Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 45 - DD WAIVER PROVIDER STANDARDS, CERTIFICATION, AND SANCTIONS › Section 45-9 - Case Management Services

Current through July 13, 2024
(a) Case management is a mandatory service
				for all participants enrolled on the waivers.
(b) Case managers shall complete all
				eligibility paperwork, as established under Chapter 46 of the Department of
				Health's Medicaid Rules, within thirty (30) calendar days.
(c) The case manager shall use
				person-centered planning to understand the needs, preferences, goals, and
				desired accomplishments of the participant. The case manager shall coordinate
				and assist the participant in accessing all needed and available resources,
				such as natural, paid, and community support. The case manager shall develop
				and monitor the implementation of an individualized plan of care.
(d) The case manager shall assure that all
				information, including but not limited to guardianship paperwork and physical
				and mailing addresses of the participant, legally authorized representative(s),
				and other contacts is updated and accurate at all times. The case manager shall
				update the Division and other providers of any changes.
(e) The case manager shall maintain a
				participant's file and service documentation.
(i) The case manager shall assure information
				is disseminated to, and received by, the participant and appropriate parties
				involved in the participant's care or as authorized by a signed release of
				information by the participant or the participant's legally authorized
				representative(s).
(ii) The case
				manager shall arrange and coordinate eligibility for applicants or waiver
				participants by providing:
(A) Targeted case
				management services to an applicant who is in the eligibility process for
				waiver services or awaiting a funding opportunity; and
(B) Services that include the coordination
				and gathering of information needed for initial and annual certification,
				clinical and financial eligibility, and the level of care
				determination.
(iii) The
				case manager shall provide the participant and any legally authorized
				representative(s) with a list of all providers available in their community in
				order to allow the participant a choice of providers. To the extent that they
				are available, participant choice shall include any certified waiver provider,
				self-directed options, Medicaid State Plan services, and services offered by
				other state agencies, as well as community and natural supports.
(A) At least once every six (6) months, the
				case manager shall provide information to the participant or the legally
				authorized representative(s) on all available waiver services, including
				self-direction service delivery options. This may be done more frequently as
				requested by the participant or legally authorized representative(s).
(B) The case manager shall coordinate
				transition plans when the participant chooses to change, stop, or add providers
				to his or her individualized plan of care, or exit the waiver, as established
				under Section
				22 of this Chapter.
(C) If the case manager chooses to
				discontinue providing services, the case manager shall give the participant,
				legally authorized representative(s), and Division thirty (30) calendar days
				written notice. The case manager shall continue to provide case management
				services for the thirty (30) calendar days, or until a new case manager is
				approved, whichever is first.
(iv) The case manager shall involve and
				assist the participant's plan of care team with developing a person-centered
				individualized plan of care in accordance with this Chapter. The case manager
				shall assist the team with planning, budgeting, and prioritizing services for
				the participant using all available resources and the assigned individual
				budget amount.
(v) The case manager
				shall complete and submit the individualized plan of care, including all
				required components, in EMWS, or its successor, at least thirty (30) days
				before the intended plan start date.
(vi) If the participant chooses to
				self-direct services on the waiver, the case manager shall assist the
				participant in modifying the individualized plan of care as needed, and
				monitoring the services of the Financial Management Service utilized by the
				participant in accordance with the approved waiver.
(vii) The case manager shall ensure all
				providers on the participant's individualized plan of care sign off on the
				plan, receive a copy of the plan, receive team meeting notes, and complete
				participant specific training as required in Section
				15(g) of this Chapter.
				Documentation of participant specific training shall be available to the
				Division upon request.
(viii) The
				case manager shall monitor and evaluate the implementation of the participant's
				individualized plan of care, including a review of the type, scope, frequency,
				duration, and effectiveness of services, as well as the participant's
				satisfaction with the supports and services. On a quarterly basis, the case
				manager shall include this information in a report prescribed by the
				Division.
(ix) The case manager
				shall report to the provider any concerns with provider implementation of the
				individualized plan of care, or concerns with the health and safety of a
				participant. Rule violations shall be reported to the Division through the
				incident reporting or complaint processes.
(x) The case manager shall send the Division
				and the provider or employer of record written notification of noncompliance
				with these rules, the health, safety, or rights of the participant specified in
				the individualized plan of care, or when documentation is not received by the
				tenth (10th) business day of the following month after services were
				provided.
(xi) The case manager
				shall securely store and retain all confidential provider documentation
				received from other providers for a participant's services for a twelve (12)
				month period from the month services were rendered and shall follow safe
				destruction policies as established under Section
				7 of this Chapter, even if the participant
				changes case managers.
(xii) The
				case manager shall document all monitoring and evaluation activities, follow-up
				on concerns and actions completed, and make appropriate changes to the
				individualized plan of care with team involvement, as needed.