Title 42, Title 42 — Welfare

Short title. This chapter may be cited as the "Wyoming Medical Assistance and Services Act". The program and services provided pursuant to this chapter and Title XIX of the federal Social Security Act may be cited as "Medicaid" or the "Medicaid program".

Definitions. (a) As used in this chapter: (i) "Categorically eligible" means any individual in need of medical assistance authorized by the legislature and by Title XIX of the federal Social Security Act to be covered by a state plan for medical assistance and services; (ii) "Med…

Authorized services and supplies. (a) Services and supplies authorized for medical assistance under this chapter include: (i) Inpatient hospital services; (ii) Outpatient hospital services; (iii) Laboratory and x-ray services; (iv) Skilled nursing home services; (v) The professio…

Powers and duties of department of health; state Medicaid agent appointed by governor. (a) The department of health shall: (i) Administer this chapter; (ii) Develop a state plan for medical assistance and services provided to qualified recipients under this chapter and otherwise …

Application for assistance; determination of eligibility; assignment of benefits; resources and income allowances defined for institutionalized spouse. (a) Any Wyoming resident may apply for medical assistance under this chapter by filing an application by telephone, by mail, in …

Uniform application throughout state; discrimination prohibited; pilot projects authorized. (a) This chapter and the state plan for medical assistance and services developed under W.S. 42-4-104(a)(ii) shall be uniformly applied within all political subdivisions of the state. (b) …

Administrative hearings. In accordance with the Wyoming Administrative Procedure Act, the department shall provide opportunity for a hearing to any individual denied medical assistance under this chapter or otherwise aggrieved by the administration of this chapter.

Charges for inpatient hospital services. A cost deduction, cost sharing or other similar charge shall not be imposed upon any recipient of medical assistance for inpatient hospital services provided on his behalf pursuant to this chapter.

Providing or obtaining assistance by misrepresentation; penalties. (a) Repealed by Laws 2019, ch. 96, § 3. (b) Repealed by Laws 2019, ch. 96, § 3. (c) No person shall knowingly make a false statement or misrepresentation or knowingly fail to disclose a material fact in obtaining …

Confidentiality of records; penalty for disclosure; authorized disclosure. (a) Any application, information and record obtained, compiled and maintained for an applicant or qualified recipient of medical assistance under this chapter is confidential and shall not be disclosed or …

Eligibility criteria; irrevocable burial trusts. (a) The department shall not consider as assets available to an applicant seeking medical assistance the corpus of a Medicaid qualifying trust: (i) That is irrevocable; (ii) In which the trustee and trustor retain no discretion wit…

Cooperative agreements authorized. The department may enter into a cooperative agreement and may contract with private attorneys to provide legal services and legal representation necessary to assist the department in enforcing its right to reimbursement created under article 2 o…

Work incentives improvement option; purchase of services; eligibility criteria; definition. (a) The department may amend the state plan for medical assistance and services developed under W.S. 42-4-104(a)(ii) to allow individuals with countable income not to exceed three hundred …

Premium calculation. (a) The calculation of premium for services under W.S. 42-4-115 shall be as follows: (i) Determine the total expenses of the Medicaid program for the most recent state fiscal year and the total number of clients in the Medicaid program served in that period; …

End stage renal dialysis program; rulemaking; funding. (a) Effective July 1, 2001, the department shall expand coverage for services authorized under W.S. 42-4-103(a)(xxiii) for qualified individuals in need of end stage renal dialysis to the extent funding is available. (b) The …

Prescription drug assistance program created; eligibility criteria; benefits provided; coverage of medications. (a) There is created a prescription drug assistance program to assist residents of the state. The program shall be a state funded program to provide prescription drug a…

Pharmacy plus program; eligibility criteria; rulemaking; termination of program. (a) The department may apply for a demonstration waiver under section 1115 of the federal Social Security Act to allow individuals with income or assets in excess of limits generally established in t…

Contracts for waiver services; authority of department; emergency case services; cost based payments; training and certification of specialists. (a) The department is authorized to enter into contracts with providers of services under a federal home and community based waiver and…

Program of all-inclusive care for the elderly. (a) The department, as an optional services program of the Medicaid program, may develop and implement a program of all- inclusive care for the elderly (PACE) in accordance with section 4802 of the Balanced Budget Act of 1997, P.L. 1…

Cooperation with paternity determination. (a) Except as otherwise provided in subsection (b) of this section, as a condition of eligibility, or continuing eligibility, for medical assistance under this chapter, a person who receives medical assistance shall cooperate in good fait…

Clubhouse rehabilitation services. (a) The director of the department shall include reimbursement for clubhouse rehabilitation services within the Medicaid program. (b) Within the limits of available funding, the department may enter into contracts with certified clubhouse provid…

Action against third party; notice; subrogation. (a) If a person who is or becomes an applicant or recipient for medical assistance under this chapter receives an injury under circumstances creating a legal liability in some third party, the applicant or recipient shall not be de…

Third party liability; authority; enforcement; notice; costs. (a) When the department provides, pays for or becomes liable for medical care, it shall have a lien for the cost of the medical assistance provided upon any and all causes of action which accrue to the person to whom t…

Settlement between recipient and tortfeasor or insurer; lien not discharged; exceptions. (a) No settlement made by and between the applicant or recipient and the tortfeasor or insurer shall discharge the right to reimbursement created pursuant to this article, against any money d…

Department subrogated to right of recovery of applicant or recipient; utilization of personal health insurance; insurance coverage of recipients. (a) The department shall be subrogated to any right of recovery or indemnification arising from an accident or occurrence resulting in…

Insurance policy termination notification requirement. (a) With respect to cases for which there is an assignment in effect pursuant to W.S. 42-4-204: (i) The department, upon receipt of the health coverage information, shall notify the obligor's insuring entity that the departme…

Claims against estates. (a) If an individual receives any medical assistance pursuant to this chapter, upon the individual's death, if single, or upon the death of the survivor of a married couple, either of whom received medical assistance, the total amount paid for medical assi…

Recovery of incorrect payments; recovery of correct payments; liens. (a) The department may through appropriate action recover any incorrect payment of medical assistance under this chapter on behalf of a recipient and may adjust any subsequent payment by an amount equal to the i…

Recovery for cost of health care. (a) The department, to the extent necessary to reimburse its costs, shall be entitled to recover from any parent who: (i) Is required by court or administrative order to provide coverage of the cost of health services to a child eligible for medi…

Short title. This act shall be known and may be cited as the "Wyoming Medicaid False Claims Act."

Definitions. (a) As used in this act: (i) "Claim" means any request or demand under the Medicaid program, whether under a contract or otherwise, for money, property or services that: (A) Is presented to an officer, employee or agent of the state or a political subdivision of the …

Acts subjecting person to treble damages; costs and civil penalties; exceptions. (a) Except as provided in subsection (c) of this section, any person who commits any of the following acts in relation to the Wyoming Medicaid program shall be liable to the state for three (3) times…

Investigations and prosecutions; powers of prosecuting authority; remedies for retaliation; venue; no private right of action. (a) The Medicaid fraud control unit created by W.S. 42-4- 403 or a district attorney may investigate alleged violations of W.S. 42-4-303(a) and (c). If t…

Limitation of actions; retroactivity; burden of proof. (a) A civil action under W.S. 42-4-304(a) shall not be brought more than six (6) years after the date on which the violation was committed or more than three (3) years after the date when facts material to the right of action…

Remedies under other laws; liberality of construction; joint and several liability. (a) The provisions of this act are not exclusive, and the remedies provided for in this act shall be in addition to any other remedies provided for in any other law or available under common law. …

Short title. This act may be cited as the "Wyoming Medicaid Fraud Control Act".

Definitions. (a) As used in this act: (i) "Claim" means as defined in W.S. 42-4-302(a)(i); (ii) "Provider" means a person who furnishes services or supplies for which payment is claimed under Medicaid; (iii) "Record" means information in physical or electronic form relating to: (…

Medicaid fraud control unit created; duties. (a) The Medicaid fraud control unit is recognized and continued in existence within the office of the attorney general. The unit shall conduct a statewide program for investigating and prosecuting violations of all applicable state law…

Access to records. (a) Notwithstanding any other provision of law, the unit shall have full access to all records held by a provider or by another person or entity acting on the provider's behalf, if the unit determines that such information is material to its duties under this a…

Reporting to unit. The department of health, department of family services, health care licensing boards, state agencies and the agents, contractors and subcontractors of these entities shall refer to the unit all cases where reasonable cause likely exists that fraud, waste, abus…

Fraud and false statements; criminal penalty. (a) In relation to the delivery of or payment for services or supplies under Medicaid, a person shall not knowingly, in whole or in part: (i) Make or cause to be made a false or fraudulent claim; (ii) Deliberately conceal a material f…

Kickbacks, bribes, undisclosed payments, referral fees and illegal copayments; criminal penalty; exception. (a) A person shall not knowingly, in whole or in part: (i) Act on behalf of a provider to purchase or lease a service or supply for which payment may be made, in whole or i…

Failure to maintain records; destruction of records; penalty. (a) A person, after submitting a claim or receiving a payment for a service or supply under Medicaid, shall not knowingly fail to maintain records required under Medicaid, including records that fully disclose the natu…

Aggregation of claims in certain cases. The amount of claims relating to violations of this act through a common scheme, or based on the same transaction or occurrence, may be aggregated to determine the level of penalty under this act, whether or not the claims were made as part…

Suspension or exclusion as provider. (a) The department of health or the department of family services may suspend or exclude a provider from providing services and supplies under Medicaid if: (i) The department determines that the provider has committed an offense under this act…

Provisions of act not exclusive remedies. The provisions of this act shall not be exclusive and do not preclude the use of any other criminal or civil remedy as authorized by law.

Rules. The attorney general, in consultation with the department of health, may adopt rules to implement W.S. 42-4-401 through 42-4- 409 and 42-4-411.