048-45 Wyo. Code R. §§ 45-27 - Initial Provider Certification

(a) An individual or entity may apply to become a provider by completing the Division's initial provider certification process and all required trainings. The applicant shall supply evidence that the applicant meets the qualifications for each service in which the applicant is seeking waiver certification.

(b) The Division shall only certify one provider per physical location.

(c) The Division shall not certify any person or entity as a waiver provider if:

(i) The person or entity has an open or pending corrective action plan with the Division;

(ii) The person or entity has an open case with the Medicaid Fraud Control Unit; or

(iii) The person has not successfully passed a background screening as provided in Section 14 of this Chapter.

(d) The Division may refuse to certify an entity that has an officer, administrator, or board member who was previously sanctioned by the Division. This refusal shall apply for a period of two (2) years from the date the person was sanctioned. The Division may also refuse to certify such person related to his or her involvement in any open or pending corrective action plan, or Medicaid Fraud Control Unit case until after the two (2) year period.

(e) A person who has been convicted of Medicaid fraud shall not be certified.

(f) The Division shall refuse to certify or shall subsequently decertify a provider applicant who fails to disclose any convictions in a court of law on the Division's provider application or organization's application.

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

(h) The Division shall initially certify a new provider or provider agency providing any service for one (1) year. The provider must complete a provider certification renewal at the end of the first year to continue providing services

(i) A person or entity may dispute an adverse action related to provider initial certification by a request for an administrative hearing, which will be administered pursuant to Chapter 4 of the Department of Health's Medicaid Rules.

Notes

048-45 Wyo. Code R. §§ 45-27

Amended, Eff. 6/21/2017. Amended, Eff. 7/26/2018. Amended, Eff. 12/20/2019.