Family Services, Dept. of

Medical Programs - General

Chapter 8: Burial Program

Effective Date: 02/10/1994 to Current

Rule Type: Current Rules & Regulations

Reference Number: 049.0026.8.02101994

Department of Family Services

Medical Programs Chapter 8 - filed 2-10-94 Burial Program

Section 1. Authority. These rules are promulgated by the Department of Family Services (DFS), pursuant to the Administrative Procedures Act, W.S. 16-3-101 et seq., and the Public Assistance and Social Services Act, W.S. 42-2-103 (c).

Section 2. Purpose. The program provides financial assistance for Wyoming residents who were Medicaid eligible at the time of death and who were without sufficient means in their own estate or other resources to provide burial or cremation. The amount paid shall not exceed the maximum amount allowed by statute after consideration of funds available to the recipient from all other sources. Burial assistance shall not include those expenses relating to cemetery costs, cash advances or funeral services.

Section 3. Definitions.

(a) 'Burial' includes those mortician's services required to dispose of the remains of a deceased person in accordance with state law. Services may include but are not limited to: removal of the deceased from place of death to a mortuary, minimum services of staff, professional embalming when required, other preparation of the body (dressing and casketing), graveside committal service if requested, minimum casket and hearse to the cemetery. Financial assistance shall NOT be provided when a burial includes cash advances or funeral services.

(b) 'Burial Fund' is a bank account, life insurance policy, or written agreement with a funeral home which is specifically designated for burial of a specified person and not commingled with funds not set aside for burial.

(c) 'Cash Advances' are fronted monies customarily provided by the funeral director which include, but are not limited to, certified copies of the death certificate, cemetery costs, ministerial gratuities, musicians and hairdressers. These items may NOT be included in a minimum burial/cremation or the Minimum Burial Cost.

(d) 'Cemetery Costs' are charges relating to, but not limited to, the opening and closing of the grave, plot, vault, columbarium, crypt, mausoleum, headstone, and perpetual care. These items may NOT be included in a minimum burial/cremation or the Minimum Burial Cost.

(e) 'Cremation' includes those mortician's services required to dispose of the remains of a deceased person in accordance with state law. Services may include but are not limited to: removal of the deceased from place of death to a mortuary, minimum services of staff, professional embalming when required, minimum cremation container, transportation to crematory, cost of cremation, return of ashes to next of kin and graveside service for internment of ashes if requested. Financial assistance shall NOT be provided when a cremation includes cash advances or funeral services.

(f) 'Financial Assistance' is the benefit provided to recipients of the Burial Program in accordance with the limitations provided in regulation and policy. The benefit shall not exceed the maximum amount allowed by statute.

(g) “Funeral Services” include but are not limited to: visitation, church/chapel services, limousine, memorial books, folders and other printed goods. These items may NOT be included in a minimum burial/cremation or the Minimum Burial Cost.

“MBC” is an acronym for Minimum Burial Cost.

(i) “Medicaid Eligible” includes individuals who receive benefits under the AFDC, SSI, IV-E, State Foster Care, State Subsidized Adoption, and Home/Institutional/Community Medical Assistance Programs. The term also includes persons who are authorized for Medicaid benefits. Individuals who receive benefits under the Minimum Medical Program, State Licensed Shelter Care, State Hospital Placement, Qualified Medicare Beneficiaries and/or Special Low-Income Medicare Beneficiaries are NOT considered to be Medicaid eligible.

(j) “Medicaid Qualifying Trust” refers to a trust or similar legal device established by the applicant/recipient (or someone acting on his/her behalf), using his/her own property, under which:

(i) the applicant/recipient is a beneficiary of all or part of the payments from the trust, and

(ii) the amount of such distribution is determined by one or more trustees who are permitted to exercise any discretion with respect to the amount to be distributed to the individual. Medicaid Qualifying Trusts include trusts that are irrevocable or revocable. A trust established by will, however, CANNOT be considered to be a Medicaid Qualifying Trust.

(k) “Minimum Burial/Cremation” includes those mortician’s services required to dispose of the remains of a deceased person in accordance with state law. See also “Burial” and “Cremation.”

(l) “Minimum Burial Cost” is the minimum cost for a mortician’s services to dispose of the remains of a deceased person in accordance with state law. The MBC may NOT include cash advances or funeral services.

(m) “Minimum Services of Staff” means the minimum overhead a mortuary charges. This cost is listed on the current General Price List supplied by the mortuary.

“Representative” is a person acting on behalf of another person.

(o) “Resources” include, but are not limited to, income still available in the month of death, whole or term life insurance policies, burial contracts, funds set aside for burial, nursing home personal needs accounts, savings and checking accounts and other liquid assets which are immediately available at the time of death.

“Resident” is a person who lived in Wyoming or was authorized for Medicaid benefits from Wyoming Medicaid while living.

Section 4. Application Process. A representative for the deceased may be required to fill out a DFS application if the deceased's resources cannot be identified through records available in the DFS office. An administrative fair hearing will be granted upon the request of a representative if benefits are denied.

Section 5. Eligibility Factors.

(a) The program provides financial assistance for Wyoming residents who were Medicaid eligible at the time of death and who were without sufficient means in their own estate or other resources to provide burial or cremation.

(b) DFS shall determine if there are resources available to the deceased which are sufficient to provide for burial or cremation. In accordance with W. S. 42-2-103 (c), an amount up to or equal to $1,500 shall be considered to be unavailable when it is in the corpus of a Medicaid Qualifying Trust.

Section 6. Services Provided.

(a) Minimum Burial Cost - All burial assistance payments will be tested against the MBC submitted by the mortician. The following criteria apply to the MBC.

(i) Mortician's Professional Services

(A) The MBC may include the following services:

(I) Burial

(1.) removal of the deceased from place of death to a mortuary, (2.) minimum services of staff, (3.) professional embalming when required, (4.) other preparation of the body (dressing and casketing), (5.) graveside committal service if requested, (6.) minimum casket offered on casket price list, (7.) hearse to cemetery.

(II) Cremation

(1.) removal of the deceased from place of death to a mortuary, (2.) minimum services of staff, (3.) professional embalming when required, (4.) minimum cremation container, (5.) transportation to crematory, (6.) cost of cremation, (7.) return of ashes to next of kin, (8.) graveside service for internment of ashes if requested.

(B) The MBC will NOT include the following funeral services or cash advances:

(I) visitation, (II) church/chapel services, (III) limousine, (IV) memorial books, folders and other printed goods, (V) cash advances, which include but are not limited to: (1.) certified copies of the death certificate, (2.) cemetery costs, (3.) minister gratuities, (4.) musicians, (5.) hairdressers, (6.) newspaper notices, (7.) taxes.

(ii) Transportation

(A) The MBC will include the following transportation costs:

(I) Out of state - Transportation for the purposes of removal of the deceased from an out-of-state place of death to a mortuary in Wyoming when:

(1.) the eligible person was receiving medical treatment out of state at the time of death, or (2.) a Medicaid eligible child in DFS custody was receiving treatment or was visiting, placed or living out of state at the time of death.

(II) Within the state - Transportation for the purposes of removal of the deceased from place of death to a mortuary when:

(1.) the mortuary normally and customarily provides services to that outlying community, or

(2.) the eligible individual has a prepaid burial contract and/or burial space arrangements in another location.

(B) The MBC will indicate all potential and typical transportation scenarios.

(C) Transportation will NOT be allowed:

(I) When the family makes a request to transport the deceased to a specific location other than those previously outlined, or

(II) to transport the deceased back to the state when he/she was out of state for any reason other than those previously outlined (i.e. vacation).

(b) Mortician’s Billing Considerations - All burial assistance charges will be tested against the MBC which is current and on file with DFS.

(i) The mortician must, at least annually in July, provide DFS with an original and one duplicate of the MBC. The mortician is responsible for notifying DFS, in writing, of any changes in the MBC.

(ii) The mortician must include a copy of the current General Price List when filing the MBC with DFS.

(iii) DFS will review each MBC upon receipt to ensure all costs are allowable and appropriate. The current General Price List shall be used to verify minimum charges on the MBC.

(iv) The bill submitted to the agency for payment must be the original and exclusive itemized bill which was signed by the deceased’s authorized representative.

(v) If there is a bona fide charge or service the mortician is required to provide, an explanation should be made on the bill. A legitimate charge of this type will not be tested against the MBC or paid. These charges could include, but are not limited to: sales tax, when the mortician must charge, and vaults, when required by a cemetery.

Section 7. Payment Processing.

(a) Payments will be made on the original and exclusive itemized bill which was signed by the deceased’s authorized representative.

(b) All charges will be tested against the MBC which is current and on file with DFS. The bill will be summarily rejected if over the MBC except as provided in Section 6 (b) (v) above.

(c) Payment will not be made on cash advances or funeral services.

(d) The deceased’s available resources shall be applied to the bill before the payment amount is determined.

(e) Payment shall not exceed the maximum amount allowed by statute.

(f) DFS shall make payments for allowable services only when the bill is received within one year from the date the services were provided.

Section 8. Hearings. An administrative fair hearing will be granted in accordance with Department of Family Services, Chapter I, Procedures For Conduct of Contested Case Hearings, upon the request of a representative of the deceased if benefits are denied. The request shall be directed to the Department within twenty (20) days of the date of the denial of benefits.

Section 9. Severability. If any portion of these rules is found to be invalid or unenforceable, the remainder shall continue in effect.