§ 42-4-104 — Powers and duties of department of health; state Medicaid agent appointed by governor

Wyoming § 42-4-104

• Jurisdiction: Wyoming
• Title 42: Welfare
• Ch. 4: MEDICAL ASSISTANCE AND SERVICES
• Art. 1: IN GENERAL

Text

(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 providing for the effective administration of this
chapter;
(iii) Maintain records on the administration of this
chapter, report to the federal government as required by federal
law and regulation and within limitations imposed under W.S.
42-4-112, may provide for the availability of information on the
administration of this chapter to interested persons;
(iv) Adopt, amend and rescind rules and regulations
on the administration of this chapter following notice and
public hearing in accordance with the Wyoming Administrative
Procedure Act.
(b) In carrying out subsection (a) of this section, the
department may:
(i) Advise, consult and cooperate with any state
agency or political subdivision, any other state, the federal
government, private industry and other interested persons;
(ii) Negotiate and enter into contract with other
public and private agencies and persons as necessary to
administer this chapter;
(iii) Directly or by contract and through one (1) or
more fiscal intermediaries, provide payments to providers of
services and supplies for medical assistance authorized by this
chapter in the manner and amount provided by this chapter;
(iv) Receive funds from any source for purposes of
carrying out this chapter;
(v) Establish reasonable limits on services and
supplies authorized under W.S. 42-4-103;
(vi) Conduct pilot projects pursuant to W.S.
42-4-107(c);
(vii) Provide for part or all of the services and
supplies authorized under W.S. 42-4-103 for some or all
categorically eligible individuals through health care insurance
or through contracts with networks of health care providers;
(viii) Purchase stop gap insurance;
(ix) Enter into intergovernmental transfer
arrangements with qualifying facilities and providers, including
but not limited to hospitals, nursing homes, hospital owned and
operated professional service providers and ground ambulance
service providers, in which all federal funding received as a
result of the intergovernmental transfer arrangements shall be
distributed to participating facilities and providers in
accordance with the terms of an approved state plan amendment or
other agreement with the centers for Medicare and Medicaid
services. Notwithstanding, if consistent with the state plan
amendment or agreement, the department may use funds derived
from such intergovernmental transfers to pay administrative
expenses incurred by the department or its agent in performing
the activities authorized under this subsection, provided that
these expenses shall not exceed a total of three percent (3%) of
the aggregate intergovernmental transfer funds collected in the
fiscal year;
(x) Provide for the withholding of medical assistance
payments from nursing care facilities in accordance with W.S.
42-8-107(b)(i).
(c) Subject to limitations imposed under this subsection,
the department shall, at least once every five (5) years but not
more than once in any three (3) year period, establish a new
base period to be used in calculating all skilled nursing homes'
medical assistance per diem base rate reimbursable under this
chapter, using the most recent cost report information provided
to the department. For purposes of medical assistance
reimbursable under this chapter, the department shall reimburse
each eligible provider of skilled nursing home services the
greater of the following amounts:
(i) Medical assistance computed on the per diem base
rate under the new base period established pursuant to this
subsection; or
(ii) For the state fiscal year beginning July 1, 2003
and ending June 30, 2004, medical assistance computed on the per
diem base rate existing prior to the establishment of the new
base period under this subsection.
(d) The department shall establish by rule the conditions
and requirements for skilled nursing home extraordinary care.
The requirements shall include, but are not limited to the
following:
(i) The care shall be previously authorized by the
department for each individual and subject to continual audit by
the department;
(ii) The cost for the care shall clearly exceed the
standard skilled nursing home per diem rate;
(iii) The cost shall be excluded from the nursing
home's cost report to the department; and
(iv) No extraordinary care payment shall be made for
equipment owned by the nursing home in providing the care.
(e) The chief administrator of the Medicaid program
created pursuant to this chapter shall be the state Medicaid
agent within the department of health, who shall be appointed by
the governor, shall serve at the pleasure of the governor and
may be removed by the governor as provided by W.S. 9-1-202. The
state Medicaid agent shall oversee and coordinate all programs
which provide Medicaid services or determine Medicaid
eligibility pursuant to W.S. 42-4-106 and chapter 2 of this
title.