Title 42, Title 42 — Welfare
12 chapters · 135 sections in this title.
W.S. § 42-4-201 Action against third party; notice; subrogation
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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…
W.S. § 42-4-202 Third party liability; authority; enforcement; notice; costs
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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…
W.S. § 42-4-203 Settlement between recipient and tortfeasor or insurer; lien not discharged; exceptions
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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…
W.S. § 42-4-204 Department subrogated to right of recovery of applicant or recipient; utilization of personal health insurance; insurance coverage of recipients
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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…
W.S. § 42-4-205 Insurance policy termination notification requirement
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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…
W.S. § 42-4-206 Claims against estates
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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…
W.S. § 42-4-207 Recovery of incorrect payments; recovery of correct payments; liens
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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…
W.S. § 42-4-208 Recovery for cost of health care
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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…
W.S. § 42-4-301 Short title
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Short title. This act shall be known and may be cited as the "Wyoming Medicaid False Claims Act."
W.S. § 42-4-302 Definitions
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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 …
W.S. § 42-4-303 Acts subjecting person to treble damages; costs and civil penalties; exceptions
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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…
W.S. § 42-4-304 Investigations and prosecutions; powers of prosecuting authority; remedies for retaliation; venue; no private right of action
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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…
W.S. § 42-4-305 Limitation of actions; retroactivity; burden of proof
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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…
W.S. § 42-4-306 Remedies under other laws; liberality of construction; joint and several liability
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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. …
W.S. § 42-4-401 Short title
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Short title. This act may be cited as the "Wyoming Medicaid Fraud Control Act".
W.S. § 42-4-402 Definitions
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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: (…
W.S. § 42-4-403 Medicaid fraud control unit created; duties
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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…
W.S. § 42-4-404 Access to records
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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…
W.S. § 42-4-405 Reporting to unit
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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…
W.S. § 42-4-406 Fraud and false statements; criminal penalty
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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…
W.S. § 42-4-407 Kickbacks, bribes, undisclosed payments, referral fees and illegal copayments; criminal penalty; exception
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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…
W.S. § 42-4-408 Failure to maintain records; destruction of records; penalty
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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…
W.S. § 42-4-409 Aggregation of claims in certain cases
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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…
W.S. § 42-4-410 Suspension or exclusion as provider
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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…
W.S. § 42-4-411 Provisions of act not exclusive remedies
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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.
W.S. § 42-4-412 Rules
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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.
W.S. § 42-5-101 Provision of information and services; refusal to accept
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Provision of information and services; refusal to accept. (a) The department of health may provide and pay for family planning and birth control information and services including interviews with trained personnel, distribution of literature, referral to a licensed physician for …
W.S. § 42-5-102 Statutory interpretation
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Statutory interpretation. (a) Nothing in W.S. 42-5-101 shall be interpreted to: (i) Interfere with a person's religious beliefs; (ii) In any way abridge the right to accept or refuse family planning and birth control services; (iii) Impose practices offensive to a person's moral …
W.S. § 42-6-101 Short title
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Short title. This act shall be known and may be cited as the "Wyoming Long Term Care Choices Act".
W.S. § 42-6-102 Definitions
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Definitions. (a) As used in this act: (i) "Adult foster care" means care in a home licensed as an adult foster home and care provided to a resident of the home while temporarily away from the adult foster home; (ii) "Adult foster care home" means any family home or facility in wh…
W.S. § 42-6-103 Rulemaking; guidance
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Rulemaking; guidance. The department is authorized to promulgate rules and regulations to implement this act. The rules and regulations shall seek to implement the objectives of this act by expanding the long term care system to one emphasizing consumer choice and home, home like…
W.S. § 42-6-104 Alternative long term care home pilot programs authorized
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Alternative long term care home pilot programs authorized. (a) Three (3) pilot program grants are authorized to study the feasibility of innovation in long term care facilities. Eligible recipients shall include cities, counties and any entity planning for long term care needs or…
W.S. § 42-6-105 Adult foster care homes; licensure; suspension or revocation
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Adult foster care homes; licensure; suspension or revocation. (a) The department may initiate and license an adult foster care pilot project subject to the following: (i) The applicant shall pay a one-time fee of one hundred dollars ($100.00) which shall be deposited in the gener…
W.S. § 42-6-106 Home and community based waiver program expanded; requirements
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Home and community based waiver program expanded; requirements. (a) Repealed By Laws 2013, Ch. 117, § 2. (b) The department is authorized to increase the provider reimbursement levels by an amount up to three dollars ($3.00) per hour for hourly services or seventeen and six-tenth…
W.S. § 42-6-107 Assisted living expansion; reimbursement increase
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Assisted living expansion; reimbursement increase. The department shall seek federal approval to increase the number of allowed slots in the assisted living Medicaid waiver from one hundred forty-six (146) to one hundred sixty-eight (168) slots.
W.S. § 42-6-108 Adult day care
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Adult day care. The department shall investigate adult day care providers in Wyoming with respect to access, rates, administration of rules and regulations and their impact on providers and clients, and shall report its findings to the joint labor, health and social services inte…
W.S. § 42-6-109 Aging and disability resource centers
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Aging and disability resource centers. (a) The department is authorized, using competitive grants and contracts, to fund a statewide network of aging and disability resource centers. (b) Locations of the aging and disability resource centers shall be determined by the department …
W.S. § 42-7-101 Short title
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Short title. This act may be cited as the "Wyoming Long-Term Care Partnership Program Act.
W.S. § 42-7-102 Definitions
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Definitions. (a) As used in this act: (i) "Agency" means the department of health; (ii) "Asset disregard" means, with respect to qualification for state Medicaid benefits, the disregard of any assets or resources in an amount equal to the insurance benefit payments that are made …
W.S. § 42-7-103 Wyoming long-term care partnership program established
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Wyoming long-term care partnership program established. (a) In accordance with title VI, section 6021 of the federal Deficit Reduction Act of 2005, there shall be established the Wyoming long-term care partnership program, to be administered by the agency with the assistance of t…
W.S. § 42-7-104 Administration
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Administration. (a) The agency and the department are authorized to adopt rules to implement and administer the provisions of this act. (b) The agency and department shall comply with all federal rules developed in accordance with title VI, section 6021 of the federal Deficit Red…
W.S. § 42-8-101 Short title
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Short title. This article shall be known and may be cited as the "Wyoming Nursing Care Facility Assessment Act."
W.S. § 42-8-102 Definitions
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Definitions. (a) As used in this article: (i) "Account" means the nursing care facility assessment account created under W.S. 42-8-103; (ii) "Department" means the department of health; (iii) "Fiscal year" means the twelve (12) month period beginning October 1 and ending Septembe…
W.S. § 42-8-103 Nursing care facility assessment account
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Nursing care facility assessment account. (a) The nursing care facility assessment account is created. (b) The state treasurer shall invest amounts deposited within the account in accordance with law, and all investment earnings shall be credited back to the account. (c) The acco…
W.S. § 42-8-104 Assessments
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Assessments. (a) Each nursing care facility shall pay the nursing care facility assessment to the account in accordance with this article. (b) The aggregated amount of assessments for all nursing facilities during a fiscal year shall be the lesser of the amount necessary to fund …
W.S. § 42-8-105 Approval of state plan
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Approval of state plan. (a) The department shall seek necessary federal approval in the form of state plan amendments in order to implement the provisions of this article. (b) The department shall adopt rules and regulations necessary to implement the provisions of this article o…
W.S. § 42-8-106 Multiple facilities
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Multiple facilities. If a person conducts, operates or maintains more than one (1) nursing care facility licensed by the department, the person shall pay the assessment for each nursing care facility separately.
W.S. § 42-8-107 Penalties for failure to pay assessment
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Penalties for failure to pay assessment. (a) If a nursing care facility fails to pay an assessment when due under this article, 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 unde…
W.S. § 42-8-108 Quarterly adjustment payments
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Quarterly adjustment payments. (a) Each nursing facility is eligible for quarterly adjustments as provided in this section. (b) The department shall determine the number of days that nursing care facility services were paid for by the Wyoming medical assistance program for the ap…
W.S. § 42-8-109 Discontinuation of the assessment and quarterly adjustment payments
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Discontinuation of the assessment and quarterly adjustment payments. (a) The assessment imposed by this article shall be discontinued if: (i) The state plan amendment reflecting the quarterly nursing care facility adjustment payments under W.S. 42-8-108 is not approved by the fed…