048-45 Wyo. Code R. § 45-27
(a) An individual or entity may apply to become a provider by completing the Division's initial provider certification packet and all required trainings. The applicant shall supply evidence that the applicant meets the qualifications for each service in which the applicant is seeking waiver certification.
(b) The Division shall only certify one provider per physical location.
(c) The Division shall not certify any person or entity as a waiver provider if:
(d) The Division may refuse to certify an entity that has an officer, administrator, or board member who was previously sanctioned by the Division. This refusal shall apply for a period of two (2) years from the date the person was sanctioned. The Division may also refuse to certify such person related to his or her involvement in any open or pending corrective action plan, or Medicaid Fraud Control Unit case until after the two (2) year period.
(e) Any person who has been convicted of Medicaid fraud shall not be certified.
(f) The Division shall refuse to certify or subsequently decertify a provider applicant who fails to disclose any convictions in a court of law on the Division's provider application or organization's application.
(g) Any falsifications of statements, documents, or any concealment of material fact may result in a denial or certification, decertification, or referral for criminal prosecution.
(h) If the Division receives information that the provider no longer meets the qualifications for each service for which the provider is certified, the Division will send notice to the provider within one business day regarding this missing qualification and the applicable sanction. If the missing qualification is not obtained within the timeframe given by the Division, the provider will be disqualified from providing such waiver service(s).
(i) The Division shall initially certify a new provider or provider agency providing any service for one year. The provider must complete a provider certification renewal at the end of the first year to continue providing services
(j) A person or entity may dispute an adverse action related to provider initial certification by a request for an administrative hearing, which will be administered pursuant to Chapter 4 of the Department of Health's Medicaid Rules.
048-45 Wyo. Code R. § 45-27
Amended, Eff. 6/21/2017.
Amended, Eff. 7/26/2018.