eligibility at any time due to a failure to verify citizenship or eligible alien status.
Propose a changeeligibility integrity, medicaid. Note: this section is effective as of 1/1/2027. (a) The department of health shall require a field for citizenship or eligible alien status on all presumptive eligibility applications. The department shall require hospitals, clinics and other qualified entities authorized to conduct presumptive eligibility determinations to collect and transmit attestations of citizenship or eligible alien status to the department. No presumptive eligibility application shall be approved unless the applicant certifies that they are a United States citizen, United States national, or alien eligible for medicaid pursuant to 42 U.S.C. § 1398b(v) and W.S. 42-12-101(b). (b) The department of health shall: (i) Beginning not later than April 1, 2027, require each hospital that accepts medicaid to include a provision on its patient admission or registration form for the patient or the patient's representative to state or indicate whether the patient is a United States citizen or lawfully present in the United States or is not lawfully present in the United States; (ii) Beginning not later than April 1, 2027, require each hospital that accepts medicaid to inform a patient, at the time this information is collected, that any submission made on an admission or registration form will not affect patient care, as required by federal law; (iii) Beginning with the calendar year ending on December 31, 2027 and each calendar year thereafter, require that each hospital shall submit an annual report to the department of health within thirty (30) days after the end of each calendar year which reports the total deidentified number of hospital admissions and emergency department visits within the previous calendar year, disaggregated based on whether the patient or the patient's representative indicated that he or she was or was not a citizen of the United States or lawfully present in the United States or declined to answer together with other information required by the department; (iv) Beginning on April 1, 2028 and each April 1 thereafter, submit a report to the governor and the joint labor, health and social services interim committee, which includes the number of total deidentified hospital admissions and emergency department visits for the previous calendar year, disaggregated based on weather the patient or patient's representative reported that the patient was or was not a citizen of the United States or lawfully present in the United States or declined to answer. The report shall also describe information relating to the costs of uncompensated care for aliens who are not lawfully present in the United States, the impact of uncompensated care on the cost or ability of hospitals to provide services to the public, hospital funding needs and other related information. The report shall also contain information based on the hospital's presumptive eligibility applications that are submitted to the department by participating providers, including the number of persons determined to be presumptively eligible for medicaid in the prior calendar year, the proportion of the persons presumptively eligible for medicaid who were verified as eligible for medicaid and the proportion of the persons presumptively eligible for medicaid who were determined to be ineligible for medicaid; (v) Adopt rules relating to the format and information to be contained in quarterly reports and the acceptable formats for hospitals to use in requesting information regarding a patients immigration status on hospital admission or registration forms.
Propose a change