048-1 Wyo. Code R. §§ 1-12 - Contingent on funding

(a) Payment contingent on funding. Payment to providers is contingent on the availability of PDAP funds. The Department shall not be obligated to make payments in the absence of such funds.

(b) Projection of costs. The Department shall project costs of the program at least quarterly and compare those projected costs against PDAP funds. If the funds available to the program are insufficient to meet the projected costs of the program, the Department shall take action to prevent the program from incurring costs beyond available funds, including taking any of the following actions:

(i) Imposing a moratorium on enrolling new recipients in the program;

(ii) Reducing the income eligibility level specified in section 4 below the federal poverty level;

(iii) Imposing higher prescription drug copayments not to exceed twenty-five dollars ($25.00) per prescription;

(iv) Eliminating specified drugs from the formulary;

(v) Carrying claims into the next biennium i f the amount of claims i s less than one twentyfourth (1/24) of the appropriation that has been enacted for the next biennium.

(c) Automatic termination of PDAP. PDAP shall be automatically discontinued, and reimbursement for services shall be suspended, when and if PDAP funds become exhausted. Claims for services which have not been paid at the time PDAP is discontinued shall be suspended until such time as additional funds are appropriated. If additional, appropriated PDAP funds become available, claims which were suspended shall not be retroactively paid unless otherwise specified by the statute or appropriation which provides for additional PDAP funds.

(d) Automatic Reinstatement of PDAP. PDAP shall be automatically reinstated, and reimbursement for services shall be reinstated, when and if the Legislature appropriates additional funds. Claims which were suspended shall not be retroactively paid unless otherwise specified by the statute or appropriation which provides for additional PDAP funds.

(e) Notice of program reduction or termination. The Department shall provide thirty days written notice, if possible, to participating providers and recipients of any program reductions or termination of the program.

(f) No appeal. A program reduction, termination, suspension, 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 1, Administrative Hearing of the Wyoming Medicaid Rules.

Notes

048-1 Wyo. Code R. §§ 1-12