Wyo. Code R. 048-0026-24
Effective Date: 11/12/1996 to Current
Rule Type: Current Rules & Regulations
Reference Number: 048.0026.24.11121996
Section 1. Purpose. These rules are implemented to amplify procedures for regulations of health care cooperative arrangements permitted under W.S. § 35-24-101 through W.S. § 35-24-116.
These rules are implemented to further Wyoming's policy of promoting quality and access to health care for all citizens, to contain health care costs, and to promote a comprehensive health care system.
These rules are to be read in conjunction with the Wyoming Administrative Procedures Act, applicable Wyoming Rules of Civil Procedure, and, addressing Contested Hearings, any rules pertaining to the conduct of hearings before the Office of Administrative Hearings.
(a) As used within the rules:
(i) 'Aggrieved Party' means any provider, purchaser or third-party payor including but not limited to any hospital, physician, allied health professional, health care provider or other person furnishing goods or services to or in competition with hospitals, insurers, hospital service corporations, medical service corporations, preferred provider organizations, health maintenance organizations or any employer or association that directly or indirectly provides health care benefits to its employees or members.
(ii) 'Anniversary Month' means the month a health care cooperative arrangement is approved.
(iii) 'Arrangement Already in Effect' means all substantiating elements included in the health care cooperative arrangement application have been working together in the State of Wyoming as proposed in the application for one (1) year prior to the filing of the application.
(iv) 'Certified Mail' means uninsured first class mail whose delivery is recorded by having the addressee sign for it.
(v) 'Comment' means a written document offering explanation, illustration, criticism, or personal opinion.
(vi) 'Contested Case' means a proceeding including but not restricted to the review of applications for health care cooperative arrangements and the administration of approved applications for health care cooperative arrangements in accordance with WSS § 16-3-101.
(vii) 'Days' means consecutive calendar days.
(viii) 'Department' means the Wyoming Department of Health.
(ix) “Director” means the Director of the Wyoming Department of Health.
(x) “Objection” means a written document offered by an aggrieved party in opposition to a health care cooperative arrangement which states the reason, grounds, or cause for expressing opposition.
(xi) “Persons on Record” means persons submitting written documentation to the Director, by certified mail, stating objections, comments, or requests for notification of a specific health care cooperative arrangement. Persons on record status must be renewed by written request, sent by certified mail to the Director, prior to December 31 of each calendar year.
(xii) “Revenue” means income received during the preceding fiscal year under the cash basis of accounting.
(xiii) “Trade Secret Information” means proprietary data including a formula, pattern, compilation, program, device, method, technique or process that:
A. Is supplied by the affected individual or organization to the State;
B. Is the subject of efforts by the individual or organization that are reasonable under the circumstances to maintain secrecy; and
C. Derives independent economic value, actual or potential, from not being generally known and not being readily ascertainable by proper means by other persons who can obtain economic value from its disclosure or use.
(a) Application content shall be in accord with W.S. § 35-24-104 and W.S. § 35-24-111.
(i) Application information is to be provided in the sequence in accord with the statutes.
(ii) If information requested by the statutes is not applicable, a statement indicating such and providing a reason therefore shall be provided in lieu of such information.
(b) Application format
(i) Applications must be in the following format:
(A) Application pages shall be numbered and printed on paper measuring 8 1/2 by 11 inches. The margins shall not be less than one (1) inch on all sides. Unless otherwise required, all applications shall be printed on white paper.
(B) Applications shall be in courier type at ten (10) characters per inch and double spaced.
(C) Footnotes shall be in the same size type and format as the text.
(D) Trade secret information shall be printed on goldenrod colored paper to assist in identifying material exempt from Wyoming's Public Record Act.
(E) The Department shall develop procedures to protect trade secret information.
(F) Applications shall be bound in a three ring notebook; and, if the application consists of multiple volumes, be numbered.
(G) Applications which do not comply with these rules shall not be accepted for filing and returned to the applicant.
(i) Applications shall be filed by presenting an original and three (3) copies to the Director.
(ii) The filing date of a conforming application shall be the date stamped received by the Department.
(iii) No application shall be filed by facsimile machine.
(iv) Applications filed with the Department become property of the State.
(v) Applications shall be accompanied by the filing fee as determined by Section 5 of these rules in accord with W.S. § 35-24-104 (d).
(i) Format required for filing of related documents shall be in accord with Section 3 (b) of these rules.
(ii) Documents relating to an application shall be filed by presenting an original and three (3) copies to the Director.
(iii) The filing date of a document shall be the date stamped received by the Department.
(iv) Documents relating to an application may be accepted by facsimile machine provided an original and three (3) copies are received by the Director no later than seven (7) days after transmission of the facsimile.
(v) Documents relating to an application shall be incorporated in the original application file.
(i) In accord with W.S. § 35-24-104 (d), filing fees shall be remitted along with the application.
(ii) Filing fees must be remitted by cashiers check made payable to the Department.
(iii) The filing fee shall be in the amount of one-fourth (1/4) of one (1) percent of total gross revenue during the last complete fiscal year for all practitioners, health care facilities, and health insurers included in the application up to a maximum amount of one hundred thousand ($100,000.00) dollars. The minimum filing fee shall be twenty-five thousand ($25,000.00) dollars.
(iv) If the calculated fee in (iii) is greater than twenty-five thousand ($25,000.00) dollars, the applicant may submit the minimum filing fee amount of twenty-five thousand ($25,000.00) dollars.
(v) The Director may request additional financing in increments of twenty-five thousand ($25,000.00) dollars with the last increment being twenty-five thousand ($25,000.00) dollars or less.
(vi) The filing fee submitted with the application and additional financing increments shall not exceed the filing fee established in (iii).
(vii) Additional filing fee increments must be submitted to the Department within thirty (30) days of the request.
(viii) Failure to submit additional filing fee increments within thirty (30) days of the request places the application on hold until such time the additional filing fee is forthcoming.
(ix) In lieu of disclosure of actual gross revenues for individual physicians, an applicant may elect to have the portion of the fee attributable to individual physicians based upon a standard imputed amount for each physician which would be set by the Department.
(x) The filing fee associated with submitting a modification to an approved application shall be in the amount of twenty-five thousand ($25,000.00) dollars.
(i) In accord with W.S. § 35-24-104 (d) and W.S. § 35-24-112 (d), all fees collected by the Department under these subsections shall be deposited into a separate account within a special revenue fund. These funds shall be expended for the activities specified in W.S. § 35-24-104 (d). The Director shall have discretion to allocate start-up costs among all applicants who submit applications.
(i) Remaining balance of the filing fee shall be refunded within thirty (30) days from the date of the Director's final determination. The Director may extend the thirty (30) day period for good cause.
(i) The applicant shall, at the time of filing, provide notice to the public and all persons on record.
(ii) The notice of a pending application shall be approved by the Director.
(iii) The public notice of a pending application shall conform to the notice criteria and shall be published for a minimum of seven (7) days in a Wyoming newspaper of general circulation in the area.
(iv) The notice of a pending application shall conform to the notice criteria and shall be mailed to all persons on record.
(i) If the Director determines that an application is unclear, incomplete, or contains an insufficient basis on which to provide a decision, the application shall be returned with a written description of the deficiencies to the applicant.
(ii) The initial review by the Director shall be completed within thirty (30) days of the date the application is filed with the Department. The Director may extend the thirty (30) day period to a maximum of sixty (60) days, for good cause.
(iii) If an application is returned to the applicant, the initial review period ceases. If an application is returned for review, a new initial review period begins.
(iv) If an application is returned to the applicant and the applicant will be resubmitting the application for further review, the filing fee shall remain deposited.
(v) If an application is returned and the applicant elects not to resubmit an amended application, the Director shall return the filing fee submitted with the application less costs associated with the initial review process.
(vi) A determination by the Director that an application is unclear, incomplete, or provides an insufficient basis to make a determination, is not subject to administrative or judicial review.
(b) Applications regarding arrangements already in effect in accord with W.S. § 35-24-105 (b):
(i) If an application relates to an arrangement already in effect before the submission of the application, the Director may decline to review the application and return the filing fee submitted with the application less costs associated with any review conducted.
(ii) A determination by the Director that an application relates to an arrangement already in effect is not subject to administrative or judicial review.
(iii) If the Director declines to review the application, the applicant may appeal the decision within thirty (30) days of the denial to review.
(a) When an application is in accord with W.S. § 35-24-104, the Director shall provide the following notifications:
(i) General Notice: Within ten (10) days of completion of the initial review of the application, the notice required shall be published for a minimum of seven (7) days in a Wyoming newspaper of general circulation in the area.
(ii) Requested Notice: The Director shall provide one (1) copy of the notice to all persons on record.
(iii) Special Notice: The Director may notify and request comments from persons. Copies of any request for comments shall be provided to the applicant.
(a) In accord with W.S. § 35-24-106:
(i) Within twenty (20) days after the publication period for notice of the proposed application, any person may submit typed comments with respect to the application.
(ii) Comments shall, to the extent applicable, conform to the application format.
(iii) Any comment regarding a specific provision of the application shall designate the specific page number(s) of the application.
(iv) Comments must be filed with the Director by delivering or mailing an original and three (3) copies. The filing date of comments shall be the date stamped received by the Department.
(v) Comments may be filed by facsimile machine provided an original is sent to the Director within seven (7) days of transmission of the facsimile.
(vi) Comments on file with the Department become property of the State.
(vii) Persons submitting comments shall provide a copy of the comments to the applicant by certified mail.
(a) The applicant shall have ten (10) days after the close of the comment period to file a response with the Director by delivering or mailing an original and three (3) copies of the response to the Department.
(i) Responses to comments shall, to the extent applicable, conform to the application format.
(ii) Responses may be filed by facsimile machine provided an original is sent to the Director within seven (7) days of transmission of the facsimile.
(iii) The filing date of a comment shall be the date stamped received by the Department.
(iv) The applicant shall provide a copy of any response to the person submitting the comment.
(a) In accord with W.S. § 35-24-106:
(i) Within thirty (30) days after the publication period for notice of the proposed application, any aggrieved party may submit written objections with respect to the application.
(ii) Objections shall, to the extent applicable, conform to the application format.
(iii) Objections regarding a specific provision of the application shall designate the specific page number(s) of the application.
(iv) Objections shall be filed by presenting or mailing an original and three (3) copies to the Director.
(v) The filing date of an objection shall be the date stamped received by the Department.
(vi) Objections may be filed by facsimile machine provided an original is sent to the Director within seven (7) days of transmission of the facsimile.
(vii) Objections on file with the Department become property of the State.
(viii) The aggrieved party submitting an objection shall provide a copy of the objection to the applicant by certified mail.
(a) In accord with W.S. § 35-24-107, the Director shall determine the review procedure to be used.
(i) The Director shall provide the applicant and aggrieved parties written notification, sent by certified mail, of the method of review to be used within fifteen (15) days of the close of the objection period.
(ii) The criteria to be used in determining the method of review shall consider the factual record, size, complexity, novelty, substance, and quantity of comments.
(iii) A contested hearing shall be held upon the request of an applicant, the timely filing of an objection by an aggrieved party, or at the determination of the Director.
(a) In accord with W.S. § 35-24-108, the Director may issue a decision based upon the record.
(i) A written decision shall be provided to the applicant and all persons on record.
(a) In accord with W.S. § 35-24-109, the Director may, prior to making a final decision on any application, order a limited hearing.
(i) A limited hearing shall be held within sixty (60) days of the close of the notice of determination of review.
(ii) The order for a limited hearing shall be sent by certified mail to the applicant, and to all persons on record.
(iii) The limited hearing shall be conducted in accord with W.S. § 35-24-109 and the Wyoming Administrative Procedures Act.
(a) In accord with W.S. § 35-24-107, a contested hearing shall be conducted when requested by the applicant, upon filing of an objection, or at the determination of the Director.
(i) The Director shall order a contested hearing no later than thirty (30) days after the conclusion of the objection period for an application under W.S. § 35-24-110. The Director may extend the thirty (30) day period for good cause.
(ii) The order for a contested hearing shall be sent, by certified mail, to the applicant, and all persons on record.
(b) The Director shall provide the public with notice of a contested hearing. The notice shall detail the purpose, date, time, and location of the hearing and be published at least seven (7) days prior to the hearing for a minimum of seven (7) days in a Wyoming newspaper of general circulation in the area.
(c) Contested hearings shall be conducted pursuant to the Wyoming Administrative Procedures Act, applicable provisions of the Wyoming Rules of Civil Procedure, and applicable rules of the Office of Administrative Hearings.
(d) The final decision shall be mailed by the Director to the applicant and all persons on record.
(a) The final decision regarding an application shall be made by the Director in accord with Wyoming statutes and rules regarding health care cooperative agreements.
(i) The final decision shall be in writing and include specific findings of fact concerning cost, access, and quality criteria and shall identify one or more of these criteria as the basis of the decision.
(ii) An approval may be conditioned on modification(s) of all or part of the proposed agreement.
(iii) A decision based upon the written record shall be made thirty (30) days after the date of notice of determination.
(iv) A decision based upon a limited hearing shall be made thirty (30) days after the conclusion of the hearing.
(v) A decision based upon a contested hearing shall be made by the Director within thirty (30) days after written recommendations are received from the hearing officer.
(vi) A copy of the final decision shall be sent, by certified mail, to the applicant and aggrieved parties. All persons on record shall be provided notice of the decision.
(b) Immunity granted by an approved application shall be limited to the activities approved by the Director in the final written decision.
(a) After the Director has rendered a decision in accord with W.S. § 35-24-112, the applicant, or any other aggrieved party, may request judicial review of the Director's decision by filing a petition for review within thirty (30) days in accord with Wyoming's Administrative Procedures Act. A determination under W.S. § 35-24-107 (a) shall not be raised on appeal.
(a) The decision to approve an application shall specify a time schedule for the submission of data required to supervise, monitor, and regulate the arrangement.
(i) Requested data shall be in the following format:
(A) The pages shall be numbered and printed on paper measuring 8 1/2 by 11 inches. The margins shall not be less than one (1) inch on all sides. Unless otherwise required, all data shall be printed on white paper.
(B) The required data shall be in courier type at ten (10) characters per inch and double spaced.
(C) Footnotes shall be in the same size type and format as the text.
(D) Trade secret information shall be designated and printed on goldenrod colored paper to assist in identifying material exempt from Wyoming's Public Record Act.
(E) The Department shall develop procedures to protect trade secret information.
(ii) The Director may, at any time, require the submission of additional data or alter the time schedule for submission of information.
(A) The applicant shall be notified, by certified mail, of any requirement for the submission of additional information or any alteration of the time for submission of materials.
(b) The Director shall notify the applicant of any nonconformity by certified mail.
(i) The Director's notice of nonconformity shall state with particularity any deficiency.
(ii) The applicant shall respond, by certified mail, within thirty (30) days from the date of the notice of nonconformity, with a written response supported by additional data which either negates the nonconformity or provides a proposal to correct any nonconformity.
(iii) Within forty (40) days of the date from the notice of nonconformity, the Director and the applicant shall meet informally for the purpose of resolving any nonconformity by agreement.
(iv) If any nonconformity cannot be resolved informally, a contested hearing shall be conducted.
(A) The hearing shall be conducted in accord with W.S. § 35-24-110.
(B) A decision shall be made by the Director within thirty (30) days after written recommendations are received from the hearing officer.
(C) A copy of the final written decision shall be sent, by certified mail, to the persons of the contested hearing.
(D) A final decision from the Director is subject to judicial review in accord with W.S. § 16-3-114.
(c) On a yearly basis, the applicant shall submit a renewal fee in accord with W.S. § 35-24-104 (d) and provide the Director with supporting documentation in accord with W.S. § 35-24-112 (d).
(i) The applicant shall submit notice of intent to renew accompanied by the renewal fee and supporting documentation to the Director no later than thirty (30) days prior to the anniversary month.
(ii) The Director shall evaluate whether the existing arrangement promotes the quality and access to health care for all citizens and whether it promotes the development of a comprehensive health care system.
(iii) If the Director determines the arrangement promotes the quality and access to health care for all citizens and promotes the development of a comprehensive health care system, a renewal shall be granted.
(d) Public comments regarding the impact of existing arrangements.
(i) Two (2) years after the date the initial application is approved, and at two year intervals thereafter, the Director shall solicit public comment. The purpose of such comments is to evaluate the arrangement’s impact on the cost, access, and quality of health care.
(A) The notice is to be published for a minimum of seven (7) days in a Wyoming newspaper of general circulation in the area.
(B) Any comments will be incorporated in files relating to the application.
(C) The applicant shall review public comments and provide a written response to the Director. The applicant shall send the person(s) making the comment(s) a copy of any response.
(a) Health care cooperative arrangements are subject to the revocation in accord with W.S. § 35-24-115.
(i) Prior to initiating an action to revoke approval, the Director shall comply with the provisions of W.S. § 35-24-114.
(ii) A proceeding to revoke approval is initiated by the Director providing notice, by certified mail, to the applicant of the proposed action.
(iii) The notice shall be in writing and specify, with particularity, the grounds for the proposed action.
(iv) Upon request of the applicant, by certified mail to the Director, a proceeding to revoke will be conducted as a contested hearing. The hearing shall be conducted in accord with W.S. § (v) Notice of a revocation proceeding shall be as follows:
(A) The notice of the time, date, and location of the revocation proceeding shall be sent, by certified mail, to the applicant and all persons on record.
(B) The Director shall publish notice of the purpose, time, date, and location of the revocation proceeding for a minimum of seven (7) days prior to the date of the hearing in a Wyoming newspaper of general circulation in the area.
(C) A contested hearing shall be conducted pursuant to the Wyoming Administrative Procedures Act, applicable provisions of the Wyoming Rules of Civil Procedure, and any rules adopted by the Office of Administrative Hearings.
(D) The Director shall issue a final decision, by certified mail, within thirty (30) days following receipt of the written recommendations from the hearing officer.
(b) An entity whose approved application has been revoked shall be required to submit a new application in accord with appropriate sections of these rules.