Health, Department of

Renal Disease Program, Administrative Procedure for End Stage

Chapter 5: Denial, Modification, Suspension or Termination of Facility Approval

Effective Date: 07/24/2014 to 12/20/2016

Rule Type: Superceded Rules & Regulations

Reference Number: 048.0049.5.07242014

CHAPTER 5

Rules and Regulations for the Wyoming End Stage Renal Disease Program

Denial, Modification, Suspension, or Termination of Facility Approval

Section 1. Authority.

These rules and regulations are promulgated by the Wyoming Department of Health, pursuant to its authority under the general provisions of the Wyoming Medical Assistance and Services Act at W.S. 42-4-101, et seq., more specifically W.S. 42-4-103(a)(xxiii) and 42-4-117, and the Wyoming Administrative Procedures Act at W.S. 16-3-101, et seq.

Section 2. Statement of Purpose.

These rules and regulations are adopted to implement the Department's authority to deny, modify, suspend, or terminate facility approval.

(a) A program approved dialysis facility, whether in-state or out-of-state, will have its privilege to participate in the Program denied, modified, suspended, or terminated if:

(i) The facility loses Medicare approval;

(ii) The facility, with interim approval from the Program, fails to receive final Medicare/CMS approval;

(iii) The facility voluntarily withdraws from participation in the Program by providing the Program with a sixty (60) day written notice;

(iv) By mutual written consent of the Program and the facility;

(v) The facility fails or refuses to submit, in a manner prescribed by the Program, information which is requested for the purpose of determining the facility's compliance with program rules;

(vi) The facility submits materially false or intentionally misleading information to the Program;

(vii) The facility fails to reimburse the Department within ninety (90) days after it has been notified in writing that over payments have been made;

(viii) The facility files false claims.

Section 3. Procedures for Denial, Modification, Suspension, or Termination of Facility Approval.

(a) The Program shall notify the Administrator of the facility by certified mail of its intent to deny, modify, suspend, or terminate Program approval, the reasons for the adverse action, in compliance with the Wyoming Department of Health, Procedures For The Conduct of Contested Case Hearings, Chapter 1 (Aug. 4, 1983).