Wyoming Administrative Code
Agency 048 - Health, Department of
Sub-Agency 0014 - Collection of Charges
Chapter 1 - COLLECTION OF CHARGES - HEALTH CARE INSTITUTIONS
Section 1-7 - Determining Established Charges
Universal Citation: WY Code of Rules 1-7
Current through December 21, 2024
(a) The legally responsible party shall complete the following procedures in determining the established charge:
(i) Complete a financial
questionnaire, identifying all income and assets, and any assets disposed of by
the legally responsible person in the past three (3) years or in accordance
with Wyoming Medicaid Procedure. The Questionnaire shall be:
(A) Signed by the legally responsible person
or his/her legal guardian or conservator under oath and subject to penalty of
false swearing as set forth in
W.S.
6-5-303;
(B) Submitted within forty-five (45) days of
the resident's admission. If the financial questionnaire is not submitted
within forty-five (45) days, the agency shall set the established charge as the
actual cost until financial information becomes available.
(ii) Provide any documents required by the
institution for verifying any information stated on the financial questionnaire
on an annual basis;
(iii) Update
the financial questionnaire on an annual basis;
(iv) Notify the institution of any change in
circumstances which affect a legally responsible persons income and assets. The
notice shall be submitted to the institution within sixty (60) days of the
changed financial status. If a legally responsible person fails to notify the
institution within sixty (60) days, the agency may set the established charge
as the actual cost;
(v) The legally
responsible person may be exempt from the requirements if the legally
responsible person pays the actual costs for services and treatment set by the
agency throughout the resident's admission to a state institution;
(vi) If payment becomes overdue or the
legally responsible person's financial status changes, the legally responsible
person shall comply with the financial disclosure requirement;
(b) The institution shall complete the following procedures in determining the established charge:
(i) Review the information stated in the
financial questionnaire;
(ii)
Verify any stated information by requesting copies of documents as necessary
which shall be incorporated into the residents record;
(iii) Allow any applicable deductions for
payments actually made by the legally responsible person including but not
limited to:
(A) Federal and state withholding
taxes;
(B) Social security taxes
and/or other required retirement deductions;
(C) Union or employee association
dues;
(D) Court ordered alimony and
child support payments.
(iv) Allow minimum living allowances for:
(A) The resident's personal support per the
schedule established by the state institution;
(B) The resident's spouse, parent and other
legal dependent's supported in the home per the schedule established by the
state institution.
(v)
Allow any applicable exemptions based upon the resident's needs and the
institution's services. Exemptions may not exceed five times the Medicaid
resource limit.
(vi) Determine the
legally responsible person's ability to pay charges based on available income,
assets, deductions and exemptions;
(vii) Obtain an assignment of benefits from
the legally responsible person who has the insurance coverage;
(viii) Established charges shall be actual
costs in the following situations:
(A) If a
legally responsible person submits claims directly to the third party payor in
lieu of assigning benefits to the institution; or
(B) If the party payor is obligated by law or
contract to pay full actual costs for services provided to a resident admitted
to an institution;
(C) If the
legally responsible person fails to submit a financial questionnaire.
(ix) Revise the established charge
upon the annual promulgation of actual costs or if a change occurs in the
resident's financial status;
(x)
Review the established charge and ability to pay on an annual basis;
(xi) Refer any payor's protest of the
established charge to the agency in accordance with W.S. W.S.
W.S.
25-11-103(b);
(xii) Submit established charges to the
administrator or his designee for approval.
Disclaimer: These regulations may not be the most recent version. Wyoming may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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