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