048.0037.4.5
Ch. 4, § 5. Notice of Right to Hearing and Adverse Action
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.