Health, Department of

Renal Disease Program, Administrative Procedure for End Stage

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

Effective Date: 09/07/2010 to 07/24/2014

Rule Type: Superceded Rules & Regulations

Reference Number: 048.0049.5.09072010

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 Rural and Frontier Health Division, 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 Division’s authority to deny, modify, suspend, or terminate ESRD facility approval.

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

(i) The facility loses Medicare approval;

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

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

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

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

(vi) The facility submits false or misleading information to the Division;

(vii) The facility fails to reimburse the program 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 ESRD 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, as well as reaffirm the facility’s right to a hearing and the method by which it may obtain a hearing.