Wyoming Administrative Code
Agency 048 - Health, Department of
Sub-Agency 0037 - Medicaid
Chapter 2 - STATE LICENSED SHELTER CARE ELIGIBILITY AND SERVICES
Section 2-27 - Reconsideration
Current through September 21, 2024
(a) Request for reconsideration. A provider may request reconsideration of the matters specified in subsection (d). Such a request must be mailed to WDH, by certified mail, return receipt requested, within twenty (20) days after the date the provider receives notice of the action. The request must state with specificity the reasons for the request. Failure to provide such a statement shall result in the dismissal of the request with prejudice.
(b) Reconsideration. WDH shall review the matter and send written notice by certified mail, return receipt requested, to the provider of its final decision within forty-five (45) days after receipt of the request for reconsideration or the receipt of any additional information requested pursuant to (c), whichever is later.
(c) Request for additional information. WDH may request additional information from the provider as part of the reconsideration process. Such a request shall be made in writing by certified mail, return receipt requested. The provider must provide the requested information within the time specified in the request. Failure to provide the requested information shall result in the dismissal of the request with prejudice.
(d) Matters subject to reconsideration. A provider may request reconsideration of a decision to recover excess payments, except that the recovery of excess payments based on a change in the provider's per diem rate pursuant to Chapter VII shall not be subject to reconsideration or an administrative hearing. The provider's right to request reconsideration pursuant to Chapter VII shall be the provider's sole remedy.
(e) Reconsideration shall be limited to whether WDH has complied with the provisions of this Chapter.
(f) Informal resolution. The provider or the Department may request an informal meeting before the final decision on reconsideration to determine whether the matter may be resolved. The substance of the discussions and/or settlement offers made pursuant to an attempt at informal resolution shall not be admissible as part of a subsequent administrative hearing or judicial proceeding.
(g) Administrative hearing. A provider may request an administrative hearing regarding the final agency decision pursuant to Chapter I of these rules by mailing by certified mail, return receipt requested or personally delivering a request for hearing to WDH within twenty (20) days after the date the provider receives notice of the final agency decision. At the hearing, the burden shall be on the provider to show that the agency's final decision does not comply with this Chapter.
(h) Failure to request reconsideration. A provider which fails to request reconsideration pursuant to this Section may not subsequently request an administrative hearing pursuant to Chapter I.
(i) Matters not subject to reconsideration.
