048-1 Wyo. Code R. § 1-11

Current through April 27, 2019

Section 1-11 - Contingent on Funding

(a) In accordance with Program Expenditure provisions of the Act, payment to participating insurance companies shall be contingent on the availability of Kid Care CHIP funds.

(b) Monitoring and projecting program expenditures. The Department shall:

• (i) Monitor program expenditures to ensure that the expenditures do not exceed program funds;

• (ii) Make monthly projections of expenditures for the remainder of the biennium based on program expenditures for the most recent six (6) calendar months, trended forward for the remainder of the biennium, and including utilization trends and the estimated amount of unpaid invoices.

(c) Program limitations. If the budget projections prepared pursuant to this Section show that there will or may be insufficient program funds, the Department may declare a partial or total moratorium on new insureds, so that otherwise eligible individuals will not be determined eligible until such time as the Department determines that sufficient program funds are available. Any such moratorium shall be no more restrictive than necessary to bring projected program expenditures into conformance with available program funds. The Department may also consider cost containment actions having no adverse effect on eligibility standards, methods and procedures. As per section 2105(d)(3) of the Social Security Act, as amended by section 2101(b) of the Affordable Care Act, the maintenance of effort (MOE) provision requires maintenance of CHIP eligibility standards, methods and procedures in effect on March 23, 2010, and to continue until a date determined by federal law.

(d) No appeal. A program reduction or termination, or the denial of eligibility because of a moratorium, shall not be adverse actions, and shall not be subject to reconsideration pursuant to this Chapter or an administrative hearing pursuant to Chapter 4 of the Medicaid rules.

048-1 Wyo. Code R. § 1-11