048-35 Wyo. Code R. § 35-4

Current through April 27, 2019

Section 35-4 - Definitions

Except as otherwise specified in Chapter 1 or as defined in this Section, the terminology used in this Chapter is the standard terminology and has the standard meaning used in accounting, health care, Medicaid, and Medicare.

(a) "Birth cost" - "Birth costs." As defined in W. S. § 14-2-1002(a)(i).

(b) "Bona fide effort to sell." The act of putting property up for sale and entering a written agreement with the Department.

(c) "Estate recovery." The recovery from the estate of a deceased client or from the estate of the spouse of a deceased client for reimbursement of Medicaid payments made on behalf of a client.

(d) "Incentive allowance." An allowance payment to the heirs, legatees or other person(s) who, having a valid claim to ownership of the deceased client's assets, who cooperate fully with the Department in maintaining and disposing of the assets so as to satisfy to the full extent possible the State's reimbursement right.

(e) "Medicaid benefit recovery." The recovery for reimbursement of Medicaid funds paid on behalf of a client.

(f) "Net proceeds." The dollar value from the sale of any real or personal property determined by deducting from the gross proceeds any amounts, including at a minimum, any liens or encumbrances against the property, realtor's commission fee, maintenance and repairs to the home required by a property inspection or needed to sell the property, an appraisal or broker's price opinion, attorney's fees and costs, and closing costs.

(g) "Non-probate estate." That portion of a client's estate or the estate of the spouse of a client which is not administered pursuant to the Wyoming Probate Code.

(h) "Probate estate." That portion of a client's estate or the estate of the spouse of a client which is administered pursuant to the Wyoming Probate Code.

(i) "Reasonable expenses incurred preserving or disposing of the asset(s)." Reasonable expenses incurred either in maintaining or disposing of the assets of a client's estate distributed pursuant to the summary distribution provisions pursuant to the Wyoming Probate Code or distribution pursuant to an affidavit, including:

(i) Closing costs for the sale of real property which results in the partial or complete satisfaction of the Department's reimbursement right (closing costs include the reasonable attorney's fees of the seller, the cost of title insurance, and recording costs);

(ii) Costs of an Administration pursuant to W.S. § 2-1-301(viii) and probate administration pursuant to W.S § 2-7-802;

(iii) An incentive allowance as prescribed in Section 6 of this rule;

(iv) If Medicaid participates in a probate with a claim then it should not reduce its lien by the amount of the costs to sell the property;

(v) Property insurance premiums;

(vi) Real or personal property taxes;

(vii) Utility costs which are necessary to preserve the property, only allowed if the property is vacant or not payable by a renter or lessee pursuant to a rental or lease agreement;

(viii) Other costs incurred pursuant to a written property management agreement signed by the Department;

(ix) Expenses incurred in providing necessary maintenance or making necessary repairs, without which the salability of the property would be substantially impaired.
- (A) Reasonable expenses do not include payment of credit card bills, telephone (cell phone) bills, or cable bills.

(j) "Third party payer." Any person, entity, agency, insurer, or government program that may be liable to pay, or that pays pursuant to an applicant's or client's right of recovery arising from an illness, injury, or disability for which Medicaid funds were paid or are obligated to be paid on behalf of the applicant or client. "Third party payer" includes, but is not limited to, the following: Medicare; liability insurance carriers; medical payments coverage carriers; workers' compensation; persons or entities alleged to be liable by contract, tort, equity, or otherwise for the client's Medicaid reimbursable expenses for the illness, injury, or disability of the applicant or client; a spouse or parent of an applicant or client who is obligated by law or court order to pay all or part of such costs; a client's estate; health insurers; self-insured plans; group health plans; long-term care insurers; service benefit plans; managed care organizations; pharmacy benefit managers; and any other parties that are, by statute, contract, or agreement legally responsible for payment of claims for health care items or services for an applicant or client.

(k) "TPL waiver." A waiver granted by CMS of the third party liability requirements of this chapter.

048-35 Wyo. Code R. § 35-4

Amended, Eff. 2/19/2019.