048-34 Wyo. Code R. §§ 34-8 - CCW Provider Certification and Recertification

(a) The Department shall not pay CCW funds to any individual or entity that provides services to a participant unless the individual or entity is a party to a fully executed provider agreement and is enrolled as a Medicaid provider and certified as a CCW provider by the Department.

(b) The Department shall establish CCW provider qualifications and participation standards to assure that CCW services are delivered in a safe and effective manner. These qualifications and standards shall:

(i) Ensure providers not be excluded from participation in federally funded health care programs by the U.S. Department of Health and Human Services, Office of Inspector General;

(ii) Be appropriate to the type of each CCW service provided;

(iii) Ensure providers have the sufficient training, experience, and education necessary to reasonably assure the health and welfare of participants;

(iv) Ensure any applicable state licensure or certification requirements are met by the entities or individuals furnishing services; and

(v) Ensure the settings and manner in which CCW services are rendered support the participant's full access to the greater community and do not have the effect of isolation or segregation.

(c) The Department shall allow for the open, continuous enrollment and certification of all willing and qualified CCW service providers without restriction or limitation on the number of providers.

(d) The following procedure governs the certification of CCW providers:

(i) An individual or entity that wishes to provide CCW services shall apply to be a provider on the forms specified by the Department, and shall submit the qualifying documentation and information required by the Department to be certified as a provider. Failure to supply all information required will result in denial of the application.

(ii) The Department or its designated agent shall make a determination on a completed application within thirty (30) calendar days of the date it receives the completed application.

(iii) If the application is denied, the Department shall notify the applicant of its decision in writing in accordance with Wyoming Medicaid Rules Chapter 4.

(e) The Department shall deny certification of any individual or entity who was previously decertified by the Department due to adverse action.

(f) The provider's certification shall become effective when all requisite state and federal verifications have been completed and the Medicaid provider agreement has been fully executed. The initial certification remains in effect for one (1) year.

(g) CCW service providers may not be certified retroactively, notwithstanding the provisions of Wyoming Medicaid Rules Chapter 3 allowing for retroactive Medicaid enrollment.

(h) All providers must adhere to the conditions for Medicaid provider participation contained in Wyoming Medicaid Rules Chapter 3.

(i) The Department shall notify all providers that their CCW certification is expiring at least ninety (90) calendar days prior to the certification expiration date. The notification shall detail requirements that the provider shall meet in order to renew their certification.

(j) Providers shall submit verification that they have met all applicable certification renewal requirements forty-five (45) calendar days prior to their certification expiration date.

(i) During recertification, the Department may require an on-site inspection.

(ii) Providers that do not submit the required verification for recertification as described in this Section shall submit transition plans to the Department detailing the transition of each participant to other settings within twenty (20) calendar days prior to their certification expiration date.

(k) Providers that fail to submit the applicable certification renewal requirements to the Department will be notified in writing that the decertification process has been initiated.

(l) A provider shall be considered voluntarily decertified if the provider fails to complete the certification renewal process and fails to respond to the Department's attempts at contacting the provider for certification renewal.

(i) A provider that is voluntarily decertified may reapply for certification at any time.

(ii) Voluntary decertification is not considered an adverse action and is not subject to the fair hearing process under Wyoming Medicaid Rules Chapter 4.

(m) Falsifications of statements or documents, or any concealment of material fact may result in a denial of certification, denial of recertification, decertification, or referral for criminal prosecution.

(n) Providers may dispute an adverse action related to the denial of a renewal of certification in accordance with Wyoming Medicaid Rules Chapters 4 and 16.

Notes

048-34 Wyo. Code R. §§ 34-8

Amended, Eff. 1/3/2024.