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

Public and Tribal Notice
Wyoming Department of Health
State Plan Amendment for Attachment 4.19-A – Inpatient Hospital Reimbursement

April 29, 2025

Public 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. The amendment will make changes to Inpatient Hospital Reimbursement including the removal of provider categories receiving Diagnosis Related Group (DRG) base rates and the specific categories for which policy adjustors are applied.

The effective date will be July 1, 2025. 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 or provide comment, please contact:

Elizabeth Lovell-Poynor
Medicaid Benefits Quality Control Manager
Division of Healthcare Financing
122 W. 25th St., 4th Floor West
Cheyenne, WY 82002
307-777-8088

Public comment will be accepted from May 1, 2025 – May 31, 2025.

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
Public Notice – Posted 01/13/2025 Core Sets Reporting
Public Notice – Posted 03/13/2025 Consolidated Appropriations Act of 2023
Public Notice – Posted 03/17/2025 Four Walls Exception for Clinic Services
Public Notice – Posted 03/18/2025 Recovery Audit Contractor Exception

Section 1 - Single State Agency Organization

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

1.4 State Medical Care Advisory Committee

1.5 Pediatric Immunization Program

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.

2.1 Application, Determination of Eligibility and Furnishing Medicaid

2.2 Coverage and Conditions of Eligibility

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

Attachment 2.2-A Supplement 2
Attachment 2.2-A Supplement 3

2.6-A Eligibility Conditions and Requirements

Attachment 2.6-A Supplement 1
Attachment 2.6-A Supplement 4
Attachment 2.6-A Supplement 5
Attachment 2.6-A Supplement 6
Attachment 2.6-A Supplement 7
Attachment 2.6-A Supplement 8
Attachment 2.6-A Supplement 9
Attachment 2.6-A Supplement 10
Attachment 2.6-A Supplement 11
Attachment 2.6-A Supplement 12a
Attachment 2.6-A Supplement 13
Attachment 2.6-A Supplement 15
Attachment 2.6-A Supplement 16

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

Attachment 3.1-A Supplement 1
Attachment 3.1-A Supplement 3

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

3.1-F Primary Care Medical Homes

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.

4.1 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 Drug Utilization Review

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

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

Attachments

4.17-A Liens and Adjustments or Recoveries

4.19-A Level of Care Inpatient Hospital Reimbursement

4.19-B Outpatient Hospital Reimbursement System

Attachment 4.19-B Supplement 1

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

Attachment 4.22-A Supplement 1

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 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

4.47 21st Century Cures Act

Section 5 - Personnel Administration

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

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