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
Public Notice and Tribal Notice
Wyoming Department of Health
Child and Adult Core Sets Quality Measure Reporting
January 13, 2025
Public and Tribal notice is hereby given that the Wyoming Department of Health intends to submit a State Plan Amendment (SPA) to the United States Department of Health and Human Services Centers for Medicare and Medicaid Services (CMS).
The Child and Adult Quality Measure Core Sets reporting SPA will formalize Wyoming Medicaid’s compliance with the mandatory reporting requirements for the Core Set of Children’s Health Care Quality Measures and the Core Set of Adult Health Care Quality Measures. As required by 42 CFR part 437, Wyoming Medicaid will report data annually on the measures specified by CMS to assess the quality of care provided to Medicaid and CHIP beneficiaries. The Wyoming Department of Health does not anticipate that this SPA will have any direct impact on any member or provider. Wyoming Department of Health also does not anticipate any direct impact on Tribes within the state, as it pertains solely to mandatory federal reporting requirements and does not alter eligibility, benefits, or provider reimbursement.
Copies of the Wyoming Medicaid State Plan will be available at the Department of Health, Division of Healthcare Financing. To obtain a copy of the State Plan Amendment, contact:
Jesse Springer,
Division of Healthcare Financing, Medicaid
122 West 25th Street, 4 West
Cheyenne, WY 82002
307-777-8048
jesse.springer@wyo.gov
Public Notice Archives
- Public Notice – posted 1/30/20 CCW Waiver Amendment
- Public Notice – posted 02/18/20 Reasonable Limits on Amounts for Necessary Medical or Remedial Care Not Covered
- Public Notice – posted 06/24/20 Hospital Affiliated Professional Services Supplemental Payment Program
- Public Notice – posted 09/01/20 Streamlined Application Changes
- Public Notice – posted 10/5/20 Proposed Medicaid Managed Care State Quality Review Strategy
- Public Notice – posted 11/18/20 MEBS Update Support Act 1012
- Public Notice – posted 12/09/20 Durable Medical Equipment
- Public Notice – posted 12/09/20 Indian Health Facilities
- Public Notice – posted 12/15/20 Rehabilitative Services
- Public Notice – posted 01/05/21 Dental Service Providers
- Public Notice – posted 01/25/21 Physician Service Providers
- Public Notice – posted 2/26/21 Drug Coverage
- Public Notice – posted 2/26/21 Medication Assisted Treatment
- Public Notice – posted 3/12/21 Covered Services
- Public Notice – posted 4-26-21 40 Quarters Requirement Change
- Public Notice – Posted 4/20/21 Removal of PACE
- Public Notice -Posted 9/29/21 Deprivation Removal
- Public Notice – Posted 1/21/22 School Based Services
- Public Notice – Posted 1/26/22 COVID-19 Vaccine DR SPA
- Public Notice – Posted 3/03/22 Clinical Trials
- Public Notice – Posted 01/10/2023 Home and Community Based Services for Psychosocial Rehabilitative Services
- Public Notice – Posted 03/10/2023 Streamlined Application Changes – Third Party Liability
- Public Notice – Posted 03/14/2023 Podiatry Services
- Public Notice – Posted 04/12/2023 Federally Qualified Health Centers and Rural Health Clinics
- Public Notice – Posted 04/24/2023 Prescription Signature Requirements During the COVID-19 PHE
- Public Notice – Posted 05/02/2023 Durable Medical Equipment and Supplies
- Public Notice – Posted 05/02/2023 Hospice Services
- Public Notice – Posted 05/10/2023 Streamlined Application Changes – 12 Month Postpartum Coverage
- Public Notice – Posted 05/22/2023 Ground Ambulance Supplemental Payment Program
- Public Notice – Posted 07/07/2023 Psychiatric Residential Treatment Facility Supplemental Payment Program
- Public Notice – Posted 09/28/2023 Outpatient Drug Coverage
- Public Notice – Posted 08/30/2023 Inpatient Hospital Reimbursement
- Public Notice – Posted 08/30/2023 Other Types of Care Attachment 4.19-B
- Public Notice – Posted 11/30/2023 Preventative Services
- Public Notice – Posted 3/19/2024 Psychosocial Rehabilitation – Clubhouse
- Public Notice – Posted 6/25/2024 Beneficiary Cost Sharing for Pharmacy Claims – Limited Dates
- Public Notice – Posted 7/31/2024 Third Party Liability Changes
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.
1.2 Organization for Administration
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
Section 2 - Coverage and Eligibility
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.
2.2-A Attachment 2.2A Groups Covered and Agencies Responsible for Eligibility
Section 3 - Services: General Provisions
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-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-F Primary Care Medical Homes
3.1-E Standards for the Coverage of Organ Transplant Procedures
Section 4 - General Program Administration
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.
4.2 Hearings for Applicants and Recipients
4.3 Safeguarding Information on Applicants and Recipients
4.5 Medicaid Agency Fraud Detection and Investigation Program
4.6 Reports
4.8 Availability of Agency Program Manuals
4.9 Reporting Provider Payments to the Internal Revenue Service
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
4.16 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
4.23 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
4.36 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-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
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
7.3 Maintenance of AFDC Effort
Attachments
Section 8 - MAGI
Page Updated 1/13/25