revision - wyoming department of healthrevision hcfa pm 94 5 april 1994 state territory 19 mb...
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RevisionHCFAPM945APRIL1994StateTerritory19MBWYOMINGSECTION3SERVICESGENERALPROVISIONS31AmountDurationandScopeofServicesaMedicaidisprovidedinaccordancewiththerequirementsof42CFRPart440SubpartBandsections1902a1902e1905a1905p19151920and1925oftheActcitation42CFRPart440SubpartB1902a1902e1905a1905p19151920and1925oftheAct1categoricallyneedyServicesforthecategoricallyneedyaredescribedbelowandinATTACHMENT31ATheseservicesincludei1902a10Aand1905aoftheActiiEachitemorservicelistedinsection1905a1through5and21oftheActisprovidedasdefinedin42CFRPart440SubpartAorforEPSDTservicessection1905rand42CFRPart441SubpartBNursemidwifeserviceslistedinsection1905a17oftheActareprovidedtotheextentthatnursemidwivesareauthorizedtopracticeunderStatelaworregulationandwithoutregardtowhethertheservicesarefurnishedintheareaofmanagementofthecareofmothersandbabiesthroughoutthematernitycycleNursemidwivesarepermittedtoenterintoindependentprovideragreementswiththeMedicaidagencywithoutregardtowhetherthenursemidwifeisunderthesupervisionoforassociatedwithaphysicianorotherhealthcareproviderNotapplicableNursemidwivesarenotauthorizedtopracticeinthisstateTNNo00005SLlpersedesTNNoqlL3ApprovalDateEffectiveDate40110
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19aRevisionHCFAPM914AUGUST1991BPDOMBNo0938CitationStateTerritory3lalAmountDurationandSCODeofServicesCategoricallYNeedYContinuedWYOMING1902a10clauseVIIofthematterfollowingoftheActFiiiPregnancyrelatedincludingfamilyplanningservicesandpostpartumservicesfora60dayperiodbeginningonthedaypregnancyendsandanyremainingdaysinthemonthinwhichthe60thdayfallsareprovidedtowomenwhowhilepregnantwereeligibleforappliedforandreceivedmedicalassistanceonthedaythepregnancyendsLXivServicesformedicalconditionsthatmaycomplicatethepregnancyotherthanpregnancyrelatedorpostpartumservicesareprovidedtopregnantwomenvServicesrelatedtopregnancyincludingprenataldeliverypostpartumandfamilyplanningservicesandtootherconditionsthatmaycomplicatepregnancyarethesameservicesprovidedtopovertyleyelpregnantwomeneligibleundertheprovisionofsections1902alOAiIVand1902alOAiiIXoftheAct1902e5oftheActTNNoq3supereQeAPprOVlTNNolo1190DateqdEffectiveDateHCFAID7982E
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19bRevisionHCFAPM927MBOctober1992CitationStateTerritoryWVMTN31a1AmountDurationandScopeofServicesCategoricallYNeedyContinued71902e7oftheAct1902e9oftheAct1902a52and1925oftheAct1905a23and1929TNNoSuperseTNNoHomehealthservicesareprovidedtoindividualsentitledtonursingfacilityservicesasindicatedinitem31bofthisplanviiInpatientservicesthatarebeingfurnishedtoinfantsandchildrendescribedinsection190211Bthrough0orsection1905n2oftheActonthedatetheinfantorchildattainsthemaximumageforcoverageundertheapprovedStateplanwillcontinueuntiltheendofthestayforwhichtheinpatientservicesarefurnishedviviiiRespiratorycareservicesareprovidedtoventilatordependentindividualsasindicatedinitem31hofthisplanixServicesareprovidedtofamilieseligibleundersection1925oftheActasindicatedinitem35ofthisplanHomeandCommunityCareforFunctionallyDisabledElderlyIndividualsasdefineddescribedandlimitedinSupplement2toAttachment31AandAppendicesAGtoSupplement2toAttachment31AxATTACHMENT31AidentifiesthemedicalandremedialservicesprovidedtothecategoricallyneedyspecifiesalllimitationsontheamountdurationandscopeofthoseservicesandliststheadditionalcoveragethatisinexcessofestablishedservicelimitsforpregnancyrelatedservicesandservicesforconditionsthatmaycomplicatethepregnancyApprovalOate3I93EffectiveOate
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State of Wyoming Section 3
Page 19 C
Citation 31a1Amount Duration and Scope of Services Categorically NeedyContinued
1905a26and 1934X Program of All Inclusive Care for the Elderly PACE services as
described and limited in Supplement 3 to Attachment 31A
ATTACHMENT 31A identifies the medical and remedial services provided tothe categorically needy Note Other programs to be offered to CategoricallyNeedy beneficiaries would specify all limitations on the amount duration andscope of those services As PACE provides services to the frail elderly populationwithout such limitation this is not applicable for this program In addition otherprograms to be offered to Categorically Needy beneficiaries would also list theadditional coverage that is in excess of established service limits for pregnancyrelated services for conditions that may complicate the pregnancy As PACE isfor the frail elderly population this also is not applicable for this program
TN No 11 003 Approval Date Effective Date 10012011
SupersedesTN NO New
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20RevisionHCFAPM91August1991stateTerritoryBPDOMBNo0938WYOMINGcitation31AmountDurationandScopeofServicescontinued42CFRPart440SubpartBa2Medicallyneedy1ThisStateplancoversthemedicallyneedyTheservicesdescribedbelowandinATTACHMENT31bareprovidedServicesforthemedicallyneedyinclude42CFR4402201902a10CivoftheActiIfservicesinaninstitutionformentaldiseases42CFR440140and440160oranintermediatecarefacilityforthementallyretardedorbothareprovidedtoanymedicallyneedygrouptheneachmedicallyneedygroupisprovidedeithertheserviceslistedinsection1905a1through5and17oftheActorsevenoftheserviceslistedinsection1905a1through20servicesareprovidedasdefinedin42CFR440SubpartAandinsections190219051915oftheActThePartand1Notapplicablewithrespecttonursemidwifeservicesundersection1902a17NursemidwivesarenotauthorizedtopracticeinthisState1902e5oftheActiiPrenatalcareanddeliveryservicesforpregnantwomenTNNofsedesApprovalDateIIq33qEffectiveDatedHCFA107982E
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120aRevisionHCFAPM91August1991stateTerritoryBPDOMBNo0938WYOMINGCitation31a2AmountDurationandScooeofServicesMedicallvNeedvContinuediiiPregnancyrelatedincludingfamilyplanningservicesandpostpartumservicesfora60dayperiodbeginningonthedaythepregnancyendsandanyremainingdaysinthemonthinwhichthe60thdayfallsareprovidedtowomenwhowhilepregnantwereeligibleforappliedforandreceivedmedicalassistanceonthedaythepregnancyends1ivServicesforanyothermedicalconditionthatmaycomplicatethepregnancyotherthanpregnancyrelatedandpostpartumservicesareprovidedtopregnantwomenfofiXcvAmbulatoryservicesasdefinedinATTACHMENT31forrecipientsunderage18andrecipientsentitledtoinstitutionalservices1NotapplicablewithrespecttorecipientsentitledtoinstitutionalservicestheplandoesnotcoverthoseservicesforthemedicallyneedyviHomehealthservicestorecipientsentitledtonursingfacilityservicesasindicatedinitem31bofthisplan42CFR440140440150440160SubpartB442441SubpartC1902a20and21oftheAct1viiServicesinaninstitutionformentaldiseasesforindividualsoverage651viiiServicesinanintermediatecarefacilityforthementallyretarded1ixInpatientpsychiatricservicesforindividualsunderage21TNNo900FsedesApprovalDate1qlEffectiveDateqHCFAID7982E
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20bRevisionHCFAPM93SMBMay1993stateCitation31a2190239ofxActWYOMINGAmountDurationandscopeofServicesMedicallvNeedYcontinued1905a23and1929oftheActxiRespiratoryprovidedindividualsthisplanHomeandCommunitycareforFunctionallyDisabledElderlyIndividualsasdefineddescribedandlimitedinsupplement2toAttachment31AandAppendicesAGtoSupplement2toAttachment31Acareservicesaretoventilatordependentasindicatedinitem31hofATTACHMENT31BidentifiestheservicesprovidedtoeachcoveredgroupofthemedicallyneedyspecifiesalllimitationsontheamountdurationandscopeofthoseitemsandspecifiestheambulatoryservicesprovidedunderthisplanandanylimitationsonthemItalsoliststheadditionalcoveragethatisinexcessofestablishedservicelimitsforpregnancyrelatedservicesandservicesforconditionsthatmaycomplicatethepregnancyTN95003SupersedesTN9213ApprovalDateJqJEffectiveDate010195
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State ofWyoming Section 3
Page 20 C
Citation 31a2Amount Duration and Scope of Services Medically Needy Continued1905a26and 1934
Program ofAll Inclusive Care for the Elderly PACE services as described andlimited in Supplement 3 to Attachment 31 A
ATTACHMENT 31 B identifies services provided to each covered group of themedically needy Note Other programs to be offered to Medically Needybeneficiaries would specify all limitations on the amount duration and scope ofthose services As PACE provides services to the frail elderly population withoutsuch limitation this is not applicable for this program In addition otherprograms to be offered to Medically Needy beneficiaries would also list theadditional coverage that is in excess of established service limits for pregnancyrelated services for conditions that may complicate the pregnancy As PACE isfor the frail elderly population this also is not applicable for this program
TN No 11 003 Approval DateSEP 0 6 2M
Effective Date 10012011
SupersedesTN NO New
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21RevisionHCFAPM981CMSOAPRIL1998StateWYOMINGCitation31AmountDurationandScopeofServicescontinueda3OtherRequiredSpecialGroupsQualifiedMedicareBeneficiaries1902a1OEiandclauseVIllofthematterfollowingFand1905p3oftheActMedicarecostsharingforqualifiedMedicarebeneficiariesdescribedinsection1905poftheActisprovidedonlyasindicatedinitem32ofthisplan1902a10Eiiand1905softheActa4iOtherRequiredSpecialGroupsQualifiedDisabledandWorkinIndividualsMedicarePartApremiumsforqualifieddisabledandworkingindividualsdescribedinsection1902a10EiioftheActareprovidedasindicatedinitem32ofthisplan1902a10Eiiiand1905p3AiioftheActiiOtherRequiredSpecialGroupsSpecifiedLowIncomeMedicareBeneficiariesMedicarePartBpremiumsforspecifiedlowincomeMedicarebeneficiariesdescribedinsection1902a10EiiioftheActareprovidedasindicatedinitem32ofthisplan1902a10Eiv11905p3Aiiand1933oftheActiiiOtherRequiredSpecialGroupsQualifyinIndividuals1MedicarePartBpremiumsforqualifyingindividualsdescribedin1902a10EivIandsubjectto1933oftheActareprovidedasindicatedinitem32ofthisplanTNNo9805SupersedesTNNo9802ApprovalDatefqIJfqEffectiveDatef11I
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21ContinuedRevisionCMSOSTATEWyomingCitation1925oftheActa5OtherRequiredSpecialGroupsFamiliesReceivinqExtendedMedicaidBenefitsExtendedMedicaidbenefitsforfamiliesdescribedinsection1925oftheActareprovidedasindicatedinitem35ofthisplanTNNo03001SupersedesTNNo9805ApprovalDate03fII03EffectiveDate01012003
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21aRevisionHCFAPM981CMSOAPRll1998StateWYOMINGCitationSec245AhoftheImmigrationandNationalityActa6LimitedCoverageforCertainAliensiAliensgrantedlawfultemporaryresidentstatusundersection245AoftheImmigrationandNationalityActwhomeetthefinancialandcategoricaleligibilityrequirementsundertheapprovedStateMedicaidplanareprovidedtheservicescoveredundertheplaniftheyAAreagedblindordisabledindividualsasdefinedinsection1614a1oftheActBArechildrenunder18yearsofageorCAreCubanorHaitianentrantsasdefinedinsection501e1and2AofPL96422ineffectonApril11983iiExceptforemergencyservicesandpregnancyrelatedservicesasdefinedin42CPR44753baliensgrantedlawfultemporaryresidentstatusundersection245AoftheImmigrationandNationalityActwhoarenotidentifiedinitems31a6iAthroughCaboveandwhomeetthefinancialandcategoricaleligibilityrequirementsundertheapprovedStateplanareprovidedservicesundertheplannoearlierthanfiveyearsfromthedatethealienisgrantedlawfultemporaryresidentstatusTNNo9805SupersedesTNNo9113ApprovalDatedIJ1EffectiveDate111ft
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21bRevisionHCFAPM914August1991StateTerritoryBPDOMSNo0938Citation3la6AmountDurationandScooeofServicesLimitedOoveraoeforCertainAlienscontinued1902aand1903voftheActi11AlienswhoarenotlawfullyadmittedforpermanentresidenceorotherwisepermanentlyresidingintheUnitedStatesundercoloroflawwhomeettheeligibilityconditionsunderthisplanexceptfortherequirementforreceiptofAFDCSSIoraStatesupplementarypaymentareprovidedMedicaidonlyforcareandeervicesnecessaryforthetreatmentofanemergencymedicalconditionincludingemergencylaboranddeliveryasdefinedinsection1903v3oftheAct1905a9oftheActa7HomelessIndividualsClinicservicesfurnishedtoeligibleindividualswhodonotresideinapermanentdwellingordonothaveafixedhomeormailingaddressareprovidedwithoutrestrictionsregardingthesiteatwhichtheservicesarefurnished1902a47and1902oftheActXa8PresumDtivelyElioiblepreonantWomen42CFR4415550FR436541902a431905a4Band1905roftheActAmbulatoryprenatalcareforpregnantwomenisprovidedduringapresumptiveeligibilityperiodifthecareisfurnishedbyaproviderthatiseligibleforpaymentundertheStateplana9EPSDTServicesTheMedicaidagencymeetstherequirementsofsections1902a431905a4Band1905roftheActwithrespecttoearlyandperiodicscreeningdiagnosticandtreatmentEPSDTservicesTNNo911iSupersedesTNNo9202ApprovalDate121oSi14EffectiveDate11192
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22RevisionHCFAPM91August1991StateTerritoryBPDOMBNo0938WYOMINGcitation31a9AmountDurationandScopeofServicesEPSDTServicescontinued42CFR44160LTheMedicaidagencyhasincontinuingcareprovidersmethodsemployedtoassurewiththeiragreementseffectagreementswithDescribedbelowarethetheproviderscompliance42CFR440240a10ComparabilitvofServicesand4402501902aand1902a10I1902a521903v1915gand1925b4oftheActExceptforthoseitemsorservicesforwhichsections1902a1902a101903v1915and1925oftheAct42CFR440250andsection245AoftheImmigrationandNationalityActpermitexceptionsiServicesmadeavailabletothecategoricallyneedyareequalinamountdurationandscopeforeachcategoricallyneedypersoniiTheamountdurationandscopeofservicesmadeavailabletothecategoricallyneedyareequaltoorgreaterthanthosemadeavailabletothemedicallyneedyiiiServicesmadeavailabletothemedicallyneedyareequalinamountdurationandscopeforeachpersoninamedicallyneedycoveragegroupLivAdditionalcoverageforpregnancyrelatedservicesandservicesforconditionsthatmaycomplicatethepregnancyareequalforcategoricallyandmedicallyneedyTNNo92FsedesApprovalDateqj3bqEffectiveDateLJqIHCFAID7982E
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23RevisionECFAAT8038BPPMay221980StateWyomingCitaticn42emPart440SubpartB42erR44115AT7890AT8034310acnehealtservicesareprovidedinaccordancgwiththerequiremmtsof42CFR441151acmehealthservicesareprovidedtoallcategoricallyneedyincUviduals21yearsofageorCNer2Banehealtservicesareprovidedtoallcategoricallyneedyirdividqlunder21yearsofagegDYesNotapplicableTheStateplanacest1jtprovideforskillednursingfacilityservicesforsuchWividuals3HallehealthservicesareprovidedtothemedicallyneedyDDYestoallYestoindiviilJage21oroverSNFservicesareprovidedYestoindividualsunderage21SNFservicesareprovidedDNc1SNFservicesarerotprovided@NotlicablethemedicallyneedyarenotincludedunderthisplanaIN7912SupesedesINApprovalDate11780EffectiveDate1017Qi
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24RevisionHCFAPM938December1993BPDOMSNo0938stateTerritoryWYOMINGCitation31AmountDurationandScooeofServicescontinued42CFR43153clAssuranceofTransoortationprovisionismadeforassuringnecessarytransportationofrecipientstoandfromprovidersMethodsusedtoassuresuchtransportationaredescribedinATTACHMENT31D42CFR48310c2PaymentforNursinqFacilityServicesTheStateincludesinnursingfacilityservicesatleasttheitemsandservicesspecifiedin42CFR48310c8iTNNO93019SupersedesTNNO9113ApprovalDateS9ffectiveDate119
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etlisicnECFA8038BPPay221980StateWYomina25Citaticn42CFR440260Jl7S9031dMethcdsardSandardstoAssureQualitvofServicesThestandardsestablishedandthemeth03susedtoassurehighqualitycarearedescribedinATrACEMENT31771rsedesAppcovalDate3217EffectileDate1177tiA
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RevisionJIiAF268CFAAT8038BPPMay221980StateWyominqCitaticn42em44120Xri89031eFaroilyPlninqServicesTherequireI1entsof42em44120aremetregardingfreedomframcoercicnorpressureofmindandooscielceandfreeanofchoiceofmethcdtolellSedforfamilyplanningIN771SupersedesINiApprovalDate32177EffectiveDate1177
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RevisionHCFAPM875BERCApril1987STATEWYOMINGCitation42CFR44130AT789031f11903i1oftheActPL99272Section9507227OMBNo09380193OptometricServicesOptometricservicesotherthanthoseprovidedunder435531and436531arenotnowbutwerepreviouslyprovidedunderthisplanServicesofthetypeanoptometristislegallyauthorizedtoperformarespecificallyincludedinthetermphysiciansservicesunderthisplanandarereimbursedwhetherfurnishedbyaphysicianoranoptometristYesNoTheconditionsprescribedinthefirstsentenceapplybutthetermphysiciansservicesdoesnotspecificallyincludeservicesofthetypeanoptometristislegallyauthorizedtoperformXNotapplicableTheconditionsinthefirstsentencedonotapplyOrganTransplantProceduresOrgantransplantproceduresareprovidedNoXYesSimilarlysituatedindividualsaretreatedalikeandanyrestrictiononthefacilitiesthatmayorpractitionerswhomayprovidethoseproceduresisconsistentwiththeaccessibilityofhighqualitycaretoindividualseligiblefortheproceduresunderthisplanStandardsforthecoverageoforgantransplantproceduresaredescribedatAttachment3IE0010TNNO04006SupersedesTNNO96005ApprovalDateEffectiveDateOctober12004
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28OKBNo09380193RevisionHCFAPM874BERCKARCH1987StateTerritorywyomingCitation42CFR431110bAT789031gParticipationbyIndianHealthServiceFacilities1902e9oftheActPL99509Section9408IndianHealthServicefacilitiesareacceptedasprovidersinaccordancewith42CFR431110bonthesamebasisasotherqualifiedprovidershRespiratoryCareServicesforVentilatorDependentIndividualsRespiratorycareservicesasdefinedinsection1902e9CoftheActareprovidedundertheplantoindividualswho1Aremedicallydependentonaventilatorforlifesupportatleastsixhoursperday2HavebeensodependentasinpatientsduringasinglestayoracontinuousstayinoneormorehospitalsSNFsorICFsforthelesserofL30consecutivedaysZdaysthemaximumnumberofinpatientdaysallowedundertheStateplan3ExceptforhomerespiratorycarewouldrequirerespiratorycareonaninpatientbasisinahospitalSNForICFforwhichMedicaidpaymentswouldbemade4Haveadequatesoeialsupportservieestobeearedforathomeand5WishtobeearedforathomeIYesTherequirementsofsection1902e9oftheAetaremetXINotapplieableTheseservicesarenotineludedintheplanLApprovalDateq7BffeetiveDate77TNNo87CSupersedesTNNo7g3HCFA101008P00IIPW
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29RevisionHCFAPM935May1993MBStateWYOMINGCitation32CoordinationofMedicaidwithMedicareandOtherInsuranceaPremiums1MedicarePartAandPartB1902a10Eiand1905p1oftheActiOualifiedMedicareBeneficiary1QMlUTheMedicaidagencypaysMedicarePartApremiumsifapplicableandPartBpremiumsforindividualsintheQMBgroupdefinedinItemA25ofATTACHMENT22AthroughthegrouppremiumpaymentarrangementunlesstheagencyhasaBuyinagreementforsuchpaymentasindicatedbelowBuyinagreementforPartAPartBTheMedicaidagencypayspremiumsforwhichthebeneficiarywouldbeliableforenrollmentinanHMOparticipatinginMedicareTN95003SupersedesTN93008ApprovalDateoCr19EffectiveDate010195
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RevisionHCFAM973CMSODecber1997Citation1902a10Eiiand1905softheAct1902a1OEiiiand1905p3AiioftheAct1902a10EivI1905p3Aiiand1933oftheActTNNo03001SupersedesTNNo9802ApprovalDate29aiiQualifiedDisabledandWorkinqIndividualODWITheMedicaidagencypaysMedicarepartApremiumsunderagrouppremiumpaymentarrangementsubjecttoanycontributionrequiredasdescribedinATTACHMENT418EforindividualsintheQDWIgroupdefinedinitemA26ofATTACHMENT22AofthisplaniiiSpecifiedLowIncomeMedicareBeneficiarySLMBTheMedicaidagencypaysMedicarePartBpremiumsundertheStatebuyinprocessforindividualsintheSLMBgroupdefinedinitemA27ofATTACHMENT22AofthisplanivQualifvinqIndividual1QI1TheMedicaidagencypaysMedicarePartBpremiumsundertheStatebuyinprocessforindividualsdescribedin1902a10Eivlandsubjectto1933oftheActytL311D3EffectiveDate01012003
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RevisionHCFAPM973CMSODecember1997StateWYOMING29bCitation1843band1905aoftheActand42CFR4316251902a30and1905aoftheActviOtherMedicaidRecipientsTheMedicaidagencypaysMedicarePartBpremiumstomakeMedicarePartBcoverageavailabletothefollowingindividualsLAllindividualswhoareareceivingbenefitsundertitlesIIVAXXIVorXVIAABDorSSIbreceivingStatesupplementsundertitleXVIorcwithingagrouplistedat42CFR431625d2IndividualsreceivingtitleIIorRailroadRetirementbenefitsMedicallyneedyindividualsFFPisnotavailableforthisgroup2OtherHealthInsuranceXTheMedicaidagencypaysinsurancepremiumsformedicaloranyothertypeofremedialcaretomaintainathirdpartyresourceforMedicaidcoveredservicesprovidedtoeligibleindividualsexceptindividuals65yearsofageorolderanddisabledindividualsentitledtoMedicarePartAbutnotenrolledinMedicarePartBEffectiveDateTNNo9802SupersedesTNNo93011ApprovalDatefjJJ3q119I
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RevisionHCFAPMMBstateTerritoryCitation1902a301902n1905aand1916oftheActSections1902a10Eiand1905p3oftheAct1901a101902a30and1905aoftheAct42CFR4316251902a101902a301905aand1905poftheActTNNoSupersedesApprovalDateTNNo4Jo29cWYOMINGbDeductiblesCoinsurance1MedicarePartAandBSUDPlement1toATTACHMENT419BdescribesthemethodsandstandardsforestablishingpaymentratesforservicescoveredunderMedicareandorthemethodologyforpaymentofMedicaredeductibleandcoinsuranceamountstotheextentavailableforeachofthefollowinggroupsiQualifiedMedicareBeneficiariesCOMBSTheMedicaidagencypaysMedicarePartAandPartBdeductibleandcoinsuranceamountsforQMBssubjecttoanynominalMedicaidcopaymentforallservicesavailableunderMedicareilOtherMedicaidRecipientsTheMedicaidagencypaysforMedicaidservicesalsocoveredunderMedicareandfurnishedtorecipientsentitledtoMedicaresubjecttoanynominalMedicaidcopaymentForservicesfurnishedtoindividualswhoaredescribedinsection32a1ivpaymentismadeasfollows1LFortheentirerangeofservicesavailableunderMedicarePartBOnlyfortheamountdurationandscopeofservicesotherwiseavailableunderthisplaniiiDualElioibleQMBplusTheMedicaidagencypaysMedicarePartAandPartBdeductibleandcoinsuranceamountsforallservicesavailableunderMedicareandpaysforallMedicaidservicesfurnishedtoindividualseligiblebothasQMBsandcategoricallyormedicallyneedysubjecttoanynominalMedicaidcopaymentEffectiveDate3HCFAID7982E
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29dRevisionHCFAPM91cOctober1991MBlOMBNoStateTerritoryCitationConditionorRequirement1906oftheActcPremiumsOeductiblesCoinsuranceandOtherCosSharinqObliqationsTheMedicaidagencypaysallpremiumsdeductiblescoinsuranceandothercostsharingobligationsforitemsandservicescoveredundertheStateplansubjecttoanynominalMedicaidcopaymentforeligibleindividualsinemployerbasedcosteffectivegrouphealthplans1902a10FoftheActWhencoverageforeligiblefamilymembersisnotpossibleunlessineligiblefamilymembersenrolltheMedicaidagencypayspremiumsforenrollmentofotherfamilymemberswhencosteffectiveInadditiontheeligibleindividualisentitledtoservicescoveredbytheStateplanwhicharenotincludedinthegrouphealthplanGuidelinesfordeterminingcosteffectivenessaredescribedinsection422hdTheMedicaidagencypayspremiumsforindividualsdescribedinitem19ofAttachment22ATNNoqOOsupercedesIApprovalDateTNNoJUtr119sEffectiveDateHCFAIO7983EX
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30RelisicnEFAT8038BPPMay221980StateIiycrninaCitaticn42cR44110142CER431620canddr792933MedicaidferIrividualsAce65orOveriniticrnDiseasesMedicaidisprovicedforLdiviCuals65yearsofaceoroldwoo3Iecatie1tsinirst1ttticnsformentaldiseasesi7YesTherequiraYle1tsof42ctPart441SuC9artCand42CPR431620car0aremetJNotlCbleJdiC3idisrctorovidedtoagedirdivid1I4insinsnmCerthisplanr1AIN84cSupersedesN77AprovalDate6g4IIEffectiveDate6F4rr
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31RevisioneO38BPPMay221980StateCibticn42CFR441252N7899Wyoming34SoecialReauirementsAcPlicabletoSterilizationProceduresAllrequirementsof42ernPart441SubpartFaremetIN794SupersedesmilAarovalDate72579EffectiveDate71179A
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31asionHCFAPM911991BPOOMBNo0938stateWYOMINGCitation1902a52and1925oftheAct35FamiliesReceivinaExtendedMedicaidBenefitsaServicesprovidedtofamiliesduringthefirst6monthperiodofextendedMedicaidbenefitsunderSection1925oftheActareequalinamountdurationandscopetoservicesprovidedtocategoricallyneedyAFOCrecipientsasdescribedinATTACHMENT31AormaybegreaterifprovidedthroughacaretakerrelativeemployershealthinsuranceplanbServicesprovidedtofamiliesduringthesecond6monthperiodofextendedMedicaidbenefitsundersection1925oftheActare11EqualinamountdurationandscopetoservicesprovidedtocategoricallyneedyAFOCrecipientsasdescribedinATTACHMENT31AormaybegreaterifprovidedthroughacaretakerrelativeemployershealthinsuranceplanLXIEqualinamountdurationandscopetoservicesprovidedtocategoricallyneedyAFOCrecipientsormaybegreaterifprovidedthroughacaretakerrelativeemployershealthinsuranceplanminusanyoneormoreofthefollowingacuteservicesLXINursingfacilityservicesotherthanservicesinaninstitutionformentaldiseasesforindividuals21yearsofageorolder11Medicalorremedialcareprovidedbylicensedpractitioners11HomehealthservicesTNNoSupersedeApprovalDateTNNoF9cJ5fEffectiveDatel1IHCFAIO7982E
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sionHCFAPM911991citationApprovalDatestate3531bBPDOMBNo0938WOMINGFamiliesReceivinaExtendedMedicaidBenefitsContinued11Privatedutynursingservices11Physicaltherapyandrelatedservices11OtherdiagnosticscreeningpreventiveandrehabilitationservicesLXIInpatienthospitalservicesandnursingfacilityservicesforindividuals65yearsofageoroverinaninstitutionformentaldiseasesLXIIntermediatecarefacilityservicesforthementallyretardedLXIInpatientpsychiatricservicesforindividualsunderage2111Hospiceservices11Respiratorycareservices11AnyothermedicalcareandanyothertypeofremedialcarerecognizedunderstatelawandspecifiedbytheSecretaryEffectiveDated9HCFA107982E
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31cRevisionHCFAPM911991BPDOMBNo0938stateWYOMINGCitation35FamiliesReceivinaExtendedMedicaidBenefitsContinuedcLITheagencypaysthefamilyspremiumsenrollmentfeesdeductiblescoinsuranceandsimilarcostsforhealthplansofferedbythecaretakersemployeraspaymentsformedicalassistanceLILI1st6monthsLI2nd6monthsTheagencyrequirescaretakerstoenrollinemployershealthplansasaconditionofeligibilityLI1st6mosLI2nd6mosdLI1TheMedicaidagencyprovidesassistancetofamiliesduringthesecond6monthperiodofextendedMedicaidbenefitsthroughthefollowingalternativemethodsLIEnrollmentinthefamilyoptionofanemployershealthplanLIEnrollmentinthefamilyoptionofastateemployeehealthplanLIEnrollmentinthestatehealthplanfortheuninsuredLIEnrollmentinaneligiblehealthmaintenanceorganizationHMOwithaprepaidenrollmentoflessthan50percentMedicaidrecipientsexceptrecipientsofextendedMedicaidTNNo3sllPersedesApprovalDateNo2EffectiveDateIHCFAIO7982E
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31dRevisionHCFAPM91BPD1991OMBNo0938StateWYOMINGCitation35FamiliesReceivingExtendedMedicaidBenetitscontinuedSupplement2toATTACHMENT31Aspecifiesanddescribesthealternativehealthcareplanesofferedincludingrequirementsforassuringthatrecipientshaveaccesstoservicesofadequatequality2TheagencyiPaysallpremiumsandenrollmentfeesimposedonthefamilyforsuchplanesiiPaysalldeductiblesandcoinsuranceimposedonthefamilyforsuchplanes36UnemployedParentForpurposesofdeterminingwhetherachildisdeprivedonthebasisofunemploymentofaparenttheagencyUsesthestandardformeasuringunemploymentwhichwasintheAFDCStatePlanineffectonJuly161996XUsesthefollowingmoreliberalstandardtomeasureunemploymentTheprincipalwageearnerisconsideredunemployedifthefamilysincomeisbelowtheprogramsincomelimitforthefamilysizeTNNo9904SupersedesTNNo9113ApprovalDate099EffectiveDateJulyL1999