Wyo. Code R. 014 | Wyoming Administrative Rules 014 — Miners' Hospital Board

211 General Agency, Board or Commission Rules

Chapter 1 General Provisions

Wyo. Code R. 014.0001.1.01082016 General Provisions

CHAPTER 1

GENERAL PROVISIONS

Section 1. Authority. The State Miner's Hospital Board (hereinafter referred to as the "Board") is created under Wyo. Stat. 30-6-101 et seq. The membership of the Board is established pursuant to statute

Section 2. Purpose. The State Miner's Hospital Board serves to carry out the purposes as delineated by statute.

Section 3. Citation. These rules and regulations shall be cited as "Rules of the State Miner's Hospital Board.

Section 4. Severability. If any provisions of these regulations or the application thereof to any person or circumstance is invalid, such invalidity shall not affect other provisions or application of these regulations which can be given effect without the invalid provision or application, and to this end the provisions of these regulations are declared to be severable.

Section 5. Chair.

(a) At the first regularly scheduled meeting of the Board each year, the members of the Board shall, as the last item of business, elect a chairperson. The elected chairperson shall, thereafter, conduct the meetings for the duration of his or her term.

(b) Any vacancy in the position of chairperson shall be addressed by the remaining Members of the Board who shall elect a chairperson at the next regularly scheduled meeting, following the vacancy.

(c) The Chairperson or his designated representative shall be authorized to execute vouchers and payment requests for authorized purchases, which purchases are authorized by the Board. All such vouchers and requests for payment shall be presented to the Wyoming State Auditor in the manner prescribed by the State Auditor's Office.

(d) The Chairperson or his designated representative shall be authorized to execute any contracts in the name of the State Miner's Hospital Board, with Board approval.

Section 6. Executive Director and Secretary.

(a) The Executive Director may be employed by the Board, which shall provide a contract of employment with such terms, conditions, pay and benefits that are consistent with the terms, conditions, pay and benefits of similar job descriptions within state government. The Board may utilize information from the Department of Administration and Information, Human Resources Division for comparable job descriptions, personnel duties and qualifications and pay bands. The annual salary of the Executive Director and any secretaries shall be set by the Board.

(i) The position of the Executive Director may be developed as a state position under the policies, rules and guidelines for state employees, as authorized by statute. If it is decided to develop a state position for the Executive Director, a position description questionnaire shall be constructed to accomplish migrating to state employee status.

(ii) The position of secretary may be either a contract or state position.

(b) The Executive Director shall be responsible for the day to day operations of the Board, hiring and supervision of secretaries and the administration of the Programs established by the Board.

(c) The Chairperson shall prepare agendas for the meetings, in consultation with the Executive Director and make necessary arrangements for the meetings.

(d) Secretaries shall perform duties as directed by the Board or the Executive Director.

Section 7. Meetings. The Board shall meet as directed in Wyo. Stat. 30-6-101(e). At each meeting, the Chairperson or his or her designee shall conduct the meeting and shall adhere to Robert's Rules of Order for the ordering of the items for discussion and resolution of the meeting or other parliamentary ordering, as the Board shall determine.

(a) Quorum. A quorum of the Board shall be constituted of five (5) duly appointed members. For the purposes of establishing a quorum, a member may be considered present for the purposes of the quorum when such member attends the meeting by means of telecommunications conference call where such member's voice vote and contribution to the discussion can be heard by all members physically present at the appointed meeting.

(b) Location. The Board shall conduct its meetings in person or by teleconference at a public hall or halls at the direction of the Chairperson. Required meetings shall be conducted in a location or locations that are conveniently accessible to the members.

(d) Executive Session. Before convening in executive sessions, the Chairperson shall publicly announce the purpose for excluding the public from the meeting place, and the time when the executive session will be concluded. An executive session shall be held in compliance with the Open Meetings Act.

(e) Notice of Meetings. Meetings shall be called at the direction of the Chairperson and as the Board shall determine. The Chairperson shall set meetings in accordance with the provisions of these rules and giving due consideration to the attendance of the greatest number of Board members. Meeting notices shall be published one time in newspapers of general circulation in the counties of Sweetwater and Campbell and as otherwise determined by the Board, giving consideration to the public interest. Meeting notices shall also be provided to interested parties, who have requested notice and have provided a name and mailing address, and to the Office of the Wyoming Attorney General, the Governor's Office and the Legislative Service Office, at their official addresses. The Executive Director shall compile and maintain the list of parties interested in notice. A notice of meeting shall provide no less than seven (7) days prior notice of the meeting, dated from the date of publication.

(f) Agenda. The Chairperson and the executive director shall prepare the agenda. Any member of the Board may request an item to be placed on the agenda. Agendas shall include those items requiring Board approval including, but not limited to, the Board's budget and financial statements, personnel action and contracts of the Board. Tentative agenda will be sent no fewer than five (5) calendar days before each Board meeting with support materials.

(g) Minutes. Minutes of meetings of the Board shall be kept in a form which will provide a permanent record of the proceedings of the Board. Minutes shall be considered public records under the Wyoming Administrative Procedure Act. Minutes shall be maintained at a place as designated by the Board.

(h) The executive director will ensure recording of Board proceedings but may appoint a recording secretary to record the proceedings of the meetings. Minutes become official after approval by the Board and shall be retained as a permanent record of the Board. Minutes shall show:

(i) The date, time and place of the meeting;

(ii) The presiding officer;

(iii) Members and guests in attendance;

(iv) Items discussed and disposition taken during the meeting;

(v) Action taken to recess to executive session with purpose and time stated; and

(vi) Time of Adjournment.

(vii) Unofficial minutes shall be delivered to Board members in advance of the next meeting of the Board and shall also be available to other interested parties. Minutes need not be read publicly, provided that the Board members have had an opportunity to review them before adoption.

(viii) A file of permanent minutes of all Board meetings will be maintained in the office of the Board to be made available for inspection upon the request of any interested parties.

(ix) The Board shall record votes in the following manner: If there is no dissent to a motion, the action shall be recorded as passed unanimously. A Board member's dissenting or abstaining vote may be recorded by name at his/her request.

Section 8. Authorization of Expenditures.

(a) The executive director may purchase or provide necessary capital equipment, supplies and services for the Board to a maximum of five hundred dollars ($500.00) per purchase. Aggregate purchases of supplies and equipment shall be made so as to not exceed the maximum. Capital purchases in excess of that amount are subject to the approval of the Board.

(i) The executive director shall distribute by mail or electronic means monthly Board financial statements to each member of the Board.

(ii) All fiscal records of the Board will be accounted for within the State of Wyoming Accounting Procedures.

(iii) Inventory records shall be maintained on physical property under control of the inventory coordinator of the Governor's Office. Acquisitions and property that is disposed of as "surplus property" shall be recorded on the Governor's perpetual inventory records.

(b) Board members, the executive director and the secretary shall present vouchers and requests for payment in accordance with the policies and procedures of the Wyoming State Auditor's Office.

(c) The Board Chairperson or his designated representative shall be authorized to approve vouchers and requests for payment consistent with the policies and procedures of the Wyoming State Auditor's Office with board approval. The Chairperson may, with a vote of approval of the Board, designate, in writing, another member of the Board who may approve vouchers and requests for payment in accordance with the policies and procedures of the Wyoming State Auditor's Office.

Section 9 . Contracts.

(a) All contracts in the name of the State Miner's Hospital Board shall be drafted in accordance with the Contract Manual for State Agencies compiled by the Wyoming Attorney General's office.

(b) Contracts shall be executed, with Board approval, in the name of the State Miner's Hospital Board by the Chairperson or his or her designee.

(c) An administrative office of the State Miner's Hospital Board shall retain a fully executed copy of all contracts, together with any related attachments or exhibits.

Section 10. Office. The State Miner's Hospital Board may have offices located in Sweetwater, Campbell, or Natrona County, Wyoming. The executive director shall maintain such offices as the Board may direct and shall be responsible for keeping such offices open for the business of the Board during normal business hours, weekdays, and such other times as the Board may direct. The executive director is the primary agent of the Board and will be available at such Offices to create a presence for the Board, its activities and interaction with the public.

History

Effective 2016-01-08

Chapter 2 Services for Miners

Wyo. Code R. 014.0001.2.04292021 Services for Miners

CHAPTER 2

SERVICES FOR MINERS

Section 1. Definitions.

(a) "Occasional" means irregular or infrequent.

(b) "Incidental" means work at a mine or qualifying processing or conversion facility that is not necessary for or, directly dependent upon, the primary function of the mine or qualifying processing or conversion facility.

(c) "Processing or conversion facility" means a facility that is dependent upon the output of a mine for feedstock and prepares minerals, coal or other geological materials, in solid or liquid form derived from an in situ leach process, prior to the first sale or transfer of the mineral to another entity. Processing does not include those facilities that use a mined product as an ingredient in a finished product or to manufacture a finished product.

Section 2. Benefit Programs. Benefits for all miners are established as follows:

(a) The board will set a medical assistance benefit per miner/per calendar year for pulmonary/respiratory, cardiac, hearing loss and musculoskeletal conditions of miners which are due to labor in the mining industry in accordance with W.S. 30-6-102(b)(i). The board may vote to increase the benefit when deemed necessary based on increased costs of medical care and when appropriate based on the budget.

(b) The board will set a hearing aid benefit to be applied toward the purchase of new or replacement hearing aids. The board may vote to increase the benefit when deemed necessary based on increased costs of hearing aids and when appropriate based on the budget.

Section 3. Registration as an Eligible Miner.

(a) To be eligible, an applicant shall submit a completed Board registration form.

(b) The following shall be submitted as evidence of an applicant's eligibility for services:

(i) Residency - The applicant shall demonstrate compliance with the requirements of W.S. 30-6-102 (f)(v) by submitting any of the following: current Wyoming driver's license, current Wyoming identification card, or any other information which verifies residency and is acceptable to the board.

(ii) Domicile- The applicant shall meet the requirements of W.S.30-6-102 (f)(iv)

(iii) Employment as a miner -The applicant shall demonstrate compliance with the requirements of W.S. 30-6-102 (f)(ii) by submitting any of the following - Employment records, W-2 forms, pension verification letters, Social Security records, or any other information that is acceptable to the board and verifies the applicant's employment as a miner.

(c) Upon acceptance of the miner's qualified application, the Board shall issue a Miners Hospital Program identification Card.

(d) The Board may require renewal of registrations to comply with statute, rules, or policy changes. A miner who fails to renew a registration on or before the renewal deadline is not eligible for benefits. A miner may re-register after the deadline if the miner continues to meet the eligibility requirements but shall not be eligible for benefits during any period in which the miner was not registered.

Section 4. Eligibility for Medical Assistance Benefit.

(a) To be eligible for the Medical Assistance Benefit a miner shall:

(i) Complete a Board registration form, have registered as an Eligible Miner as provided in Section 3 and receive a valid Miner's Hospital Program Identification Card;

(ii) Submit a State licensed medical provider's written statement that the miner is in need of the services or benefits described in W.S. 30-6-102,

(iii) The eligible miner shall provide a State licensed medical provider's statement of injury and inability to work as miner with Workers Compensation records; mine personnel records; medical records; Social Security Records; or any other information which verifies that the injury occurred and the miner is unable to work due to the injury.

(b) The following shall be submitted as evidence of an individual's eligibility for the benefit:

(i) Diagnosis of the condition from a State licensed medical provider that verifies the condition and need for treatment and

(ii) Verification that no other sources of benefits exist, which may include:

(A) Explanation of Benefits from the miner's insurance company, Medicaid or Medicare or any other third-party responsible to pay for treatment received:

(B) A statement from a State licensed medical provider that other third party sources of payment have been explored and exhausted or

(C) An affidavit from the claimant certifying that he or she is not covered by any policy of insurance that provides coverage of or reimbursement for prescription medications.

(iii) A statement from a State licensed medical provider, statement from a health insurance company, or statement under penalty of perjury from the miner, the miner's next of kin or personal representative of the amount of out of pocket expenses incurred.

Section 5. Acceptance of Claims.

(a) Claims for medical assistance:

(i) A State licensed medical provider or miner shall submit claims for benefits directly to the Board's third-party administrator on a standard health insurance claim form or other forms acceptable to the third party administrator.

(b) Claims for Prescription Drug Assistance:

(i) A qualified miner covered by insurance providing prescription drug coverage may submit pharmacy receipts accompanied by a claim form with the miner's name and mailing address to the Board's third-party administrator. The miner's out-of-pocket costs for covered prescriptions shall be paid directly to the miner.

(ii) Qualified miners with no insurance may request a Prescription Hardship benefit. The Board shall determine the benefit on a case by case basis and the miner will be issued a Miner's Hospital Prescription Benefit Card that allows pharmacies to charge the entire cost of covered prescriptions, up to the annual maximum allowed under Section 2(a), to the Board. The prescription hardship benefit must be renewed every October.

(c) Accepted claims will only be paid if budgeted funds are available. Once the funds budgeted for the biennium are exhausted, no further claims for services provided during that biennium will be paid.

(d) All claims for a calendar year must be received on or before June 30 of the following.

(e) Claims received but not accepted or paid due to lack of budgeted funds may not be resubmitted.

Section 6. Payment of Accepted Claims. All payments except reimbursement for covered prescription drugs will be made directly to State licensed medical providers, or pharmacies. Reimbursements may be made directly to the qualified miner for good cause. Payment for prescription drug reimbursement may be made directly to miners.

Section 7. Denial of Registration, Services, or Benefits.

(a) Upon receiving of a registration form or claim for benefits, the Executive Director or staff shall review the form and information or claim submitted. If the applicant clearly qualifies, the applicant shall be registered or benefits shall be dispersed. If there are questions regarding eligibility or claims, the Executive Director shall forward the application or claim to the Review Committee (RC). The RC shall consist of the Executive Director and two (2) members of the board designated by the board chairman.

(i) The RC shall review the application or claim and all other information available and following the review may:

(A) Approve the application or claim; or

(B) If there are questions as to whether denial is appropriate, forward the application and a RC report to the Assistant Attorney General assigned to the Board for prosecution to review.

(ii) If, after review, the RC and Assistant Attorney General recommends denial of an application or claim:

(A) A preliminary denial letter shall be sent to applicant or claimant by registered mail, return receipt requested. The letter shall state the basis for the denial, including applicable rules.

(B) If preliminarily denied, the applicant or claimant shall submit a written request for a hearing within 15 days of the date of the denial letter or the denial is final.

(b) A denial hearing is a formal contested case hearing conducted pursuant to the Wyoming Administrative Procedure Act.

(c) The applicant has the burden of proving that the applicant is eligible for registration. The claimant has the burden of proving the claim should be paid.

(d) The hearing will be conducted by the Office of Administrative Hearings in accordance with its Uniform Rules for Contested Case Practice and Procedure. The hearing officer shall submit proposed findings of fact, conclusions of law and order to the Board within thirty (30) days of the hearing's conclusion. The miner and review committee may submit exceptions to the proposed order within ten (10) days after service. By incorporating the Office of Administrative Hearings' Uniform Rules, the Board makes the following findings;

(i) Incorporating the full text of the Uniform Rules would be cumbersome and inefficient given the length and nature of the rules;

(ii) The incorporation is limited to the Uniform Rules adopted by the Office of Administrative Hearings and effective on October 17, 2014, and shall not include any subsequent editions or amendments to the Uniform Rules.

(iii) Copies of the Uniform Rules are available to the public at the Board's office.

(iv) An electronic copy of the Uniform Rules is available to the public at the following web address: http://mhb.state.wy.us

(e) Proposed orders will be given consideration, but are not binding upon the Board. All final decisions will be issued by the Board and shall be based exclusively upon the evidence in the record and matters officially noticed. The Review Committee shall not participate in the Board's final decision.

(i) A Petition for Judicial Review of the Board decision may be filed in the district court in accordance with the Wyoming Rules of Appellate Procedure.

(ii) If a Petition for Judicial Review is filed in the district court, the petitioner shall either arrange the preparation and pay for the transcript of the testimony, or reimburse the Board for the cost of the transcript if previously prepared at Board expense.