Article 1 in general 351101. Local contributions; disposition


24112.  Final decision; conditions for approval; findings; ongoing supervision and reporting; renewal fees



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3524112.  Final decision; conditions for approval; findings; ongoing supervision and reporting; renewal fees.
(a)  The director shall issue a written decision approving or disapproving the application.
(b)  The director may condition approval on a modification of all or part of the proposed arrangement to eliminate any restriction on competition that is not reasonably related to the goals of reducing cost or improving access or quality. The director may also establish conditions for approval that are reasonably necessary to protect against abuses of private economic power and to ensure that the arrangement is appropriately supervised and regulated by the state.
(c)  The decision by the director approving or disapproving an application shall include specific findings of fact concerning cost, access and quality criteria and shall identify one (1) or more of these criteria as the basis for the decision.
(d)  The decision to approve an application shall require periodic submission of specific data by the applicant relating to cost, access and quality and to the extent feasible, the applicant shall identify objective standards of cost, access and quality by which the success of the arrangement will be measured. If the director determines that the scope of a particular proposed arrangement is such that the arrangement is certain to have neither a positive or negative impact on any one (1) of the criteria, the director may not require the submission of data or establish an objective standard relating to that criteria. An applicant shall submit a renewal fee together with information required under this subsection, in an amount determined by the department subject to limitations imposed under W.S. 3524104(d). Revenues from fees collected shall be deposited into the account established under W.S. 3524104(d).
3524113.  Judicial review.
After the director has rendered a decision under W.S. 3524112 and in accordance with W.S. 163114, the applicant or any other aggrieved party may request judicial review of the director's decision by filing a petition for review within thirty (30) days in accordance with the Wyoming Administrative Procedure Act. A determination under W.S. 3524107(a) shall not be raised as an issue on appeal.
3524114.  Ongoing supervision following application approval; procedures; solicitation of public comment on arrangement impacts.
(a)  The director shall appropriately supervise, monitor and regulate approved arrangements consistent with subsection (b) of this section.
(b)  The decision approving the application shall specify a time schedule for the submission of data by the applicant, which shall be at least once a year and shall identify the data required to be submitted. The director may at any time require the submission of additional data or alter the time schedule. Upon review of the data submitted, the director shall notify the applicant on compliance of the arrangement with the initial decision or subsequent orders. If the arrangement is not in compliance, the director shall identify those respects in which the arrangement does not conform to the decision.
(c)  An applicant receiving notification that an arrangement is not in compliance may respond with additional data within thirty (30) days. The response may include a proposal and time schedule by which the applicant will bring the arrangement into compliance with the initial decision or subsequent orders. If the arrangement is not in compliance and the director and the applicant cannot agree to the terms of bringing the arrangement into compliance, the matter shall be set for hearing. The hearing shall be conducted as a contested case in the manner prescribed under W.S. 3524110. The hearing officer shall issue a written recommendation to the director who shall issue a final decision within thirty (30) days following issuance of the recommendation. A copy of the recommendation and final decision shall be provided to all parties to the contested case hearing. A final decision by the director is subject to judicial review in accordance with W.S. 163114.
(d)  The director shall publish notice two (2) years after the date the initial application is approved and at two (2) year intervals thereafter, soliciting comments from the public concerning the impact the arrangement has had on cost, access and quality. The director may request additional oral or written information from the applicant or from any other source.
3524115.  Revocation of approval; conditions; notice; public comment; hearing; revocation alternatives specified; liability of applicant.
(a)  Subject to subsection (d) of this section, the director shall revoke his initial approval of an application if the arrangement:
(i)  Is not in substantial compliance with the terms of the application;
(ii)  Is not in substantial compliance with the conditions of approval;
(iii)  Has not and is not likely to substantially achieve improvements in cost, access or quality or the promotion of a comprehensive health care system in the state as identified in the initial decision as the basis for approval of the arrangement; or
(iv)  Is not promoting reductions in cost and improvements in access and quality to the extent competition would do so due to changing conditions in the marketplace. Revocation under this paragraph shall be identified in writing by the director together with reasons therefor.
(b)  The director shall initiate a proceeding to revoke approval by providing written notice to the applicant describing in detail the basis for the proposed revocation. Notice of the proceeding shall be published and provided to all interested parties in the manner and time specified under W.S. 3524104(b), which shall request the submission of comments to the director.
(c)  A proceeding to revoke an approval shall be conducted as a contested case proceeding upon the written request of the applicant. The attorney general may appear as a party. The contested hearing shall be conducted in the manner prescribed by W.S. 3524110. Decisions of the director in a proceeding to revoke approval are subject to judicial review in accordance with W.S. 163114.
(d)  In deciding whether to revoke an approval, the director shall consider the hardship the revocation may impose on the applicant and any potential disruption of the market as a whole. The director shall also consider based upon a demonstration by the applicant, if the arrangement can be modified, restructured or regulated in a manner to remedy the problem upon which the revocation proceeding is based. Before approving an alternative to revocation that involves modifying or restructuring an arrangement, the director shall publish notice stating that any person may comment on the proposed modification or restructuring within twenty (20) days after publication of the notice. The director shall not approve any modification or restructuring until the comment period has concluded. An approved modified or restructured arrangement is subject to appropriate supervision in the manner provided under W.S. 3524114.
(e)  An applicant that has had its approval revoked is not required to terminate the arrangement. The applicant cannot be held liable under state or federal antitrust law for acts that occurred while the approval was in effect, except to the extent the applicant failed to substantially comply with terms of its application or failed to substantially comply with terms of the approval. The applicant is subject to state and federal antitrust law after the revocation becomes effective and may be held liable for acts that occur after the revocation.
3524116.  Application of insurance code.
Nothing in this chapter shall relieve an applicant or recipient of an exception under this chapter from applicable provisions of the Wyoming Insurance Code.
CHAPTER 25

PUBLIC PROGRAMS


ARTICLE 1

CHILD HEALTH INSURANCE PROGRAM


3525101.  Uninsured child health insurance program.
There is created a child health insurance program for families with a gross monthly income at or below one hundred eighty-five percent (185%) of the federal poverty level, until July 1, 2005, and thereafter, for families with a gross monthly income at or below two hundred percent (200%) of the federal poverty level.
3525102.  Definitions.
(a)  As used in this act:
(i)  "Child" means a person who has not yet reached the nineteenth anniversary of his birth;
(ii)  "Department" means the department of health;
(iii)  "Federal poverty level" means the federal poverty guideline updated annually in the federal register by the United States department of health and human services under the authority of section 673(2) of the Omnibus Budget Reconciliation Act of 1981;
(iv)  "Private health insurance" means an individual insurance policy or contract for the purpose of paying for or reimbursing the cost of dental, hospital and medical care;
(v)  "State plan" means the state plan required by Public Law 105-33 to be submitted by the state to the United States secretary of health and human services to receive federal funding for a child health insurance program;
(vi)  "This act" means W.S. 3525101 through 3525108.
3525103.  Child health insurance program eligibility.
Subject to approval of the state plan by the United States secretary of health and human services, and subject to available state and federal funding the department shall provide a health insurance plan offered through a private insurance company licensed by the insurance commissioner to write insurance in Wyoming for an eligible child whose monthly gross family income is not more than one hundred eighty-five percent (185%) of the federal poverty level, until July 1, 2005, and thereafter, whose monthly gross family income is not more than two hundred percent (200%) of the federal poverty level. A child who is determined eligible to receive benefits under this section shall remain eligible for twelve (12) months as long as the child resides in the state of Wyoming and has not yet attained nineteen (19) years of age. A child's eligibility to receive benefits under this act shall be redetermined on an annual basis. A simplified application process, which includes minimum eligibility requirements, shall be provided throughout the state at various public and private establishments approved by the department of health. To be determined eligible to receive benefits under this section, a child shall not be eligible under the Wyoming Medical Assistance and Services Act, shall not have been covered under another health insurance plan for a minimum of one (1) month prior to application for coverage under this act or, upon birth, the child would not otherwise be covered by a public or private health insurance plan. Eligibility under this section shall be determined by the department of health or its designee.
3525104.  Private insurance program benefits.
A child eligible for services under this act shall receive benefits developed by the health benefits committee established under W.S. 3525105 that include cost sharing factors, not to exceed the maximum allowable under Public Law 10533, exclusions and limitations. The benefit package shall include, at a minimum, inpatient and outpatient hospital services, physician services, laboratory and x-ray services, well-baby and well-child care including age appropriate immunizations and the additional services of prescription drug coverage, vision coverage and dental coverage which will include preventive and basic services developed by the health benefits committee.
3525105.  Health benefits plan committee.
(a)  A health benefits plan committee is hereby established and shall be composed of ten (10) members, which include:
(i)  The director of the Wyoming department of health or his designee;
(ii)  The director of the Wyoming department of family services or his designee;
(iii)  The Wyoming insurance commissioner or his designee;
(iv)  One (1) representative each, appointed by the governor, consisting of:
(A)  An authorized insurer writing individual and group health insurance business in Wyoming;
(B)  An employer;
(C)  A parent;
(D)  A licensed insurance agent experienced in selling health insurance;
(E)  A licensed physician who specializes in pediatric care or family medicine;
(F)  A licensed health care provider experienced in providing pediatric care; and
(G)  A member of the general public.
(b)  The terms of the committee members appointed by the governor shall be four (4) years. Members of the committee appointed prior to July 1, 2003 may continue to serve the remainder of their terms. The committee shall review on at least a biennial basis the form and level of benefits to be made available pursuant W.S. 3525104.
(c)  The committee shall develop a package of benefits as allowed by section 2103(a)(4) of Public Law 105-33, including cost sharing factors, exclusions and limitations.
(d)  The committee shall submit its recommendations to the director of the department for approval no later than October 1, 2003, and at least biennially thereafter.
(e)  Members of the committee shall be reimbursed for travel and per diem in the same manner as state employees. Members may also be reimbursed for any committee-related expenses which receive prior approval by the department. Members shall not be otherwise compensated for their services.
(f)  Committee meetings shall be open to the public.
3525106.  Private health insurance plan request for proposals.
(a)  The department shall publish notice of a request for proposals from qualified insurers to provide a health insurance plan for children insured under W.S. 3525103 of this act. The department shall award the contract for this service to an insurer based on price, the provision of benchmark services determined pursuant to W.S. 3525105(c), and other factors listed in the department's request. The contract for health insurance awarded under this section shall contain provisions with respect to exclusions from coverage for preexisting conditions that are no more restrictive than those described in section 2102 (b)(1)(B)(ii) of Public Law 105-33. The contract shall include provisions for changes in terms and conditions and for rebidding in case major changes are needed. The department shall have the right to rebid the contract after two (2) years.
(b)  Biennially, the department may allow the contractor to adjust the price charged for the coverage, but if the price is increased, the department may, after public notice, rebid the contract.
(c)  If the department does not receive a proposal from an insurance company within one hundred twenty (120) days after issuing the request for proposals required in subsection (a) of this section, the department may provide services to children eligible under this act with a public health benefit package designed to provide the same services as authorized under the Wyoming Medical Assistance and Services Act. A medical provider who accepts payment for services provided under this subsection shall not charge or attempt to collect payments in excess of the rate schedule established by the department of health.
3525107.  Program expenditures; monitoring; recommendations; required action to limit expenditures to budget available.
(a)  The department shall project monthly expenditures under this act each month through the end of the biennium based upon the level of activity for the previous months and the trend in expenditures compared to previous expenditures. If the projections indicate that expenditures may exceed the federal and state funds available under this act, the department, may, by rule and regulation and subject to availability of funds, limit participation in the program under this section as follows:
(i)  The department may impose a partial or total moratorium on new enrollments in the programs under this act until funds are available to meet the needs of new enrollees;
(ii)  For current recipients of benefits under this act, priority for the continuation of funding shall be given to those families with the lowest incomes.
(b)  In the last six (6) months of the biennium, the department shall include a projection of expenditures for the next biennium based on the spending for the current biennium unless the legislature provides for a different level of funding for the next biennium.
(c)  The funding for the child health insurance program shall be deemed to be included within the division of health care financing line item within the department of health budget unless a separate line item is provided in the budget bill. General fund expenditures for the child health program shall not exceed the amount needed to match federal funds without explicit authorization enacted in the budget bill.
3525108.  Implementation; duties; restrictions on the department of health.
(a)  The department shall:
(i)  Administer this act within the fiscal constraints of Public Law 105-33 and subsequent federal enactments governing this program and the state budget as enacted by the legislature;
(ii)  Develop a state plan for child health insurance to qualified recipients under this act and otherwise provide for the effective administration of this act;
(iii)  Maintain records on the administration of this act and report to the federal government as required by federal law and regulation;
(iv)  Adopt, amend and rescind rules and regulations on the administration of this act following notice and public hearing in accordance with the Wyoming Administrative Procedure Act;
(v)  Establish indicators for measuring access, process, quality and outcomes effectiveness in improving children's health.
(b)  The department shall not implement:
(i)  The program under this act until a state plan has been approved by the United States secretary of health and human services; and
(ii)  Any state plan that does not conform to the requirements of this act.
3525109.  Repealed By Laws 2003, Ch. 99, § 2.
3525110.  Repealed By Laws 2003, Ch. 99, § 2.
3525111.  Repealed by Laws 2016, ch. 20, § 2.
ARTICLE 2

WYOMING CANCER CONTROL ACT


3525201.  Short title.
This act shall be known and may be cited as the "Wyoming Cancer Control Act."
3525202.  Definitions.
(a)  As used in this act:
(i)  "CDC" means the federal center for disease prevention and control;
(ii)  "County cancer resource coordinator program" means a program undertaken through a private organization, county hospital, hospital district hospital or city or county health department which provides local level education, outreach, patient navigation services, community planning and data collection in order to lessen the impact of cancer on Wyoming people;
(iii)  "Department" means the department of health;
(iv)  "Evidence based" means relying on scientifically valid evidence. Scientifically valid evidence relies on studies and experiments including systematic reviews of multiple randomized controlled trials or epidemiological studies, one (1) or more randomized controlled trials, one (1) or more epidemiological studies and the recommendations of nationally and internationally recognized groups of experts in the field;
(v)  "Medicaid" means the joint federal and state program of health care financing for the poor authorized by Title XIX of the federal Social Security Act and title 42 of the Wyoming statutes;
(vi)  "Statewide comprehensive cancer control steering committee" means a committee whose mission is defined by the 2006-2010 Wyoming cancer control plan and which provides advice and guidance to the Wyoming comprehensive cancer control program. The committee is a private entity whose members include government employees;
(vii)  "This act" means W.S. 3525201 through 3525206.
3525203.  Cancer control plan and program.
(a)  The department shall develop a comprehensive cancer control plan. The department shall begin with the plan and recommendations in the Wyoming cancer control plan published in October 2005 by the Wyoming comprehensive cancer control consortium. The goals shall be to reduce the numbers of people affected by cancer with improved prevention and education and, for those individuals who are diagnosed with cancer, the goal shall be to provide diagnostic, therapeutic and palliative interventions that are evidence based, scientifically proven best of care. The comprehensive cancer control plan may include:
(i)  Cancer prevention and education for both the public, health care professionals and institutions;
(ii)  Evidence based early detection, screening, diagnosis and treatment;
(iii)  Research and data collection;
(iv)  Palliative care including pain management and other steps to improve the quality of life of probably terminal cancer patients;
(v)  Rehabilitation of cancer victims; and
(vi)  Programs to assist cancer survivors in returning to normal life.
(b)  In financing and implementing the program established pursuant to subsection (a) of this section the department shall consider the use of the Medicaid program. This section does not constitute authorization to expand the services and eligibilities of the Medicaid program which requires specific legislative authorization. The department may recommend such authorization where appropriate.
(c)  The department may contract with one (1) or more third parties to develop and implement the plans authorized by this section. Any contract awarded under this section shall be awarded on the basis of competitive bids and shall include specific requirements relating to outcome based evaluation.
(d)  Subject to the restriction of subsection (b) of this section, the department may accept state, federal, local and nongovernmental funds for developing and implementing the plans established pursuant to this section.
(e)  The department may solicit proposals for grants under this section by publication of a request for proposals. Grant recipients under this section may include local governments, private nonprofit organizations, schools and other organizations as appropriate. Any grants to organizations not political subdivisions of the state of Wyoming or under the absolute control of the state shall be subject to any restriction necessary to comply with Article 16, Section 6 of the Wyoming Constitution. Any request for proposals used during the competitive grant process shall include specific requirements relating to outcome based evaluation of the grant recipient's performance.
(f)  The department shall collaborate and coordinate with public and private entities including state and local governments and the CDC to assure maximum effective use of resources, people and money. The department shall take advice, as appropriate, from the statewide comprehensive cancer control steering committee.
(g)  Considering funds available and the purposes for which those funds are made available, the department shall give emphasis to the following cancer control and prevention programs:
(i)  The county cancer resource coordinator program. This program shall be a pilot program in two (2) sites, one (1) urban and one (1) rural. Each program shall cover at least one (1) county and may cover several counties. The program may be expanded to additional sites if sufficient funds become available;
(ii)  Public education relating to cancer prevention and awareness for all cancers;
(iii)  Early detection of cancer including those cancers identified in the state cancer control plan and specifically including the Wyoming colorectal cancer early detection and prevention program;
(iv)  Programs and public education which promote the reduction of risk factors to reduce cancer and other chronic diseases within the state; and
(v)  Programs and public education which enhance treatment and quality of care of those impacted by cancer within the state.
(h)  The department may propose cancer control as a specific line item in its biennial budget.
(j)  The department shall, in accordance with the Wyoming Administrative Procedure Act, promulgate rules and regulations as appropriate to implement this act.
(k)  The department shall report on its activities, program outcomes, conclusions and goals for the next two (2) years under this act to the joint labor, health and social services interim committee. The report shall be due on October 1 of every odd numbered year.

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