Administrative Rule Review Report #AR11-043
Legislative Service Office
29-Aug-11
AGENCY: Department of Health
DATE SUBMITTED: 8/22/2011
SUBJECT: Chapter 1, Definitions; Chapter 4, Administrative Hearings; Chapter 16, Program Integrity; Chapter 39, Recovery of Excess Payments (Repeal); Chapter 38, Safeguarding Information on Applicants and Recipients (Repeal).
NATURE OF RULES: Legislative and procedural.
STATUTORY AUTHORITY: W.S. 42-4-104(a)(iv).
DETERMINATION OF PROCEDURAL COMPLIANCE BASED UPON INFORMATION SUBMITTED BY THE AGENCY TO LSO: Apparently complete to date.
SUMMARY OF RULES: The Department of Health is amending its Medicaid rules. The Department’s Statement of Reasons provides a complete and accurate summary of the changes to existing licensing rules. The changes are primarily non-substantive reorganization of the rules and to comply with federal law. Changes include:
· Creation of a new Chapter 1 for definitions applicable to all chapters;
· Moving revised procedures for contested hearings from Chapter 1 to a new Chapter 4;
· Merger of Chapter 39-Recovery of Excess Payments into Chapter 16-Medicaid Program Integrity, including provisions for: investigation of suspected fraud by providers; required record keeping; sanctions for providers and clients; overpayments recovery; suspension or termination of providers; disposition of recovered funds.
· Miscellaneous revisions regarding additional provider screenings, termination of providers, enhanced program integrity, additional federal reporting and enhanced civil penalty provisions – all to comply with requirements of the federal Affordable Care Act;
FINDINGS: The rules appear to be within the scope of statutory authority and legislative intent.
STAFF RECOMMENDATION: That the rules be placed on the Consent List and be approved by the Council as submitted by the Agency.
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Gerald W. Laska
Staff Attorney
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David K. Gruver
Assistant Director
GWL