2024 24LSO-0014
STATE OF WYOMING Working Draft
0.5
DRAFT ONLY
NOT APPROVED FOR
INTRODUCTION
HOUSE BILL NO.
Medicaid-third party payor conditions.
Sponsored by: Joint Labor, Health & Social Services Interim Committee
A BILL
for
1 AN ACT relating to the Wyoming Medical Assistance and
2 Services Act; requiring health insurers to respond to state
3 inquiries within sixty (60) days; prohibiting health
4 insurers from denying Medicaid payments as specified; and
5 providing for an effective date.
6
7 Be It Enacted by the Legislature of the State of Wyoming:
8
9 Section 1. W.S. 42-4-204(e)(iii) and (iv)(intro) is
10 amended to read:
11
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2024 STATE OF WYOMING 24LSO-0014
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1 42-4-204. Department subrogated to right of recovery
2 of applicant or recipient; utilization of personal health
3 insurance; insurance coverage of recipients.
4
5 (e) In addition to the separate requirements set
6 forth in W.S. 42-4-205, all health insurers, including all
7 self-insured plans, group health plans as defined in
8 section 607(1) of the Employee Retirement Income Security
9 Act of 1974, service benefit plans, managed care
10 organizations, pharmacy benefit managers, or other parties
11 that are, by statute, contract, or agreement, legally
12 responsible for payment of a claim for a health care item
13 or service, shall agree, as a condition of doing business
14 in the state of Wyoming, to:
15
16 (iii) Respond within sixty (60) days to any
17 inquiry by the state regarding a claim for payment for any
18 health care item or service that is submitted not later
19 than three (3) years after the date of the provision of
20 such health care item or service; and
21
22 (iv) Agree not to deny a claim submitted by the
23 state solely on the basis of the date of submission of the
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1 claim, the type or format of the claim form, a failure to
2 obtain required prior authorization or a failure to present
3 proper documentation at the point of sale that is the basis
4 of the claim, if:
5
6 ***********************************************************
7 *******************
8 STAFF COMMENT
9
10 The Wyoming Department of Health’s proposed amendment to
11 (e)(iv)(intro) included the following additional language
12 that is probably unnecessary to include in statute: as the
13 department’s payment of a claim for a medical item or
14 service is considered the equivalent of the recipient
15 having obtained authorization for the item or service.
16
17 ***********************************************************
18 *******************
19
20 Section 2. This act is effective July 1, 2024.
21
22 (END)
3 [Bill Number]

Statutes affected:
24LSO-0014 v0.5: 42-4-204