048.0037.4.5

Ch. 4, § 5. Notice of Right to Hearing and Adverse Action

Last amended: 2020Length: 257 wordsOfficial source

Cite as Medicaid Rules, Ch. 4, § 5

(a) Applicants and clients. The Department shall provide notice at the time of any adverse action. The notice shall include: (i) An explanation of: (A) The individual's right to request a hearing; or (B) An explanation of circumstances where a hearing will be granted based on a change in the law. (ii) The method for requesting a hearing; (iii) The individual's right to be represented by a legally authorized representative, including a lawyer admitted to practice in Wyoming, a relative, friend or other spokesperson; (iv) Notice that the individual shall notify the Department in writing that they will be represented; (v) The intended action; (vi) The effective date of the intended action; (vii) The reason(s) for the intended action; (viii) The specific regulations that support, or the change in federal or state law that requires the action; (ix) Where applicable, an explanation of the circumstances under which benefits may be continued if a hearing is requested pursuant to 42 C.F.R. § 431.231. (b) Providers. The Department shall notify a provider of the right to a hearing following the request for reconsideration, at the time of the notice of adverse action, except when issuing a notice of claims payment or denial. The notice shall include: (i) A statement of the intended action; (ii) The effective date of the intended action; (iii) The reason(s) for the intended action; (iv) The specific regulations that support, or the change in federal or state law that requires the action; (v) The right to representation by a lawyer admitted to practice in Wyoming.
048.0037.4.5: Ch. 4, § 5. Notice of Right to Hearing and Adverse Action | Justis AI