048-35 Wyo. Code R. §§ 35-10 - Medicaid Third Party Liability Recovery
(a) The Department may not agree to a
settlement which involves the compromise or release of any portion of the
federal medical assistance percentage, except as allowed by federal
law.
(b) Amount of the Department's
recovery. The Department may recover from any settlement or judgment involving
a third party payer the full amount of Medicaid funds paid or to be paid on
behalf of the client because of the injury, illness, or disability for which
such payments were made.
(i) If the
Department does not file an independent action or intervene in an existing
action, the Department shall calculate its reduced lien by deducting:
(A) Thirty-three percent (33%) for attorney's
fees; and
(B) A proportionate share
of the reasonable attorney's costs incurred in obtaining the client's recovery.
(I) The Department's proportionate share of
the reasonable costs incurred in making the client's recovery shall be
determined by:
(1.) Dividing the amount of
the Department's recovery (the amount of Medicaid benefits reimbursed minus
attorney's fees as provided in this Section) by the amount of the client's
gross recovery; and
(2.)
Multiplying the determined fraction by the reasonable costs incurred in making
the recovery.
(II) For
purposes of this section, "the reasonable attorney's costs incurred in making
the client's recovery" shall be court costs, costs of litigation, travel costs,
expert witness fees, deposition expenses, and any other costs necessarily
incurred in making the recovery. Reasonable costs shall be in the sole
discretion of the Department and shall not include any items for which the
client is not also responsible.
(ii) The Department may consider the
cost-effectiveness of reducing its claim for reimbursement after evaluating all
relevant factors, including:
(A) Available
insurance coverage or other factors relating to the assets or solvency of the
liable third party;
(B) Factual and
legal issues pertaining to liability;
(C) Legal issues or restrictions on the
Department's recovery, including problems of proof affecting the ability to
obtain settlement or judgment and;
(D) Estimated fees and costs associated with
the Department pursuing its claim.
(c) Structured settlements. A client's
recovery shall not be placed in a structured settlement until the Department
has been reimbursed and issued a release of its reimbursement right. If a
client prematurely enters into a structured settlement under which the initial
payment to the client is insufficient to reimburse the Department, the client
shall pay the Department all funds received in each installment until the
Department is paid in full. All structured settlements shall fully comply with
the requirements pertaining to annuities under the Department's
rules.
(d) Future Medicaid
payments. Except as otherwise agreed, the settlement of a client's claim does
not preclude the Department from seeking Medicaid benefit recovery for Medicaid
payments made after the date of such settlement.
(e) The Department shall have the right to
recover directly from a third party payer to the extent of Medicaid funds paid
or to be paid on behalf of a client when the existence and extent of liability
of such third party payer is established. In situations where a Medicaid client
was not represented by legal counsel, an attorney representing an insurance
company shall not disburse any insurance proceeds to the Medicaid client prior
to submitting a statement of available proceeds (declaration sheet), payment to
the Department, and approval by the Department.
(f) The Department shall have the right to
recover from any attorney who knowingly fails to notify the Department of any
settlement of judgment or fails to ensure the Department is reimbursed to the
extent of its reimbursement right.
(g) The Department shall have the right to
recover directly from a provider which has received Medicaid funds paid on
behalf of a client to the extent the provider has received payments from a
third party payer for the same services.
(h) The Department shall have the right to
recover from any attorney who knowingly fails to notify the Department of any
settlement or judgment or fails to ensure the Department is reimbursed to the
extent of its reimbursement right.
Notes
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