Title 42 — Title 42 — Welfare

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 allinclusive care for the elderly (PACE) in accordance with section 4802 of the Balanced Budget Act of 1997, P.L. 105…

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…

notice; costs. Third party liability; authority; enforcement; (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…

requirement. Insurance policy termination notification (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."

(a) Definitions. 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. 42-4403 or a district attorney may investigate alleged violations of W.S. 42-4-303(a) and (c). If the…

proof. Limitation of actions; retroactivity; burden of (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: (…

"This act" means W.S. 42-4-401 through 42-4-412. 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 p…

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 (ii) Deliberately conceal a material fact; cl…

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 42-4409 and 42-4-411.

to accept. Provision of information and services; refusal (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 …

Statutory interpretation. (a) Nothing in (i) W.S. 42-5-101 shall be interpreted to: 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) standards; or Impose practices offensive to a p…

Short title. This act shall be known and may be cited as the "Wyoming Long Term Care Choices Act".

(a) Definitions. 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…

"This act" means W.S. 42-6-101 through 42-6-109. 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 on…

authorized. Alternative long term care home pilot programs (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…

or revocation. Adult foster care homes; licensure; suspension (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…

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…

increase. Assisted living expansion; reimbursement 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.

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…

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 …

Short title. This act may be cited as the "Wyoming Long-Term Care Partnership Program Act.

(a) Definitions. 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 …

established. Wyoming long-term care partnership program (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…

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…

Short title. This article shall be known and may be cited as the "Wyoming Nursing Care Facility Assessment Act."

(a) Definitions. 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…

(a) created. Nursing care facility assessment account. The nursing care facility assessment account is (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…

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 …

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…