Wyo. Code R. 048-0049-5
Renal Disease Program, Administrative Procedure for End Stage
Chapter 5: Denial/Modification/Suspension/Termination of Facility Approval
Effective Date: 10/12/1988 to 09/07/2010
Rule Type: Superceded Rules & Regulations
Reference Number: 048.0049.5.10121988
Section 1. 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 fails or refuses to enter into a contract with the Division to participate in the Wyoming ESRD Program;
(iii) The facility, with interim approval from the ESRD Program, fails to get Medicare/HCFA approval;
(iv) The contract between the facility and the Division is terminated for any reason, including:
(A) The facility's failure to comply with the terms of applicable contract and inability to cure such failure within 30 days after receipt of written notice from the Division;
(B) The contracting parties are unable to agree upon any amendment which would therefore be needed to enable continuation of services;
(C) The facility voluntarily withdraws from participation in the ESRD Program by providing the Division with a 60 day written notice; or
(D) 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 performance under the contract;
(vi) The facility submits false or misleading information to the Division;
(vii) The facility fails to reimburse the program within 90 days after it has been notified in writing that over payments have been made;
(viii) The facility files false claims.
Section 2. 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 contestant’s right to a hearing and the method by which he may obtain a hearing.