048-22 Wyo. Code R. §§ 22-6 - Requests for Reconsideration and Administrative Hearings

(a) The individual for whom the determination was made, or his or her guardian or legal representative, if applicable, may request reconsideration of the Department's nursing facility level of care determination.

(i) Reconsideration requests are an opportunity for alternative dispute resolution, are not a prerequisite to request an administrative hearing, and shall not impede the individual's right to request an administrative hearing in accordance with Chapter 4.

(b) The Department shall approve only those reconsideration requests which are submitted in writing within twenty (20) business days of the notice of adverse action and in accordance with the Department's established procedures.

(c) For approved reconsideration requests, the Department or its agent shall review the level of care assessment results to determine whether its procedures, instruments, methods, and criteria were applied appropriately, and the Department shall:

(i) Require a second level of care assessment be conducted by a different level of care assessor; or

(ii) Affirm the Department's nursing facility level of care determination and provide the individual a notice of adverse action and the right to request an administrative hearing in accordance with Chapter 4.

(d) When a second level of care assessment is required, the Department shall make a reconsideration determination based solely upon the results of the second level of care assessment.

(e) In accordance with Chapter 4, the Department shall provide notice of adverse action and the right to request an administrative hearing to any individual whose Medicaid service coverage or eligibility is denied, reduced, terminated, or suspended as a result of its reconsideration determination.

Notes

048-22 Wyo. Code R. §§ 22-6

Amended, Eff. 10/5/2021.