2019 Wyoming Statutes
Title 42 - Welfare
Chapter 4 - Medical Assistance and Services
Article 1 - In General
Section 42-4-123 - Air Ambulance Transport Services for Wyoming Residents; Sunset. Note: This Is Effective as of 4/1/2020.

42-4-123. Air ambulance transport services for Wyoming residents; sunset. Note: this is effective as of 4/1/2020.

(a) With the consent of the governor, the department shall apply, in the form of any necessary federal waiver, state plan amendment or other agreement, to the United States department of health and human services and endeavor to make coverage of air ambulance transport services through Medicaid available to all Wyoming residents, except that coverage may be limited to specified groups of Wyoming residents as necessary to obtain approval.

(b) Contingent on federal approval under subsection (a) of this section, there is created the air ambulance transport services program under the department.

(c) Coverage for air ambulance transport services under this section shall be provided through retroactive eligibility. A Wyoming resident or air ambulance provider may make a claim for payment of air ambulance transport services to the department. A claim shall be submitted within ninety (90) days of air ambulance transport services occurring, except for good cause as determined by the department. An air ambulance provider shall provide services under this section if the provider otherwise makes air ambulance transport services available to persons in Wyoming who are eligible for Medicaid independent of the coverage provided by this section. Except as otherwise provided in subsection (d) of this section, an air ambulance provider who provides services under this section shall accept payment under this subsection as full satisfaction of all charges, costs and fees relating to air ambulance transport services.

(d) An air ambulance provider shall collect a copay or other cost sharing requirement for services covered under this section, as established by the department and consistent with federal requirements, based on the following:

(i) For persons who are eligible for Medicaid independent of the coverage provided by this section, any copay or other cost sharing requirement shall be consistent with the copay or cost sharing requirement specified for other services under Medicaid;

(ii) For persons who are not eligible for Medicaid independent of the coverage provided by this section, any copay or cost sharing requirement shall be proportionate, based on income and shall not be greater than fifty percent (50%) of the allowable costs for air ambulance transport under this section, as determined by the department.

(e) All premium assessments and reimbursements received under this section shall be deposited into the air ambulance coverage account and shall be used by the department to pay air ambulance transport claims covered under this section, as well as to administer this section.

(f) Consistent with subsection (a) of this section, all air ambulance transport services otherwise provided or covered by any program administered by the state of Wyoming, including, but not limited to, the State Employees and Officials Group Insurance Act and the Wyoming Worker's Compensation Act, shall be covered under this section. Other than paying reimbursements under this section, state agencies shall not have a duty to provide or cover air ambulance transport services after the department begins providing services under this section, except for persons otherwise not covered pursuant to subsection (a) of this section.

(g) To facilitate coverage under this section, the department of workforce services, the department of administration and information and other state agencies that are otherwise responsible for coverage of air ambulance transport services shall pay reimbursement for these services to the air ambulance coverage account, in the manner prescribed by the department of health after consultation with the relevant state agency. As a component of reimbursement under this section, the department of health shall require a state agency to pay, on a proportional basis, administrative costs necessary to implement this section.

(h) The department may enter into agreements with the following persons for the purposes of this section:

(i) Air ambulance providers;

(ii) Persons who provide dispatch for air ambulance transport services;

(iii) A third party administrator;

(iv) Any other person or entity necessary to implement this section, except as otherwise provided by subsection (j) of this section.

(j) The insurance commissioner may enter into agreements with employee welfare benefit plans, as defined in 29 U.S.C. § 1002, and other health insurance plans operating in this state not subject to state regulation, in order to make air ambulance transport coverage available under this section to insured persons covered by those plans. If a plan enters into an agreement under this paragraph, the plan shall pay an assessment on net premiums and net considerations in this state to the insurance commissioner as otherwise provided in W.S. 26-4-103(n) but shall not be required to file a report under W.S. 26-4-103(a).

(k) There is created the air ambulance coverage account. Premium assessments collected by the insurance commissioner and state agency reimbursements paid to the department of health under this section shall be deposited into the account and used by the department to cover air ambulance transport services under this section and to implement this section. Other funds used to provide air ambulance coverage, including federal funds, may be deposited into the account. The account may be divided into subaccounts for purposes of administrative management. Funds in the account and any amounts earned from those funds are continuously appropriated and shall not lapse at the end of any fiscal period. For accounting and investing only, subaccounts shall be treated as separate accounts.

(m) The rules of the department governing administrative hearings under Medicaid shall apply to any action of the department under this section. The department may, if appropriate, establish a managed care program under this section.

(n) Federal funds shall only be expended under this section for persons who are eligible for Medicaid independent of the coverage provided by this section, or as otherwise provided by federal law or any waiver, state plan amendment or agreement executed with the federal government.

(o) This section shall not apply to Wyoming residents eligible for Medicare.

(p) The department shall adopt all necessary rules to implement this section, including:

(i) Payment rates, which shall be set as a percentage multiplier of current Medicare air ambulance transport service rates applicable to rural Wyoming, and which shall balance the following priorities:

(A) The financial risk to Wyoming residents, including potential cost sharing requirements;

(B) Adequate air ambulance service provider participation and access to services;

(C) Quality of services;

(D) Availability of program funding; and

(E) Unnecessary utilization and cost growth in the industry.

(ii) Procedures for filing a claim for payment under this section.

(q) As used in this section:

(i) "Air ambulance coverage account" means the account created by subsection (k) of this section;

(ii) "Air ambulance provider" means a person who provides air ambulance transport services in Wyoming;

(iii) "Air ambulance transport" means medical conveyance by air in the following situations:

(A) Emergency circumstances;

(B) Nonemergency, but medically necessary circumstances, as determined by a licensed health care provider, pursuant to rule of the department.

(iv) "Emergency" means a situation in which immediate medical care is necessary to prevent death or serious injury, or additional serious injury, pursuant to rule of the department;

(v) "Wyoming resident" means a natural person who is either of the following:

(A) Domiciled in Wyoming;

(B) Covered by the Wyoming Worker's Compensation Act.

(r) This section is repealed effective July 1, 2023.