reglab/statecodes huggingface dataset:
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 43 - ACQUIRED BRAIN INJURY HOME AND COMMUNITY BASED WAIVER › Section 43-16 - Provider Records

Current through July 13, 2024
(a) A provider
				shall comply with Chapter 3, Provider Participation, of the Wyoming Medicaid
				Rules, Section
				7,
				which is incorporated by this reference.
(b) Individually-selected service
				coordinators shall maintain copies of documentation from other providers for a
				twelve month period.
(c) For
				documentation of case management services, individually-selected service
				coordinators shall comply with Chapter 3, Section
				7,
				which is incorporated by this reference.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 43 - ACQUIRED BRAIN INJURY HOME AND COMMUNITY BASED WAIVER › Section 43-19 - Excluded Services

Current through July 13, 2024
(a) Services not
				covered under the waiver include:
(i)
				Services furnished to a participant while in an institution.
(ii) Room and board of participant, which are
				the responsibility of the participant or representative payee.
(iii) Room and board expenses of a live-in
				personal caregiver or provider.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 43 - ACQUIRED BRAIN INJURY HOME AND COMMUNITY BASED WAIVER › Section 43-20 - Third-party Liability

Current through July 13, 2024
(a) Submission of
				claims. Claims for which third-party liability exists shall be submitted in
				accordance with Chapter 35.
(b)
				Medicaid payment. The Medicaid payment for a claim for which
				third
-
party liability exists shall be the difference
				between the Medicaid allowable payment and the third party payment. In no case
				shall the Medicaid payment exceed the payment otherwise allowable pursuant to
				this Chapter.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 43 - ACQUIRED BRAIN INJURY HOME AND COMMUNITY BASED WAIVER › Section 43-22 - Recovery of Excess Payments or Overpayments

Current through July 13, 2024
(a) The
				Department may recover excess payments pursuant to Chapter 39.
(b) The Department may recover overpayments
				pursuant to Chapter 16.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 43 - ACQUIRED BRAIN INJURY HOME AND COMMUNITY BASED WAIVER › Section 43-23 - Audits

Current through July 13, 2024
(a) The Division or the Centers for Medicare
				and Medicaid Services may audit a provider's financial records, medical
				records, or employment records, at any time to determine whether the provider
				has received excess payments or overpayments.
(b) The Division or the Centers for Medicare
				and Medicaid Services may perform audits through employees, agents, or through
				a third party. Audits shall be performed in accordance with generally accepted
				auditing standards.
(c)
				Disallowance. The Division shall recover excess payments or overpayments
				pursuant to Section
				22
				of this Chapter.
(d) Reporting
				audit results. If at anytime during a financial audit or a medical audit, the
				Division discovers evidence suggesting fraud or abuse by a provider, that
				evidence, in addition to the Division's final audit report regarding that
				provider, shall be referred to the Medicaid Fraud Control Unit.
(e) The Division shall share the results of
				the audit with the provider before excess payments or overpayments are
				recovered. However, nothing in this section shall abrogate the rights of the
				State to recover excess payments or overpayments in accordance with Chapter 16
				or Chapter 39.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 43 - ACQUIRED BRAIN INJURY HOME AND COMMUNITY BASED WAIVER › Section 43-24 - Reconsideration

Current through July 13, 2024
A provider may request that the Department reconsider a
				  decision to recover excess payments or overpayments. The request for
				  reconsideration, the reconsideration, and any administrative hearing shall be
				  pursuant to the reconsideration provisions of Chapter 3, Chapter 16 or Chapter
				  39 as applicable.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 43 - ACQUIRED BRAIN INJURY HOME AND COMMUNITY BASED WAIVER › Section 43-26 - Interpretation of Chapter

Current through July 13, 2024
(a) The order in
				which the provisions of this Chapter appear is not to be construed to mean that
				any one provision is more or less important than any other provision.
(b) The text of this Chapter shall control
				the titles of its various provisions.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 43 - ACQUIRED BRAIN INJURY HOME AND COMMUNITY BASED WAIVER › Section 43-27 - Superseding Effect

Current through July 13, 2024
This Chapter supersedes all prior rules or policy statements
				  issued by the Division, including Provider Manuals and Provider Bulletins,
				  which are inconsistent with this Chapter, except Chapter 1, Rules for
				  Individually-selected Service Coordinators of the Rules of the Developmental
				  Disabilities Division, which remains in effect.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 43 - ACQUIRED BRAIN INJURY HOME AND COMMUNITY BASED WAIVER › Section 43-28 - Severability

Current through July 13, 2024
If any portion of this Chapter is found to be invalid or
				  unenforceable, the remainder shall continue in full force and
				  effect.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 44 - ENVIRONMENTAL MODIFICATIONS AND SPECIALIZED EQUIPMENT FOR MEDICAID HOME AND COMMUNITY-BASED WAIVER SERVICES › Section 44-1 - Authority

Current through July 13, 2024
This Chapter is promulgated by the Department of Health
				  pursuant to Wyoming Statute
										9-2-102 and the Wyoming Medical Assistance
				  and Services Act at Wyoming Statutes
				  
										42-4-101
				  through -121
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 44 - ENVIRONMENTAL MODIFICATIONS AND SPECIALIZED EQUIPMENT FOR MEDICAID HOME AND COMMUNITY-BASED WAIVER SERVICES › Section 44-2 - Purpose and Applicability

Current through July 13, 2024
(a) This Chapter shall apply to and govern
				Medicaid reimbursement of environmental modification and specialized equipment
				services provided under the Wyoming Medicaid Comprehensive Waiver and Wyoming
				Medicaid Supports Waiver, (herein collectively referred to as the "DD
				Waivers").
(b) This Chapter, in
				addition to Chapters 45 and 46 of the Department of Health's Medicaid Rules,
				shall govern services and provider requirements of the DD Waivers.
(c) The Division of Healthcare Financing,
				hereafter referred to as the "Division," may issue provider manuals and
				provider bulletins to providers or other affected parties to interpret the
				provisions of this Chapter. Such provider manuals and provider bulletins shall
				be consistent with and reflect the policies contained in this Chapter. The
				provisions contained in provider manuals and provider bulletins shall be
				subordinate to the provisions of this Chapter.
(d) Wyoming's currently approved Centers for
				Medicare and Medicaid Services (CMS) Comprehensive and Supports Waiver
				Applications and the Comprehensive and Supports Waiver Service Index apply to
				this Chapter.
(e) The requirements
				of Title XIX of the Social Security Act, 42 C.F.R. Part 441, Subpart G and the
				Medicaid Sate Plan apply to this Chapter.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 44 - ENVIRONMENTAL MODIFICATIONS AND SPECIALIZED EQUIPMENT FOR MEDICAID HOME AND COMMUNITY-BASED WAIVER SERVICES › Section 44-3 - General Provisions

Current through July 13, 2024
(a) Except as otherwise specified in Chapter
				1 of the Department of Health's Medicaid Rules, or as defined in this Section,
				the terminology used in this Chapter is the standard terminology and has the
				standard meaning used in accounting, health care, Medicaid, and
				Medicare.
(b) "Case manager" means
				individual who provides case management services, as established in Chapter 45,
				Section 9.
(c) "Relative" means a participant's
				biological, step, or adoptive parent(s).
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 44 - ENVIRONMENTAL MODIFICATIONS AND SPECIALIZED EQUIPMENT FOR MEDICAID HOME AND COMMUNITY-BASED WAIVER SERVICES › Section 44-4 - Environmental Modifications - Scope and Limitations

Current through July 13, 2024
(a) Environmental modifications to a
				participant's residence shall meet at least two of the following criteria:
(i) Be functionally necessary;
(ii) Contribute to a person's ability to
				remain in or return to his or her home and out of an intermediate care facility
				for individuals with an intellectual or developmental disability (ICF/IID) or
				other institutional setting; and
(iii) Be necessary to ensure the person's
				health, welfare, and safety.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 44 - ENVIRONMENTAL MODIFICATIONS AND SPECIALIZED EQUIPMENT FOR MEDICAID HOME AND COMMUNITY-BASED WAIVER SERVICES › Section 44-5 - Environmental Modifications Approval Process

Current through July 13, 2024
(a) The plan of care team may request
				environmental modifications during the six-month or annual plan of care
				meeting. Environmental modification requests submitted at other times during
				the plan of care year may be submitted if significant health, safety, or access
				concerns are identified.
(b) When
				the plan of care team identifies an environmental concern or need, the case
				manager shall submit the following information to the Division for the overall
				scope of the project:
(i) A description of
				the environmental concern or need;
(ii) A description of how the environmental
				concern is related to the participant's diagnosed disability, based on an
				assessment from an occupational or physical therapist; and
(iii) A description of how the environmental
				modification will:
(A) Contribute to the
				participant's ability to remain in, or return to, his or her home;
(B) Increase the participant's
				independence;
(C) Address the
				participant's accessibility concerns; and
(D) Address health and safety needs of the
				participant.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 44 - ENVIRONMENTAL MODIFICATIONS AND SPECIALIZED EQUIPMENT FOR MEDICAID HOME AND COMMUNITY-BASED WAIVER SERVICES › Section 44-6 - Specialized Equipment - Scope and Limitations

Current through July 13, 2024
(a) Specialized equipment shall be
				functionally necessary and meet at least two of the following criteria:
(i) Be necessary to increase ability to
				perform activities of daily living or to perceive, control, or communicate with
				the environment in which the person lives;
(ii) Be necessary to enable the participant
				to function with greater independence and without which the person would
				require institutionalization; and
(iii) Be necessary to ensure the person's
				health, welfare, and safety.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 44 - ENVIRONMENTAL MODIFICATIONS AND SPECIALIZED EQUIPMENT FOR MEDICAID HOME AND COMMUNITY-BASED WAIVER SERVICES › Section 44-7 - Specialized Equipment Approval Process

Current through July 13, 2024
(a) The team may submit requests for
				specialized equipment during the six-month or annual plan of care meeting.
				Specialized equipment requests submitted at other times during the plan of care
				year may be submitted if significant health, safety, or access concerns are
				identified.
(b) Approval for
				specialized equipment shall require:
(i)
				Prior authorization from the Division; and
(ii) A recommendation from a therapist or
				professional with expertise in the area of need. The recommendation shall
				include:
(A) A description of the functional
				need for the specialized equipment;
(B) How the specialized equipment will
				contribute to a person's ability to remain in or return to his or her home and
				out of an ICF/IID or other institutional setting;
(C) How the specialized equipment will
				increase the individual's independence and decrease the need for other
				services;
(D) How the specialized
				equipment addresses accessibility, health, or safety needs of the
				participant;
(E) Documentation that
				the participant has the capability to use the equipment;
(F) Documentation that the waiver is the
				payer of last resort;
(G) A
				description of how equipment shall be delivered and who will train the person
				and providers on the equipment; and
(H) Documentation of two (2) quotes for the
				purchase of the equipment, including a maximum markup on the equipment of 20%.
(I) The quotes may include a detailed
				description of the need and costs for expert assembly of the equipment in
				addition to the 20% markup.
(II)
				The quotes may include a detailed description of the need and cost for training
				on the specialized equipment in addition to the 20% markup.
(III) If two (2) quotes cannot be obtained,
				an explanation as to why only one (1) quote was submitted shall accompany the
				request.
(IV) The Division may
				review any request that does not include more than one (1) quote.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 44 - ENVIRONMENTAL MODIFICATIONS AND SPECIALIZED EQUIPMENT FOR MEDICAID HOME AND COMMUNITY-BASED WAIVER SERVICES › Section 44-8 - Interpretation of Chapter

Current through July 13, 2024
(a) The order in which the provisions of this
				Chapter appear is not to be construed to mean that any one provision is more or
				less important than any other provision.
(b) The text of this Chapter shall control
				the titles of its various provisions.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 44 - ENVIRONMENTAL MODIFICATIONS AND SPECIALIZED EQUIPMENT FOR MEDICAID HOME AND COMMUNITY-BASED WAIVER SERVICES › Section 44-9 - Superseding Effect

Current through July 13, 2024
This Chapter supersedes all prior rules or policy statements
				  issued by the Division, including Provider Manuals and Provider Bulletins,
				  which are inconsistent with this Chapter.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 44 - ENVIRONMENTAL MODIFICATIONS AND SPECIALIZED EQUIPMENT FOR MEDICAID HOME AND COMMUNITY-BASED WAIVER SERVICES › Section 44-10 - Severability

Current through July 13, 2024
If any portion of this Chapter is found to be invalid or
				  unenforceable, the remainder shall continue in full force and effect.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 44 - ENVIRONMENTAL MODIFICATIONS AND SPECIALIZED EQUIPMENT FOR MEDICAID HOME AND COMMUNITY-BASED WAIVER SERVICES › Section 44-11 - Incorporation by Reference

Current through July 13, 2024
(a) For any code, standard, rule, or
				regulation incorporated by reference in these rules:
(i) The Department has determined that
				incorporation of the full text in these rules would be cumbersome or
				inefficient given the length or nature of the rules;
(ii) The incorporation by reference does not
				include any later amendments or editions of the incorporated matter beyond the
				applicable date identified in subsection (b) of this section; and
(iii) The incorporated code, standard, rule,
				or regulation is maintained at the Department and is available for public
				inspection and copying at cost at the same location.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 45 - DD WAIVER PROVIDER STANDARDS, CERTIFICATION, AND SANCTIONS › Section 45-1 - Authority

Current through July 13, 2024
This Chapter is promulgated by the Department of Health
				  pursuant to Wyoming Statute
										9-2-102 and the Wyoming Medical Assistance
				  and Services Act at
				  W.S.
				  42-4-101 through -121.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 45 - DD WAIVER PROVIDER STANDARDS, CERTIFICATION, AND SANCTIONS › Section 45-2 - Purpose and Applicability

Current through July 13, 2024
(a) This Chapter was adopted to govern
				certification of providers under the Wyoming Medicaid Supports Waiver and
				Comprehensive Waiver (hereinafter collectively referred to as the "DD
				Waivers").
(b) This Chapter, in
				addition to Chapters 44 and 46 of the Wyoming Medicaid Rules, shall govern
				services and provider requirements of the DD Waivers.
(c) The Division of Healthcare Financing,
				hereinafter referred to as the "Division," may issue provider manuals and
				provider bulletins to providers or other affected parties to interpret the
				provisions of this Chapter. Such provider manuals and provider bulletins shall
				be consistent with and reflect the rule provision's policies, as revised in
				this Chapter. The provisions contained in provider manuals or provider
				bulletins shall be subordinate to the provisions of this Chapter.
(d) Wyoming's currently approved Centers for
				Medicare and Medicaid Services (CMS) Comprehensive and Supports Waiver
				Applications and the Comprehensive and Supports Waiver Service Index apply to
				this Chapter.
(e) The requirements
				of Title XIX of the Social Security Act, 42 C.F.R., Part 441, Subpart G and the
				Medicaid State Plan apply to this Chapter.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 45 - DD WAIVER PROVIDER STANDARDS, CERTIFICATION, AND SANCTIONS › Section 45-3 - General Provisions

Current through July 13, 2024
(a) Except as otherwise specified in Chapter
				1 of the Department of Health's Medicaid Rules, or as defined in this Section,
				the terminology used in this Chapter is the standard terminology and has the
				standard meaning used in accounting, health care, Medicaid, and
				Medicare.
(b) "Case manager" means
				an individual who provides case management services, as established in Section
				9 of this Chapter.
(c) "Corrective Action Plan", referred to
				previously as a quality improvement plan, means a step by step plan of action
				developed by the provider to achieve targeted outcomes for resolution of
				identified errors in an effort to eliminate repeated deficient
				practices.
(d) "Elopement" means
				the unexpected or unauthorized absence of a participant for more than is
				approved in the participant's individualized plan of care when that person is
				receiving waiver services, or the unexpected or unauthorized absence of any
				duration of a participant whose absence constitutes an immediate danger to
				themselves or others. This could be an unexpected participant action, which may
				not be intentional and may be due to wandering that is secondary to
				dementia.
(e) "Licensed Medical
				Professional" means a medical professional licensed to practice in the State of
				Wyoming and authorized to prescribe medication.
(f) "Relative" means a participant's
				biological, step, or adoptive parent(s).
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 45 - DD WAIVER PROVIDER STANDARDS, CERTIFICATION, AND SANCTIONS › Section 45-4 - Rights of Participants Receiving Services

Current through July 13, 2024
(a) Each participant receiving services has
				the same legal rights and responsibilities guaranteed to all other U.S.
				citizens under the United States and Wyoming constitutions and federal and
				state laws.
(b) Participant rights
				shall not be modified or suspended except in accordance with state or federal
				law and this Chapter. A participant's right to dignity and respect, to be free
				from coercion, and to receive services in settings that are physically
				accessible to the participant shall not be limited or restricted.
(c) The participant, the participant's
				legally authorized representative(s), the participant's case manager, and the
				Division shall be informed in writing of the grounds for a denial or limitation
				of rights. Such notice shall be written in plain language and shall include a
				statement that the participant may choose an alternative provider, if the
				participant or legally authorized representative disagrees with the denial or
				limitation. If the Division disallows a limitation of a right in an
				individualized plan of care, this decision will apply to any provider offering
				services to the participant. Rights restrictions shall constitute a material
				change to the individualized plan of care. The following participant rights
				shall not be denied or limited, except for the purpose of an identified health
				or safety need, which shall be included in the participant's individualized
				plan of care:
(i) The right to
				privacy;
(ii) The right to freedom
				from restraint;
(iii) The right to
				privacy in their sleeping or living quarters;
(iv) The right to sleeping and living
				quarters that have entrance doors that can be locked by the individual, with
				only appropriate staff having keys to doors;
(v) The right to choose with whom and where
				they live;
(vi) Freedom to furnish
				and decorate their sleeping or living quarters within the lease or other
				agreement;
(vii) Freedom and
				support to control their own schedules and activities;
(viii) Freedom and support to have access to
				food at any time;
(ix) Freedom to
				have visitors of their choosing at any time, and associate with people of their
				choosing;
(x) Freedom to
				communicate with people of their choosing;
(xi) Freedom to keep and use their personal
				possessions and property;
(xii)
				Control over how they spend their personal resources;
(xiii) The right to access the community;
				and
(xiv) The right to make and
				receive telephone calls. No person shall limit a participant's right to make
				calls to Protection & Advocacy, or state and federal oversight or
				protection agencies as protected by
				42 U.S.C.
				10841(1)(M), such as the
				Division or Department of Family Services.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 45 - DD WAIVER PROVIDER STANDARDS, CERTIFICATION, AND SANCTIONS › Section 45-5 - Provider Qualifications for Each Waiver Service

Current through July 13, 2024
(a) All individual waiver providers,
				subcontractors, and provider employees offering direct services to waiver
				participants shall meet the following requirements unless otherwise specified
				in this Section:
(i) Be eighteen (18) years
				or older;
(ii) Be certified by the
				Division to provide the indicated service;
(iii) Maintain current CPR and First Aid
				Certification, which includes hands-on training from a trainer certified with a
				curriculum consistent with training standards set forth by the American Heart
				Association or the American Red Cross;
(iv) Have a valid email address, internet
				access, and the means to upload documentation into a Division designated
				portal; and
(v) If assisting with
				medications, maintain a current certificate in medication assistance training
				offered through the Division.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 45 - DD WAIVER PROVIDER STANDARDS, CERTIFICATION, AND SANCTIONS › Section 45-6 - Standards for all Providers

Current through July 13, 2024
(a) Consistent with the provisions of this
				chapter, providers shall:
(i) Protect
				participants from abuse, neglect, mistreatment, intimidation, and
				exploitation;
(ii) Treat
				participants with consideration, respect, and dignity;
(iii) Honor participants' preferences,
				interests, and goals;
(iv) Provide
				participants with daily opportunities to make choices and participate in
				decision making;
(v) Facilitate
				activities that are meaningful and functional for each participant;
(vi) Direct services toward maximizing the
				growth and development of each participant for maximum community participation
				and citizenship;
(vii) Provide
				services in the most appropriate, least restrictive, most integrated
				environment;
(viii) Encourage
				participants to express their wishes, desires, and needs;
(ix) Protect and promote the health, safety,
				and well-being of each participant;
(x) Design services to meet the needs of all
				participants served by the provider; and
(xi) Establish and implement written policies
				and procedures that:
(A) Are available to
				staff, participants, legally authorized representatives and, upon request, the
				general public;
(B) Are updated or
				revised as needed by rule or policy changes;
(C) Are reviewed at least annually with
				employees; and
(D) Describe the
				provider's operation and how systems are set up to meet participants'
				needs.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 45 - DD WAIVER PROVIDER STANDARDS, CERTIFICATION, AND SANCTIONS › Section 45-7 - Provider Recordkeeping and Data Collection

Current through July 13, 2024
(a) The provider shall collect and maintain
				data, records, and information as necessary to provide services.
(b) The provider shall develop and maintain a
				record keeping system that includes a separate record for each participant
				served.
(c) The provider shall
				develop and implement a systematic organization of records to ensure
				permanency, accuracy, completeness, and easy retrieval of
				information.
(d) The provider shall
				develop a process relating to retention, safe storage, and safe destruction of
				the participant's records to ensure retention of necessary information and to
				protect confidentiality of records. The provider shall retain all records
				relating to the participant and the provision of services in accordance with
				Chapter 3 of the Department of Health's Medicaid Rules.
(e) If there are changes in ownership of the
				provider agency, complete and accurate copies of all participant records shall
				be transferred to the participant's newly chosen provider. Before dissolution
				of any provider agency, the provider shall follow Medicaid disenrollment
				procedures and notify the Division in writing of the location and secure
				storage of any remaining participant records.
(f) The provider shall establish and
				implement policies that govern access to, duplication, dissemination, and
				release of information from the participant's record, which are consistent with
				applicable state and federal laws.
(g) Except as otherwise provided by law, the
				provider shall obtain a written authorization from the participant or the
				participant's legally authorized representative for the release of participant
				information that identifies or can readily be associated with the identity of a
				participant. The authorization shall comply with the requirements for hospital
				records identified in
				W.S.
				35-2-607.
(h) Providers shall make all records
				maintained or controlled by the provider available upon request to Division
				staff, representatives from the State or Federal Medicaid programs, or the
				Medicaid Fraud Control Unit, without prior written authorization, consent, or
				other form of release.
(i) The
				provider shall specify the method and frequency for obtaining authorizations
				for medical treatment and consents.
(j) The provider shall ensure that all record
				entries are dated, legible, and clearly identify the person making the
				entry.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 45 - DD WAIVER PROVIDER STANDARDS, CERTIFICATION, AND SANCTIONS › Section 45-8 - Documentation Standards

Current through July 13, 2024
(a) In addition to the requirements of
				Chapter 3 of the Department of Health's Medicaid Rules, the following
				provisions shall apply to the documentation of services, and medical and
				financial records, including information regarding dates of services,
				diagnoses, services furnished, and claims affected by this Chapter.
(b) A provider shall complete all required
				documentation, including the required signatures, before or at the time the
				provider submits a claim.
(i) Documentation
				prepared or completed after the submission of a claim is prohibited. The
				Division shall deem the documentation to be insufficient to substantiate the
				claim, and Medicaid funds shall be withheld or recovered.
(ii) Documentation shall not be altered in
				any way once billing is submitted, unless the participant or legally authorized
				representative requests an amendment to the documentation in accordance with
				the patient privacy rules in the Health Insurance Portability and
				Accountability Act of 1996.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 45 - DD WAIVER PROVIDER STANDARDS, CERTIFICATION, AND SANCTIONS › Section 45-11 - Rate Reimbursement Requirements

Current through July 13, 2024
(a) Providers shall be reimbursed for
				services through the rate methodology established in the corresponding waiver
				agreement with CMS.
(b) Rates paid
				to providers for waiver services shall be less than or equal to the usual and
				customary rates for similar non-waiver services.
(i) The Department shall consult with waiver
				service providers, developmental disability waiver program participants and
				their families to gather information about reimbursement rates prior to
				calculating the new reimbursement rates.
(ii) If third party expertise is necessary,
				the Department shall follow a competitive bidding process to procure the
				services of an expert in the development of cost-based waiver program payments
				to assist with the development of new reimbursement rates for waiver
				providers.
(iii) The Department
				shall receive approval from CMS prior to the implementation of a new or
				modified reimbursement rate setting methodology.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 45 - DD WAIVER PROVIDER STANDARDS, CERTIFICATION, AND SANCTIONS › Section 45-13 - Standards for Home and Community Based Waiver Services

Current through July 13, 2024
(a) Certified waiver providers offering
				direct care services to participants in a provider owned or operated service
				setting shall meet all applicable federal, state, city, county, and tribal
				health and safety code requirements. A service setting includes the provider's
				home, if services are routinely provided in that setting.
(b) Certified waiver providers shall provide
				services that are home and community-based in nature, which means the service
				setting:
(i) Assists the participant to
				achieve success in the setting environment and supports full access to the
				greater community to the same degree as individuals not receiving Medicaid home
				and community based services (HCBS);
(ii) Is selected by the individual from
				options including non-disability specific settings;
(iii) Assists the participant to advocate for
				him or herself, and participate in life-long learning opportunities;
(iv) Ensures an individual's rights of
				privacy, dignity, respect, and freedom from coercion and restraint;
(v) Optimizes, but does not regiment,
				individual initiative, autonomy, and independence in making life choices,
				including daily activities, recreational activities, physical environment, and
				with whom to interact;
(vi)
				Facilitates individual choice regarding services and supports and who provides
				them; and
(vii) Encourages
				individuals to have visitors of their choosing at any time.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 45 - DD WAIVER PROVIDER STANDARDS, CERTIFICATION, AND SANCTIONS › Section 45-14 - Background Check Requirements

Current through July 13, 2024
(a) All persons providing waiver services
				including: managers, supervisors, direct care staff, participant employees
				hired through self-direction, and any other person who may have unsupervised
				access to participants shall complete and pass a background screening as
				referenced in this Section. Persons who do not successfully pass a background
				screening shall not supervise, provide, or bill for waiver services, or
				otherwise have unsupervised access to participants on behalf of a
				provider.
(b) Certified providers,
				their employees, and all legal entities supervising, providing, or billing for
				waiver services shall also pass and maintain documentation of successful
				Department of Family Services Central Registry screening and an Office of
				Inspector General Exclusion Database screening. Entities that do not
				successfully pass these screenings shall be denied certification or
				terminated.
(c) Any provider or
				participant who employs an individual or entity to supervise, provide, or bill
				for waiver services who has not completed all required background checks may be
				subject to sanctions under these rules.
(d) Providers and self-direction employees
				shall show evidence of current background screenings for all required persons
				as part of the provider or employee's certification renewal.
(e) A successful background screening shall
				include:
(i) A Wyoming Department of Family
				Services Central Registry Screening, which shows that the individual is not
				listed on the Central Registry.
(ii) A United States Department of Health and
				Human Services, Office of Inspector General's Exclusions Database search
				result, which shows that the individual or entity is not currently
				excluded.
(iii) A state and
				national fingerprinted criminal history record check which shows that the
				individual has not been convicted, plead guilty, no contest to, or does not
				have a pending deferred prosecution for:
(A)
				An Offense Against the Person, including:
(I)
				Homicide (W.S.
				6-2-101 );
(II) Kidnapping (W.S.
				W.S.
				6-2-201 );
(III) Sexual assault (W.S.
				W.S. 6-2-301
				);
(IV) Robbery and blackmail
				(W.S.
				6-2-401 );
(V) Assault and battery (W.S.
				6-2-501 );
(VI) Human trafficking (W.S.
				6-2-701 ); and
(VII) Similar laws of any other state or the
				United States relating to these crimes.
(B) An Offense Against Morals, Decency and
				Family including:
(I) Bigamy (W.S.
				6-4-401 );
(II) Incest (W.S.
				6-4-402 );
(III) Abandoning or endangering children
				(W.S.
				W.S.
				6-4-403 );
(IV) Violation of order of protection
				(W.S.
				6-4-404 );
(V) Endangering children; controlled
				substances (W.S.
				6-4-405 ); and
(VI) Similar laws of any other state or the
				United States relating to these crimes.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 45 - DD WAIVER PROVIDER STANDARDS, CERTIFICATION, AND SANCTIONS › Section 45-15 - Provider Training Standards

Current through July 13, 2024
(a) In addition to the other training
				standards in this Chapter and the Department of Health's Medicaid Rules,
				providers shall ensure that employees, including management staff responsible
				for providing supports and services to participants, receive training in the
				areas specified in this Section prior to working unsupervised with participants
				in services.
(b) Staff responsible
				for providing direct services shall receive participant specific training from
				a trained staff member prior to working alone with participants.
(c) The provider shall maintain documentation
				that staff are qualified to provide waiver services through evidence of
				completed trainings, including the date training was completed, who conducted
				the training, and how the employee demonstrated understanding. The provider
				shall ensure that training is conducted by persons with expertise in the topic
				area, who are qualified by education, training, and experience, and maintain
				complete verification of such.
(d)
				All persons qualified to provide waiver services shall complete training in the
				following areas prior to delivering services. Providers may choose to develop
				their own training modules for employees or use Division modules, as long as
				the provider covers the key elements of each topic specified in the Division
				module with Division approval. General training topics include:
(i) Participant choice;
(ii) The rights of participants in accordance
				with state and federal laws, and any rights restrictions for each participant
				with whom a person works;
(iii)
				Confidentiality;
(iv) Dignity and
				respect;
(v) Preventing,
				recognizing and reporting abuse, neglect, intimidation, exploitation, and all
				other categories listed on the Division's Notification of Incident
				form;
(vi) Responding to injury,
				illness, and emergencies;
(vii)
				Billing and documentation of services;
(viii) Releases of information;
(ix) Grievance and complaint procedures for
				participants, legally authorized representatives, provider employees, and
				community members; and
(x)
				Implementing and documenting participant objectives and progress on
				objectives.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 45 - DD WAIVER PROVIDER STANDARDS, CERTIFICATION, AND SANCTIONS › Section 45-17 - Positive Behavior Supports

Current through July 13, 2024
(a) Habilitation services shall be designed
				to maximize the potential of the participant. Services shall be provided in the
				setting that is the least restrictive for the participant.
(b) Participants shall have a positive
				behavior support plan in place if restraints are outlined in their
				individualized plan of care.
(c) A
				participant with a challenging behavior identified by the plan of care team
				shall have a current functional behavioral analysis conducted within the last
				year to identify what the person is trying to communicate through the
				behavior(s), to identify the function or possible purpose for the behavior(s),
				to explore antecedents and contributing factors to behaviors, and to review and
				describe potentially positive behavioral supports and interventions in order to
				develop a positive behavior support plan.
(i)
				Challenging behaviors may include actions by the participant that constitute a
				threat to the person's immediate health and safety, the health and safety of
				others in the environment, a persistent pattern of behaviors that inhibit the
				participant's functioning in public places and integration within the
				community, or uncontrolled symptoms of a physical or mental
				condition.
(ii) The functional
				behavioral analysis shall include data compiled regarding all challenging
				behaviors exhibited, and be utilized to develop the positive behavior support
				plan used by the provider during the provision of waiver services.
(iii) A provider or provider staff
				knowledgeable of the participant shall complete the functional behavior
				analysis, which shall include input from the team, participant, and any legally
				authorized representative(s).
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 45 - DD WAIVER PROVIDER STANDARDS, CERTIFICATION, AND SANCTIONS › Section 45-18 - Restraint Standards

Current through July 13, 2024
(a) Restraint includes physical, chemical,
				and mechanical restraints, as further defined in this Section.
(b) The entire plan of care team shall agree
				to the use of restraints, confirmed with a signature from the participant,
				legally authorized representative, and all providers involved, and be
				consistent with this Section.
(c)
				When the use of positive behavior supports is not effective in modifying or
				changing a participant's challenging behavior, the participant's plan of care
				team may implement a restraint protocol to supplement the positive behavior
				support plan, subject to the provisions of this Section.
(d) Providers shall not use aversive
				techniques to modify a person's behavior. Aversive techniques include any
				intervention that causes pain, harm, discomfort, or social humiliation for the
				purpose of modifying or reducing a behavior.
(e) A provider serving more than five (5)
				participants with restraints in their plans is required to have one (1)
				employee complete training on positive behavior supports through any program
				approved by the Division. An additional employee shall be certified for every
				ten (10) additional participants with restraints in their plan.
(f) The plan of care team shall review the
				participant's plan thoroughly to ensure the individualized plan of care is not
				so restrictive that it repeatedly provokes behaviors that lead to the use of
				restraints.
(g) When restraints are
				deemed necessary, the individualized plan of care shall include a restraint
				protocol that includes:
(i) If a person other
				than the participant authorizes the use of restraint, the legal document, court
				order, guardianship papers, or medical orders that demonstrate this authority;
				and
(ii) For any restraint imposed,
				demonstration that the standards outlined in Section
				4(h)(i) of this Chapter
				are met.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 45 - DD WAIVER PROVIDER STANDARDS, CERTIFICATION, AND SANCTIONS › Section 45-20 - Notification of Incident Process

Current through July 13, 2024
(a) Providers shall report the following
				incidents involving waiver participants to the Division, the Department of
				Family Services, Protection & Advocacy System, Inc., the case manager,
				legally authorized representative(s), and law enforcement immediately after
				assuring the health and safety of the participant and other individuals:
(i) Suspected abuse as defined by
				W.S.
				35-20-102 or
				W.S.
				14-3-202;
(ii) Suspected self-abuse;
(iii) Suspected neglect as defined in
				W.S.
				35-20-102 or
				W.S.
				14-3-202;
(iv) Suspected self-neglect as defined W.S.
				W.S.
				35-20-102;
(v) Suspected abandonment as defined in
				W.S.
				35-20-102;
(vi) Suspected exploitation as defined in
				W.S.
				35-20-102;
(vii) Suspected intimidation as defined by
				W.S.
				W.S.
				35-20-102;
(viii) Sexual abuse as defined in
				W.S.
				35-20-102; and
(ix) Death.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 45 - DD WAIVER PROVIDER STANDARDS, CERTIFICATION, AND SANCTIONS › Section 45-21 - Complaint Process

Current through July 13, 2024
(a) A provider or provider employee who has a
				reasonable suspicion that a participant's health or safety is in jeopardy shall
				immediately contact the Division, Protection & Advocacy Systems, Inc., and
				other governmental agencies, such as law enforcement or DFS to report incidents
				or concerns.
(b) A provider shall
				have policies and procedures for handling complaints, including:
(i) How it will attempt to resolve the
				complaint;
(ii) How it will
				document actions, follow-up, and resolution of the complaint;
(iii) How and when information shall be
				shared with the complainant, legally authorized representative, and the case
				manager; and
(iv) How the
				complainant will be informed of the process to file a formal complaint with the
				Division.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 45 - DD WAIVER PROVIDER STANDARDS, CERTIFICATION, AND SANCTIONS › Section 45-22 - Transition Process

Current through July 13, 2024
(a) The participant or legally authorized
				representative may choose to change any provider at any time and for any
				reason.
(b) A provider who is
				terminating services with a participant shall notify the participant and the
				Division in writing at least thirty (30) calendar days prior to ending
				services, unless the Division approves a shorter transition period in advance.
				Failure to provide services during this thirty (30) calendar day period shall
				be considered abandonment of services and may result in decertification of the
				provider.
(c) When a participant or
				legally authorized representative chooses to change providers, they shall
				inform the case manager of the decision. The case manager shall notify the
				provider of a participant's or legally authorized representative's decision to
				discontinue services within three (3) business days.
(d) When a transition is requested, the case
				manager shall notify the Division of the request for change within three (3)
				business days of the request.
(i) If the
				participant or legally authorized representative requests a change of case
				manager, the case manager shall review choice and make provider lists available
				to the participant and legally authorized representative.
(ii) If the participant or legally authorized
				representative requests a change of a provider other than the case manager, the
				case manager shall review choice and provider lists with the participant or
				legally authorized representative.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 45 - DD WAIVER PROVIDER STANDARDS, CERTIFICATION, AND SANCTIONS › Section 45-23 - Notice of Costs to the Participant

Current through July 13, 2024
(a) The provider shall develop and implement
				a system to notify participants and legally authorized representatives of any
				associated cost to the participant for a service or item, and the terms of
				payment.
(b) Written notice shall
				be given to the participant before initiation of service and before any change.
				Providers shall allow participants and their legally authorized representative
				adequate time to review the notice before the participant chooses services from
				the provider, or before the changes are implemented.
(c) A provider's cost notice shall specify
				that participants will not be charged for services or items that are covered
				through other funding sources. This includes, but is not limited to, items
				necessary to provide habilitation and transportation related to habilitation.
				The cost notice shall also identify:
(i) Who
				is responsible for replacement or compensation when the participants' personal
				items are damaged or missing; and
(ii) How participants will be compensated
				when staff, guests, or other participants in service, who do not reside in the
				location (i.e., respite), utilize the environment and eat food paid for by
				participants.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 45 - DD WAIVER PROVIDER STANDARDS, CERTIFICATION, AND SANCTIONS › Section 45-24 - Participant Funds and Personal Property

Current through July 13, 2024
(a) Standards in this Section apply to any
				provider who takes responsibility for the funds or personal property of a
				participant. This includes:
(i) Serving as
				representative payee;
(ii) Managing
				the funds of the participant;
(iii)
				Receiving benefits or funds on behalf of the participant; or
(iv) Temporarily safeguarding funds or
				personal property for the participant.