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Wyoming Medicaid State Plan

The State Plan is a contract between a State and the Federal government, enabling the delivery of health care.  It ensures that a State abides by Federal rules and gets FFP.  The State Plan sets out groups to be covered, services provided and limitations, reimbursement methodologies, and administrative requirements.

 

To view the process on getting a State Plan Amendment approved click on the flow chart link. 

Region 8 Medicaid SPA Process Flow Chart


Public Notices for Pending State Plan Amendments

SPA 13-007 - Care Management Entity

SPA 14-010 - Primary Care Case Management

Medicaid Co-Pay Changes

 

Proposed State Plan Amendments

SPA 13-007 Care Management Entity - Attachment 3.1-I

 


Table of Contents | Index | Section 1Section 2Section 3Section 4Section 5Section 6Section 7 |

 

Section 1 - Single State Agency Organization

This section provides information regarding the State’s designation of the Wyoming Medicaid Single State Agency, the authority under which it operates and a description of the organization, statewide operation and the State Medical Care Advisory Committee.

1.1   Designation and Authority

1.2   Organization for Administration

1.3   Statewide Operations

1.4   State Medical Care Advisory Committee

Attachments

1.1-A   Attorney General’s Certification

1.2-A   Organization and Function of State Agency

1.2-B   Organization and Function of Medical Assistance Unit

1.2-C   Professional Medical and Supporting Staff

1.2-D   Description of Staff Making Eligibility Determination

 

Section 2 - Coverage and Eligibility

This section outlines coverage and eligibility conditions for Wyoming Medicaid such as the categories of eligible persons and the levels of income, resources and assets required to assess financial eligibility for the various programs and groups.

2.1   Application Determination of Eligibility and Furnishing Medicaid

2.2   Coverage and Conditions of Eligibility

2.3   Residence

2.4   Blindness

2.5   Disability

2.6   Financial Eligibility

2.7   Medicaid Furnished Out of State

Attachments

2.2-A   Groups Covered and Agencies Responsible for Eligibility

2.6-A   Eligibility Conditions and Requirements (States Only)

Section 3 - Services:  General Provisions  

This section provides information on amount, duration and scope of Wyoming Medicaid services including coordination with Medicare Part B, services for elderly or those in institutions for mental disease, special requirements for sterilization procedures, Medicaid for Medicare cost sharing for qualified Medicare beneficiaries, and ambulatory prenatal care for pregnant women during the presumptive eligibility period.

3.1   Amount, Duration and Scope of Services

3.2   Coordination of Medicaid with Medicare Part B

3.3   Medicaid for Individual Age 65 or Over in Institutions for Mental Disease

3.4   Special Requirement Applicable to Sterilization Procedure

3.5   Medicaid for Medicare Cost Sharing for Qualified Medicare Beneficiaries

3.6   Ambulatory Prenatal Care for Pregnant Women

Attachments

3.1-A   Amount, Duration, and scope of Medical and Remedial Care and Services Provided to the Categorically Needy

3.1-B   Amount, Duration, and Scope of Services Provided Medically Needy Groups  

3.1-C   Standards and Methods of Assuring High Quality Care        

3.1-D   Methods of Providing Transportation         

3.1-E   Standards for the Coverage of Organ Transplant Procedures

 

Section 4 - General Program Administration 

This section provides information on general program administration, quality and utilization control and provider reimbursement. It also includes sections on hearing for applicants and recipients, fraud detection, facility surveys and inspections and the appeals process.

4.1   Methods of Administration

4.2   Hearings for Applicants and Recipients

4.3   Safeguarding Information on Applicants and Recipients

4.4   Medicaid Quality Control

4.5   Medicaid Agency Fraud Detection and Investigation Program

4.6   Reports

4.7   Maintenance of Records

4.8   Availability of Agency Program Manuals

4.9   Reporting Provider Payments to the Internal Revenue Service

4.10   Free Choice of Providers

4.11   Relations with Standard-Setting and Survey Agencies

4.12   Consultation to Medical Facilities

4.13   Required Provider Agreement

4.14   Utilization/Quality Control

4.15   Inspection of Care in Skilled Nursing and Intermediate Care Facilities and Institutions for Mental Diseases

4.16   Relations with State Health and Vocational Rehabilitation Agencies and Title V Grantees

4.17   Liens and Recoveries

4.18   Cost Sharing and Similar Charges

4.19   Payment for Services

4.20   Direct Payments to Certain Recipients for Physicians' or Dentists' Services

4.21   Prohibition Against Reassignment of Provider Claims

4.22   Third Party Liability

4.23   Use of Contracts

4.24   Standards for Payments for Skilled Nursing and Intermediate Care Facility Services

4.25   Program for Licensing Administrators of Nursing Homes

4.26   RESERVED

4.27   Disclosure of Survey Information and Provider or Contractor Evaluation

4.28   Appeals Process for Skilled Nursing and Intermediate Care Facilities

4.29   Conflict of Interest Provisions

4.30   Exclusion of Providers and Suspension of Practitioners Convicted and Other Individuals

4.31   Disclosure of Information by Providers and Fiscal Agents

4.32   Income and Eligibility Verification System

4.33   Medicaid Eligibility Cards for Homeless Individuals

4.34   Systematic Alien Verification for Entitlements

4.35   Remedies for Skilled Nursing and Intermediate Care Facilities that Do Not Meet Requirements of Participation

4.36   Required Coordination Between the Medicaid and WIC Programs

4.38   Nurse Aide Training and Competency Evaluation for Nursing Facilities

4.39   Preadmission Screening and Annual Resident Review in Nursing Facilities

4.40   Survey and Certification Process

4.41   Resident Assessment for Nursing Facilities

4.42   Employee Education About False Claims Recoveries

4.43   Cooperation with Medicaid Integrity Program Efforts

4.44   Medicaid Prohibition on Payments to Institutions or Entities Located Outside of the United States

4.46   Provider Screening and Enrollment

Attachments

4.11-A   Standards for Institutions

4.16-A   Maternal and Child Health and Health Care Financing Interagency Agreement

4.17-A   Liens and Adjustments or Recoveries

4.18-A   Charges Imposed on Categorically Needy

4.18-B   Medically Needy Premium

4.18-C   Charges Imposed on Medically Needy and other Optional Groups

4.18-D   Premiums Imposed on Low Income Pregnant Women and Infants

4.18-E   Premiums Imposed on Qualified Disabled and Working Individuals

4.18-H   Emergency Room Co-pay for Non-Emergency Care 

4.19-A   Level of Care Inpatient Hospital Reimbursement

4.19-B   Outpatient Hospital Reimbursement System

4.19-C   Payments for Reserved Beds

4.19-D   Nursing Home Reimbursement System

4.19-E   Timely Claims Payment - Definition of Claim

4.22-A   Requirements for Third Party Liability - Identifying Liable Resources

4.22-B   Requirements for Third Party Liability - Payment for Claims

4.22-C   Cost Effective Methods for Employer Based Group Health Insurance

4.30      Sanctions for Psychiatric Hospitals 

4.32-A   Income and Eligibility Verification System Procedures

4.33-A   Method for Issuance of Medicaid Eligibility Cards to Homeless Individuals

4.34-A   Requirements for Advance Directives Under State Plans for Medical Assistance

4.35      Enforcement of Compliance for Nursing Facilities

4.38-A   Collection of Additional Registry Information

4.39-A   Definition of Specialized Services

4.40      Survey and Certification Education Program

4.42-A   Methodology of Compliance Oversight of the False Claim Act

4.43      Cooperation with Medicaid Integrity Program Efforts

4.46      Provider Screen and Enrollment 

 

Section 5 - Personnel Administration

This section details the standards for personnel administration in the Medicaid program and provides assurances the State is in compliance with Federal Regulations regarding personnel administration standards and training.

5.1   Standard of Personnel Administration

5.2   RESERVED

5.3   Training Programs; Sub-professional and Volunteer Programs

Attachments

None

 

Section 6 - Financial Administration

This section provides assurances the State is in compliance with Federal Regulations regarding fiscal policies and accountability, cost allocation and financial participation.

6.1   Fiscal Policies and Accountability

6.2   Cost Allocation

6.3   State Financial Participation

Attachments

None

 

Section 7 - General Provisions

This section covers additional federal requirements such as State Plan amendments, nondiscrimination and the Governor’s review.

7.1   Plan Amendments

7.2   Nondiscrimination

7.3   Maintenance of AFDC Effort

7.4   State Governor's Review

 Attachments

 7.2-A   Methods of Administration – Civil Rights (Title VI)