Wyo. Code R. 048-0048-1
Public Health Laboratory
Chapter 1: Children's Health Insurance Program
Effective Date: 11/22/1999 to 03/21/2000
Rule Type: Expired Emergency Rules & Regulations
Reference Number: 048.0048.1.11221999
This Chapter is promulgated by the Division of Public Health of the Department of Health pursuant to the Child Health Insurance Program Act at W. S. § 35-25-101 et seq., and the Wyoming Administrative Procedures Act at W. S. §16-3-101 et seq.
(a) This Chapter shall apply to and govern the Children's Health Insurance Program, other than the Voucher Program, which shall be governed by Chapter 2 of the Children's Health Insurance Program of the Rules of the Division of Public Health.
(b) The Division may issue Manuals, Bulletins, or both, to interpret the provisions of this Chapter. Such Manuals and Bulletins shall be consistent with and reflect the policies contained in this Chapter. The provisions contained in Manuals or Bulletins shall be subordinate to the provisions of this Chapter.
(a) This Chapter is intended to be read in conjunction with the Child Health Insurance Program Act, W. S. § 35-25-101 et seq., and Title XXI of the Social Security Act (Title IV, Subtitle J of Pub. L. No. 105-33, to be codified at 42 U.S.C. §§ 1397aa through 1397jj.
(b) In accordance with Section 2102(b)(4) of Pub. L. No. 105-33, to be codified at 42 U.S.C. § 1397bb, nothing in this Chapter shall be construed as providing an individual with an entitlement to child health assistance.
(c) The incorporation by reference of any external standard is intended to be the incorporation of that standard as it is in effect on the effective date of this Chapter, including any applicable amendments, corrections, or revisions.
Section 4. Definitions. Except as otherwise specified in this section, the terminology used in this Chapter is the standard terminology and has the standard meaning used in health care, health insurance, and Medicaid.
(a) "Act." The "Child Health Insurance Program Act" as enacted by the 1999 Wyoming Legislature and codified at W.S. 35-25-101 through 35-25-110.
(b) "Admission certification." "Admission certification" as defined by Chapter 8 of the Medicaid rules, which definition is incorporated by this reference.
(c) 'Adverse action.' 'Adverse action' as defined in Chapter 1 of the Medicaid rules, which definition is incorporated by this reference, except that the denial of or termination of CHIP is not an 'adverse action.'
(d) 'Alien.' A person residing in, and who is not a citizen of, the United States of America.
(e) 'Applicant.' A child on whose behalf an application for coverage by the Children's Health Insurance Program has been submitted, but there has been no final determination of eligibility.
(f) 'Application.' The form, specified by the Division, on which an applicant indicates in writing the desire to receive benefits.
(g) 'Application date.' The date an application for the Children's Health Insurance Program is received and date stamped by DFS.
(h) 'Approve.' To determine an applicant is eligible for CHIP benefits.
(i) 'Assistance unit.' The financially responsible persons living together whose income is considered in determining eligibility for CHIP.
(j) 'Benefit month.' The calendar month for which Children's Health Insurance Program eligibility will be approved.
(k) 'Benefits.' Coverage under the Children's Health Insurance Program.
(l) 'Benefit start date.' The date on which CHIP eligibility is approved.
(m) 'Biennium.' The period covering two State fiscal years following each regularly scheduled budget session of the Wyoming Legislature.
(n) 'Change in circumstances.' A change in an insured's address or health insurance coverage.
(o) 'Change report.' A form, as prescribed by the Department, used to report a change in circumstances to DFS.
(p) 'Chapter 1 of the Medicaid rules.' Chapter 1, Medicaid Fair Hearings, of the Wyoming Medicaid rules.
(q) 'Chapter 3 of the Medicaid rules.' Chapter 3, Provider Participation, of the Wyoming Medicaid rules.
(r) 'Chapter 4 of the Medicaid rules.' Chapter 4, Third Party Liability, of the Wyoming Medicaid rules.
(s) “Chapter 8 of the Medicaid rules.” Chapter 8, Inpatient Admission Certification, of the Wyoming Medicaid rules.
(t) “Chapter 16 of the Medicaid rules.” Chapter 16, Medicaid Program Integrity, of the Wyoming Medicaid rules.
(u) “Chapter 35 of the Medicaid rules.” Chapter 35, Medicaid Benefit Recovery, of the Wyoming Medicaid rules.
(v) “Chapter 39 of the Medicaid rules.” Chapter 39, Recovery of Excess Payments, of the Wyoming Medicaid rules.
(w) “Child.” A person under age nineteen (19). A person is under age nineteen before the person’s nineteenth birthday.
(x) “Children’s Health Insurance Program (CHIP).” The program established pursuant to the Child Health Insurance Program Act at W. S. § 35-25-101 et seq. and this Chapter which provides payments of Children’s Health Insurance Program funds to providers for Children’s Health Insurance Program covered services furnished to insureds.
(y) “Children’s Health Insurance Program allowable payment.” The allowable payment established pursuant to Section 11.
(z) “Children’s Health Insurance Program covered service.” Those medically necessary services which are also Medicaid covered services.
(aa) “Children’s Health Insurance Program funds.” That combination of Federal funds and State funds which is available to the Department to make payments to providers for services furnished to children eligible under this Chapter. The federal portion shall be the enhanced Federal Medical Assistance Percentage. The state portion shall be the State match.
(bb) “Children’s Health Insurance Program state plan.” The state plan prepared by the Division pursuant to Title IV, Subtitle J, of Pub. L. No. 105-33 (to be codified at 42 U.S.C. §1397aa(b)), submitted to and approved by HHS.
(cc) “Citizen.” An individual who is a citizen or the dependent of a citizen of the United States of America.
(dd) “Claim.” A request by a provider for payment of Children’s Health Insurance Program funds for Children’s Health Insurance Program covered services provided to an insured.
(ee) “Copayment.” A charge to an insured for covered services.”
(ff) “Countable income.” Income, including earned income, unearned income, and in-kind income, which is used to determine program eligibility. “Countable income” does not include exempt income or income disregards.
(gg) “Department.” The Wyoming Department of Health, its agent, designee, or successor.
(hh) “Department of Family Services (DFS).” The Wyoming Department of Family Services, its agent, designee, or successor.
(ii) “Division.” The Division of Public Health (DPH) of the Department, its agent, designee, or successor.
(jj) “DPH Chapter 2.” Chapter 2, Children’s Health Insurance Program, Voucher Program, of the Division’s rules.
(kk) “Eligible.” An applicant who is approved.
(ll) “Enhanced FMAP.” The enhanced FMAP as determined pursuant to P.L. 105-33, Sec. 4901(a), 111 Stat. 560 (to be codified at 42 U.S.C. § 1397ee(b), which is incorporated by this reference.
(mm) “Equipment.” Items, including durable medical equipment, that are designed for repeated use, have a medical purpose and are intended for home use.
(nn) “Excess payments.” Children’s Health Insurance Program funds received by a provider to which the provider is not entitled for any reason, including payments which exceed the Children’s Health Insurance Program allowable payment. “Excess payments” includes, but is not limited to:
(i) Overpayments;
(ii) Payments made as a result of system errors;
(iii) Payments for services furnished to a non-insured;
(iv) Payments for non-covered services furnished to an insured;
(v) Payments for services which are not documented and/or supported by medical records and/or financial records;
(vi) Payments for services for which admission certification has been denied or withdrawn;
(vii) Payments which exceed a provider’s usual and customary charge, unless otherwise permitted by the Department’s rules.
(oo) “Family.” An assistance unit.
(pp) “Federal poverty level.” The poverty line as specified in the federal poverty guidelines as published and updated annually in the Federal Register pursuant to Section 673(2) of OBRA.
(qq) “Financially responsible adult.” The person or persons legally responsible to support one or more children.
(rr) “Financial records.” All records, in whatever form, used or maintained by a provider in the conduct of its business affairs and which are necessary to substantiate or understand claims submitted to the Department.
(ss) “Guardian.” An insured’s legally appointed conservator or guardian.
(tt) “HCFA.” The Health Care Financing Administration of the United States Department of Health and Human Services, its agent, designee, or successor.
(uu) “HHS.” The United States Department of Health and Human Services, its agent, designee, or successor.
(vv) “Household.” The person or persons who live together in a residence. A “household” may include one or more assistance units.
(ww) “Income.” Earned income, unearned income, or in-kind payments received from any source, excluding money classified as a resource and/or exempt income:
(i) Earned income includes:
(A) Any payment received by an employee or agent in cash or in-kind as wages, salary, tips, commissions, or pursuant to a contract.
(B) Net profits received from activities in which the individual is engaged. “Net profits” means the total sum before deductions for personal or employment expenses and excludes the meal allowance used by the Federal Insurance Contribution Act (FICA).
(ii) Exempt income. Money set aside or free from program policy limits and not counted against program income limits. The following income is exempt:
(A) Income which is required to be excluded under a federal statute;
(B) Unearned income paid in-kind to a household member, such as payments made to a third party for food, shelter, clothing, or other needs.
(C) Educational income, such as grants, scholarships, fellowships, education loans, and work-study income paid to a person who is enrolled in an educational program;
Needs-based veteran’s benefits;
(E) Reimbursement for expenses incurred by the individual; and
(F) Child care assistance paid under Title XX of the Social Security Act.
(iii) In-kind income. Goods or services received in lieu of cash. In-kind income is countable when the individual has a legal right to liquidate such goods or services to cash.
(iv) Unearned income. Income received which is neither earned by providing goods or services nor defined as a resource.
(xx) 'Income disregard.' Income which is not included in countable income. Income disregards shall be determined as follows:
(i) Each working member of a household shall receive a $200.00 per month disregard, except that a married couple shall be entitled to a $400.00 per month disregard;
(ii) All earned income of a full-time high school student under age eighteen (18) who is living with a caretaker relative;
(iii) Twenty-five percent of the assistance unit's gross self-employment income or a deduction of actual business expenses.
(yy) 'Ineligible.' Not authorized to be an insured under the Children's Health Insurance Program,
(zz) 'Inmate of a public institution.' 'Inmate of a public institution' as defined in 42 C.F.R. § 435.1009, which definition is incorporated by this reference.
(aaa) 'Institution for mental disease.' 'Institution for mental diseases' as defined in 42 C.F.R. § 435.1009, which definition is incorporated by this reference.
(bbb) 'Insured.' A person who has been determined eligible for the Children's Health Insurance Program.
(ccc) 'Medicaid.' Medical assistance and services provided pursuant to Title XIX of the Social Security Act and/or the Wyoming Medical Assistance and Services Act of 1967, as amended. 'Medicaid' includes any successor or replacement program enacted by Congress or the Wyoming Legislature.
(ddd) 'Medically necessary' or 'medical necessity.' A health service that is required to diagnose, treat, cure or prevent an illness, injury or disease which has been diagnosed or is reasonably suspected; to relieve pain; or to improve and preserve health and be essential to life. The service must be:
(i) Consistent with the diagnosis and treatment of the insured's condition;
(ii) In accordance with the standards of good medical practice among the provider's peer group;
(iii) Required to meet the medical needs of the insured and undertaken for reasons other than the convenience of the insured and the provider; and (iv) Performed in the most cost effective and appropriate setting required by the insured's condition.
(eee) 'Medical records.' All records, in whatever form, in the possession of or subject to the control of a provider which describe the insured's diagnosis, treatment or condition.
(fff) 'Month.' A calendar month.
(ggg) 'Notice of action.' A written notice mailed to an insured which informs the insured of intended action affecting eligibility for benefits. The notice shall include the action to be taken, the effective date of the action, and the legal authority for the action. Notice shall be timely if mailed, by first-class United States mail, ten days before the effective date of the intended action.
(hhh) 'OBRA.' The Omnibus Budget Reconciliation Act of 1981, Pub. L. No. 97-35.
(iii) 'Overpayments.' Children's Health Insurance Program funds received by a provider as the result of fraud or abuse, as those terms are defined in Chapter 16 of the Medicaid rules, which definitions are incorporated by this reference.
(jjj) 'Periodic review.' A review of an insured's eligibility. A periodic review shall be conducted twelve months after the benefit effective date, and every twelve months thereafter.
(kkk) 'Prior authorized.' 'Prior authorized' as defined in Chapter 3 of the Medicaid rules, which definition is incorporated by this reference.
(lll) 'Program.' The Children's Health Insurance Program.
(mmm) 'Provider.' Any individual or entity that has furnished Children's Health Insurance Program covered services to an insured, has submitted a claim, and satisfies the conditions of Section 6.
(nnn) 'Provider agreement.' A 'provider agreement' as that term is defined in Chapter 3 of the Medicaid rules, which definition is incorporated by this reference.
(ooo) 'Residence.' The place an insured uses as his or her primary dwelling place and intends to continue to use indefinitely for that purpose.
(ppp) 'Resident.' A person who lives in the State of Wyoming and has the intention of continuing to live in the State.
(qqq) 'Resource.' Real or personal property in which an individual has a legal interest.
(rrr) 'Services.' Health or medical services, medical supplies or equipment.
(sss) 'State fiscal year.' July 1st through June 30th of the following calendar year.
(ttt) “State general funds.” The dollar amount of the state funds appropriated by the Wyoming Legislature for the Children’s Health Insurance Program.
(uuu) “State match.” The state general funds appropriated to match the enhanced FMAP. “State match” may include grant funds received by the Department from a non-governmental source if such funds are granted to constitute a portion of the State’s expenditures for this program.
(vvv) “State plan.” The state plan required by Pub. L. No. 105-33.
(www) “System error.” “System error” as defined in Chapter 39 of the Medicaid rules, which definition is incorporated by this reference.
(xxx) “Targeted low income child.” A child whose family’s gross countable monthly income as determined pursuant to Section 5 is one hundred thirty-three (133) percent or less of the federal poverty level, and:
(i) Is not eligible for Medicaid;
(ii) Has not been covered by a private health insurance plan for one month (30 days) or more before the date of application; or
(iii) Upon birth is not covered by a public or private health insurance plan. (yyy) “Termination.” To remove an insured from CHIP, and/or close the insured’s file.
(zzz) “The program.” The Children’s Health Insurance Program.
(aaaa) “Third party payer.” “Third party payer” as defined in Chapter 4 of the Medicaid rules, which definition is incorporated by this reference.
(bbbb) “Usual and customary charge.” The provider’s charge for comparable services provided to non-insureds.
(cccc) “Voucher eligible child.” A low income child whose family’s gross monthly income is more than one-hundred thirty-three percent and not more than one-hundred fifty percent of the federal poverty level.
(dddd) “Voucher Program.” The program established pursuant to the Child Health Insurance Program Act at W. S. § 35-25-101 et seq. and DPH Chapter 2 which provides health insurance premiums for voucher eligible children.
Section 5. Eligibility.
(a) Introduction. This section is intended to provide uniform procedures for determining eligibility for the Children’s Health Insurance Program.
(b) Application process. DFS shall follow the process described below when an individual makes a request for the Children’s Health Insurance Program:
(i) An application shall be provided;
(ii) A separate application shall be required for each assistance unit, and the applicant shall be notified, in writing, of the result;
(iii) The application shall be accepted when complete, and date stamped;
(iv) Applicants shall be informed of the eligibility criteria and their rights and responsibilities, and the services available under the program;
(A) An application shall be approved if the applicant is found to be eligible; or
(B) An application shall be denied if the applicant: (1) is found to be ineligible; (2) does not provide all required information; (3) has withdrawn the application; (4) cannot be located; (5) is an inmate of a public institution; or (6) is a resident in an institution for mental disease.
(v) Documentation of the action taken and the reasons for the action shall be placed in the applicant’s case file.
(vi) DFS shall provide written notice, delivered by first-class United States mail, to the applicant of the determination.
(v) A completed application shall be acted upon within forty-five (45) days from the date it is received;
(c) Rights of applicants. Applicants have the following rights:
(i) To apply without delay at DFS;
(ii) To be accompanied and/or assisted by the person of choice in requesting and/or completing an application;
(iii) To request assistance from DFS in completing an application;
(iv) To apply for the Children’s Health Insurance Program either in person or by mail;
(v) The application and all personally identifiable information shall be kept confidential and shall not be disclosed except as necessary to determine or verify eligibility or in accordance with the rules of the Department.
(vi) Persons requesting program assistance shall be informed:
(A) Orally or in writing of the program eligibility factors and required verifications;
(B) In writing of the benefit effective date; and
(C) In writing of their rights and responsibilities.
(vii) The denial of benefits is not an adverse action and an applicant shall not be entitled to an administrative hearing pursuant to Chapter 1 of the Medicaid rules.
(d) Responsibilities of applicants.
(i) An applicant must complete an application in the form and in the manner specified in writing by the Department. The application must be:
(A) Completed;
(B) Dated; and
(C) Signed under penalty of perjury by the applicant’s parent or guardian.
(ii) An applicant must cooperate fully in the process of determining eligibility, including the following:
(A) Provide any and all necessary information, whether required by the application or requested by DFS; and
(B) Promptly provide a notice of change to reflect change in circumstances, including a change of address and health insurance coverage.
(e) Verifications. The following information shall be documented, and such documentation shall be maintained in the individual’s case file:
(i) Lawful alien status;
(ii) The reasons for the denial of eligibility.
(f) Citizenship. Eligibility is limited to:
(i) Citizens; and
(ii) The following lawfully admitted aliens, Persons:
(A) Who are admitted to the United States as refugees under Section 207 of the Immigration and Naturalization Act (“INA”);
(a) Payments only to providers. No person or entity that furnishes Children's Health Insurance Program covered service to an insured shall receive Children's Health Insurance Program funds unless the person or entity is a provider.
(b) Medicaid providers. A provider which meets the Medicaid provider participation requirements and the conditions of participation contained in Chapter 3, which requirements are incorporated by this reference, shall be deemed to be a provider pursuant to this Chapter.
(c) Submission of claims. Any person or entity that submits a claim shall be deemed to have agreed to be bound by the provisions of this Chapter.
(d) Covered services. Children's Health Insurance Program covered services are eligible for reimbursement from Children's Health Insurance Program funds.
(a) Identification Cards. The Division issues Children's Health Insurance Program identification cards to insureds. Such cards are valid only for the period after the date shown on the card.
(b) If an individual seeks services and does not have a valid Children's Health Insurance Program identification card, the provider must verify the individual's eligibility using the Department's eligibility verification services. The Department shall disseminate those procedures through Provider Manuals and/or Bulletins. If a provider fails to verify eligibility, the Department shall not be responsible for paying for such services.
(c) Failure to notify provider of eligibility. If a provider furnishes services to an individual who fails to notify the provider that he or she is an insured, the provider has the option of submitting a claim to the Department seeking Children's Health Insurance Program reimbursement or seeking payment from the insured's parent or guardian.
(d) Retrospective payment. A provider which furnishes services to an individual that becomes an insured after the date of services may submit a claim to the Department seeking Children's Health Insurance Program reimbursement for services furnished during the benefit month for which the individual was determined to be eligible.
Section 8. Provider records. A provider must comply with the record-keeping requirements of Chapter 3 of the Medicaid rules, which requirements are incorporated by this reference.
Section 9. Prior authorization. A provider must comply with the prior authorization requirements of Chapter 3 of the Medicaid rules, which requirements are incorporated by this reference.
Section 10. Admission certification. A provider of inpatient hospital services must comply with the admission certification requirements of Chapter 8 of the Medicaid rules, which requirements are incorporated by this reference.
(a) Payer of last resort. The Children's Health Insurance Program is the payer of last resort. A provider may not seek Children's Health Insurance Program funds as payment for services furnished to an insured until payment from third parties has been sought pursuant to Section 14.
(b) Payment in full of covered services. If the service is a covered service, a provider may not request, receive or attempt to collect any payment from the insured or the insured's family for the service. The provider must accept the Children's Health Insurance Program allowable payment as payment in full for the services.
(c) Payment for noncovered services. A provider that provides a noncovered service to an insured may seek payment from the insured's parent or guardian if the provider informed the parent or guardian, in writing, of the insured's potential liability before providing the service, and the parent or guardian agreed in writing to pay for such services before they were furnished.
(d) Submission of claims.
(i) Claims must be submitted to the Department in the manner and on the forms specified by the Department, must include documentation of admission certification or prior authorization, if necessary, and such other documentation or records as the Department may request.
(ii) Claims must be submitted to and finalized on or before twelve months after the date of service or the date of discharge, whichever is later.
(A) The date of submission is the date the claim is received by the Department.
(B) Claims not timely submitted shall be rejected.
(iii) A provider shall not bill the Department in excess of the provider's usual and customary charge for the service.
(iv) A provider may seek Children's Health Insurance Program funds through a business agent for services furnished to an insured if the business agent's compensation is related to the actual cost of processing the billing and is not related on a percentage or other basis to the amount of the claim and is not dependent upon payment of the claim.
(v) A provider is responsible for all claims, whether submitted directly or through an agent, designee, employee or other intermediary.
(vi) Any loss of Children's Health Insurance Program funds caused by provider error is the responsibility of the provider and the provider may not bill the insured for such services.
Section 12. Children's Health Insurance Program allowable payment. The Children's Health Insurance Program allowable payment for covered services shall be the same as the Medicaid allow- able payment for the same or similar services as established pursuant to the Department’s Medicaid rules.
Section 13. Copayments. There shall be no copayments for Children’s Health Insurance Program covered services.
Section 14. Third party liability and benefit recovery. A provider must comply with Chapter 4 and 35 of the Medicaid rules. All references in those Chapters to “Medicaid” shall be replaced with “Children’s Health Insurance Program” for purposes of this Chapter.
Section 15. Recovery of excess payments. The Department may recover excess payments pursuant to Chapter 39 of the Medicaid rules. All references in that Chapter to “Medicaid” shall be replaced with “Children’s Health Insurance Program” for purposes of this Chapter.
Section 16. Recovery of overpayments. The Department may recover overpayments pursuant to Chapter 16 of the Medicaid rules. All references in that Chapter to “Medicaid” shall be replaced with “Children’s Health Insurance Program” for purposes of this Chapter
(a) A provider may request that the Department reconsider a decision to recover excess payments. Such request must be mailed to the Department by certified mail, return receipt requested within twenty days of the date the facility receives notice pursuant to Section 15. The reconsideration provisions of Chapter 3 of the Medicaid rules, which provisions are incorporated by this reference, shall govern all aspects of the reconsideration and any administrative hearing.
(b) Eligibility determinations and redetermination. There shall be no reconsideration or administrative hearing involving eligibility determinations and/or redetermination.
Section 18. Disposition of recovered funds. Any and all recovered Children’s Health Insurance Program funds shall be returned to the program and used to provide additional services.
(a) Payment contingent on funding. In accordance with Program Expenditure provisions of the Child Health Insurance Program Act (codified at W.S. § 35-35-108 et seq.), payment to providers is contingent on the availability of Children’s Health Insurance Program funds. The Department shall not be obligated to make payments in the absence of such funds.
(b) Monitoring and projecting program expenditures. The Department shall:
(i) Monitor program expenditures to ensure that expenditures do not exceed program funds;
(ii) Make monthly projections of expenditures for the remainder of the biennium based on program expenditures for the most recent six calendar months, trended forward for the remainder of the biennium, and including utilization trends and the estimated amount of unpaid claims.
(c) Program limitations. If the budget projections prepared pursuant to this Section show that there will or may be insufficient program funds, the Department may declare a partial or total moratorium on new insureds so that otherwise eligible individuals will not be determined eligible until such time as the Department determines that sufficient program funds are available. Any such moratorium shall be no more restrictive than necessary to bring projected program expenditures into conformance with available program funds.
(d) Automatic termination of Children’s Health Insurance Program. The program shall be automatically discontinued, and reimbursement for covered services shall be suspended, when and if appropriated funds become exhausted.
(e) Notice of program reduction or termination. The Department shall provide thirty days written notice, if possible, to providers and insureds of any program reductions and/or termination of the program.
(f) No appeal. A program reduction or termination, or the denial of eligibility because of a moratorium, shall not be adverse actions and shall not be subject to reconsideration pursuant to this Chapter or an administrative hearing pursuant to Chapter 1.
(a) Financial audits. The Department may audit a provider’s financial records at any time to determine the accuracy and appropriateness of claims submitted to the Department. The Department may recover any excess payments pursuant to Section 15.
(b) Medical audits. The Department may audit a provider’s medical records at any time pursuant to Chapter 16 of the Medicaid rules, which is incorporated by this reference, and take any action authorized by that Chapter.
(a) The order in which the provisions of this Chapter appear is not to be construed to mean that any one provision is more or less important than any other provision.
(b) The text of this Chapter shall control the titles of its various provisions.
Section 22. Superseding effect. When promulgated, this Chapter supersedes all prior rules or policy statements issued by the Department, including Manuals or Bulletins, which are inconsistent with this Chapter.
(a) If any portion of this Chapter is found to be invalid or unenforceable, the remainder shall continue in full force and effect.
(b) If any portion of this Chapter is inconsistent with the provisions required by HHS as part of the State Plan, the State Plan shall control.