he 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.
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
August 30, 2023
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. The SPA documents changes to the Diagnosis Related Group (DRG) payment method for hospital inpatient services, the calculation of supplemental payments for government-owned hospitals through the Qualified Rate Adjustment (QRA) program, the calculation of supplemental payments for privately-owned hospitals through the Private Hospital Supplemental (PHS) payment program, and makes a very small wording change the language describing Disproportionate Share Hospital (DSH) supplemental payments. This SPA also includes new documentation of the WY Medicaid hospital inpatient Upper Payment Limit demonstration methodology, and documents the method used for calculating Medicaid reimbursement on hospital inpatient Medicare Crossover claims in which Medicare is the primary payer. A separate public and tribal notice was posted earlier in the summer of 2023 for a new supplemental payment program also documented in State Plan Attachment 4.19- A. This new supplemental payment program is for services provided by Psychiatric Residential Treatment Facilities (PRTFs).
The SPA changes include the following:
- Diagnosis Related Group (DRG): Wyoming Medicaid intends to update the DRG payment methodology for hospital inpatient services. This includes updating from version 33 of All Patient Refined (APR) DRG to version 40, updating some payment parameters including policy adjustors, and changing the categories of hospitals receiving separate base rates.
- Qualified Rate Adjustment (QRA) and Private Hospital Supplemental (PHS) Payment Programs: Wyoming Medicaid intends to remove the description of how the hospital outpatient UPL is determined from these two sections.
- Disproportionate Share Hospitals (DSH): Wyoming Medicaid intends to make a wording substitution to Section 4.(c)(ii)(c) to replace “QRA payments” with “all hospital supplemental payments.”
- Inpatient UPL: Wyoming Medicaid intends to add a new section to State Plan Attachment 4.19-A to describe the current WY Medicaid hospital inpatient Upper Payment Limit demonstration methodology. Also, new with SFY 2024 WY Medicaid plans to shift from cost-based to Medicare pricing for determination of the UPL for hospitals that are paid by Medicare via the Medicare Inpatient Prospective Payment System (IPPS).
- Inpatient Crossover: Wyoming Medicaid intends to add a new section to State Plan Attachment 4.19-A to describe the payment method for calculation of Medicaid Allowed Amount on hospital inpatient Medicare crossover claims in which Medicare is the primary payer. This payment method is already in place and documented in State Plan Attachment 4.19-B.
Wyoming Medicaid estimates this programmatic change to be budget neutral for the Medicaid general fund, but will use approved inter-governmental transfer, assessment, and distribution methodologies to access additional federal revenue for qualifying providers and services. Pursuant to governing statute, Wyoming Medicaid may withhold up to 3% of calculated payments to cover the program’s administrative costs.
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:
Sheree L. Nall
Provider Rate & Actuary Contract Manager
Division of Healthcare Financing
122 W. 25th St., 4th Floor West
Cheyenne, WY 82002
307-777-80756
Public comment will be accepted from August 30, 2023 – September 30, 2023.
Public and Tribal Notice
Wyoming Department of Health
State Plan Amendment for Attachment 4.19-B – Other Types of Care August 30, 2023
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. The SPA documents changes to the calculation of hospital outpatient supplemental payments to government owned hospitals through the Qualified Rate Adjustment (QRA) program and the calculation of supplemental payments to privately-owned hospitals through the Private Hospital Supplemental (PHS) payment program. This SPA also adds documentation of the WY Medicaid hospital outpatient and professional services Upper Payment Limit (UPL) demonstration methodologies. A separate public and tribal notice was posted earlier in the summer of 2023 for a new supplemental payment program also documented in State Plan Attachment 4.19-B. This new supplemental payment program is for ground ambulance services.
The SPA changes include the following:
∙ Qualified Rate Adjustment (QRA) Payment: Wyoming Medicaid intends to remove the description of how the hospital outpatient UPL is determined from this section. ∙ Private Hospital Supplemental (PHS) Payment: Wyoming Medicaid intends to remove the description of how the hospital outpatient UPL is determined from this section.
∙ Hospital Outpatient Upper Payment Limit (UPL): Wyoming Medicaid intends to add language describing the hospital outpatient UPL calculation method. The calculation methodology is not new nor changing. Documentation of these calculation methods is simply being added to the State Plan under this SPA.
∙ Professional Services Supplemental Payment (PSSP) Upper Payment Limit (UPL): Wyoming Medicaid intends to add language describing the PSSP UPL calculation methodology. The calculation method is not new nor changing. Documentation of these calculation methods is simply being added to the State Plan under this SPA.
Wyoming Medicaid estimates this programmatic change to be budget neutral for both the Medicaid general fund and hospitals who contribute the non-federal share of supplemental payments through inter-governmental transfers and the private hospital health care assessment. Pursuant to governing statute, Wyoming Medicaid may withhold up to 3% of calculated payments to cover the program’s administrative costs.
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:
Sheree L. Nall
Provider Rate & Actuary Contract Manager
Division of Healthcare Financing
122 W. 25th St., 4th Floor West
Cheyenne, WY 82002
307-777-80756
Public comment will be accepted from August 30, 2023 – September 30, 2023.
Public Notices for Pending Waiver Amendments
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
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