Statutes, codes, and regulations
Wyoming Administrative Code
Agency 048 - Health, Department ofSubagency 0037 - Medicaid
Chapter 22 - RULES AND REGULATIONS FOR MEDICAID EVALUATION OF MEDICAL NECESSITY FOR MEDICAID LONG TERM CARE PROGRAMS
Section 22-7 - Reconsideration

048-22 Wyo. Code R. § 22-7

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Current through April 27, 2019
Section 22-7 - Reconsideration

(a) Request for reconsideration.

  • (i) A provider shall not request that the Department reconsider a determination of medical necessity made pursuant to this Chapter.
  • (ii) An applicant, client, or their representative may request that the Department reconsider an adverse determination of medical necessity made pursuant to this Chapter. Such requests shall be submitted to the Department in writing within ten (10) days of the date the client or applicant receives the denial letter from the medical necessity evaluator.

(b) Reconsideration. The Department shall review the request and order that a second evaluation of medical necessity be performed by a different evaluator. Clients currently receiving Medicaid services shall continue to receive those services during reconsideration.

(c) Request for additional information. The Department may request additional information from the applicant or client as part of the reconsideration process. The requested information shall be provided within thirty (30) days after the date of the request. Failure to provide the requested information shall result in the dismissal of the reconsideration. Information may be obtained from the medical necessity evaluator as part of the reconsideration process.

048-22 Wyo. Code R. § 22-7