Statutes, codes, and regulations
Wyoming Administrative Code
Agency 048 - Health, Department ofSubagency 0037 - Medicaid
Chapter 16 - PROGRAM INTEGRITY
Section 16-20 - Reconsideration

048-16 Wyo. Code R. § 16-20

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Current through April 27, 2019
Section 16-20 - Reconsideration

(a) Request for reconsideration.

  • (i) A provider may request that the Department reconsider an adverse action. Such request shall be mailed to the Department by certified mail within twenty (20) days after the date the provider receives notice pursuant to subsection 9(d) of this Chapter. The request must state with specificity the reasons for the request. Failure to provide such a statement shall result in the dismissal of the request with prejudice. A provider may submit any additional relevant information at the time of the request.
  • (ii) A client may request that the Department reconsider a decision to recover overpayments. Such request must be mailed to the Department by certified mail, return receipt requested, within twenty (20) days of the date the individual receives notice pursuant to Section 10 of this Chapter. A client may submit any additional relevant information at the time of the request.

(b) Reconsideration. The Department shall review the decision and send written notice of its final decision by certified mail, return receipt requested, to the party requesting reconsideration within forty-five (45) days after receipt of the request for reconsideration or the receipt of any additional information requested pursuant to subsection (c) below, whichever is later.

(c) Request for additional information. The Department may request additional information from the party requesting reconsideration as part of the reconsideration process. Such a request shall be made in writing by certified mail, return receipt requested. The party to whom the request is directed must provide the requested information within thirty (30) days after the date of the request. Failure to provide the requested information shall result in the dismissal of the request for reconsideration with prejudice.

(d) Matters subject to reconsideration. Reconsideration shall be limited to whether the Department has complied with the provisions of this Chapter or other applicable rules of the Department.

(e) Informal resolution. The party requesting reconsideration or the Department may request an informal meeting before the final decision on reconsideration to determine whether the matter may be resolved. The substance of the discussions and/or settlement offers made pursuant to an attempt at informal resolution shall not be admissible as part of a subsequent administrative hearing or judicial proceeding.

(f) Failure to Request Reconsideration.

  • (i) A provider that fails to request reconsideration pursuant to this section may not subsequently request an administrative hearing pursuant to Chapter 4 regarding the adverse action.
  • (ii) A client may elect not to request reconsideration and may request an administrative hearing pursuant to Chapter 4 regarding the adverse action. Such a request for hearing shall be made by mailing by certified mail, return receipt requested, or personally delivering a request for hearing to the Department within thirty (30) days of the date of the notice of the adverse action.

048-16 Wyo. Code R. § 16-20