reglab/statecodes huggingface dataset:
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 47 - CHILDREN'S MENTAL HEALTH WAIVER (CMHW) AND CARE MANAGEMENT ENTITY (CME) RULES › Section 47-10 - Individualized Plan of Care

Current through July 13, 2024
(a) An individualized plan of care (POC)
				shall be developed with the Family Care Coordinator (FCC), family, youth, and
				family team (CFT) within thirty (30) days of selection of an FCC.
(b) A crisis plan shall be included as part
				of the POC to assist in stabilizing the youth and family during a
				crisis.
(c) The POC shall be
				updated at least every ninety (90) days. More frequent updates may be necessary
				depending on the needs of the youth and his or her family.
(d) Each youth's PCP shall be documented in
				the POC.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 47 - CHILDREN'S MENTAL HEALTH WAIVER (CMHW) AND CARE MANAGEMENT ENTITY (CME) RULES › Section 47-11 - Benefit Plan and Covered Services

Current through July 13, 2024
(a) Services delivered by the CME shall be
				appropriate in type, frequency, and duration.
(b) Services shall include HFWA services
				only, and be subject to the following requirements:
(i) A ratio of no more than one (1) FCC for a
				total of ten (10) persons (1:10) being served by that FCC regardless of the
				referral source;
(ii) A ratio of no
				more than one (1) Family Support Partner (FSP) for a total of ten (10) persons
				(1:10) being served by that FSP regardless of the referral source;
(iii) A ratio of no more than one (1) Youth
				Support Partner (YSP) for a total of twenty-five (25) persons (1:25) being
				served by that YSP regardless of the referral source;
(iv) Adequate capacity for FSPs and YSPs.
				Every family shall initially be provided a FSP and YSP until the family decides
				they do not need either an FSP or YSP; and
(v) Natural supports consisting of a family
				member, friend, or community member selected by the participant or family, or
				both, to participate on the CFT. Any form of supports to the family or youth by
				an unpaid family member, friend, or community members.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 47 - CHILDREN'S MENTAL HEALTH WAIVER (CMHW) AND CARE MANAGEMENT ENTITY (CME) RULES › Section 47-12 - Quality Reporting

Current through July 13, 2024
(a) The Department shall perform, at minimum,
				quarterly monitoring of the CME 1915(b) waiver program's impact, access, and
				quality to ensure access to adequate services where medically necessary.
(i) The Department shall establish standards
				of quality for CME adherence, including, but not limited to, plan assurances on
				network adequacy.
(ii) The
				Department shall deem the CME in compliance with standards as long as the
				accrediting agency maintains standards as required by the Department.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 47 - CHILDREN'S MENTAL HEALTH WAIVER (CMHW) AND CARE MANAGEMENT ENTITY (CME) RULES › Section 47-13 - Provider Organization Standards

Current through July 13, 2024
The CME and its providers shall comply with all Department
				  standards. Through annual provider certification visits and ongoing incident
				  and complaint management systems, the Department will assess providers for
				  ongoing compliance with the HCBS settings. Certification requirements will be
				  adjusted to ensure services settings for the waivers remain in settings that
				  are not institutional or isolating in nature. Any areas of concern will be
				  addressed by the Department's corrective action and sanctioning process
				  pursuant to Chapter 16 of the Wyoming Medicaid Rules.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 47 - CHILDREN'S MENTAL HEALTH WAIVER (CMHW) AND CARE MANAGEMENT ENTITY (CME) RULES › Section 47-14 - Conflict of Interest

Current through July 13, 2024
Conflicts of interest that may result in provider practices
				  that have an appearance of impropriety are prohibited. The Department and the
				  CME shall issue policy regarding conflict of interest in the form of manuals
				  and bulletins to provide guidance to providers on how to avoid practices that
				  result in a potential conflict of interest.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 47 - CHILDREN'S MENTAL HEALTH WAIVER (CMHW) AND CARE MANAGEMENT ENTITY (CME) RULES › Section 47-15 - Provider Recordkeeping and Data Collection

Current through July 13, 2024
For the purposes of data collection, the Medicaid Management
				  Information System shall capture all eligibility data as well as claims and
				  encounter data.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 47 - CHILDREN'S MENTAL HEALTH WAIVER (CMHW) AND CARE MANAGEMENT ENTITY (CME) RULES › Section 47-17 - Background Check Requirements

Current through July 13, 2024
(a) All service providers shall successfully
				complete a central registry check, a Federal Bureau of investigation
				(FBI)/Division of Criminal Investigation (DCI) background screening, and an
				Office of the Inspector General (OIG) background screening.
(i) A successful background check shall
				verify the person has not been convicted of an Offense Against the Person
				including:
(A) Homicide (W.S. §
											
												6-2-101 et seq.);
(B) Kidnapping (W.S. §
											
												6-2-201 et seq.);
(C) Sexual assault (W.S. §
											
												6-2-301 et
				seq.);
(D) Robbery and blackmail
				(W.S. §
											
												6-2-401 et seq.);
(E) Assault and battery (W.S. §
											
												6-2-501 et seq.); or
(F) 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 47 - CHILDREN'S MENTAL HEALTH WAIVER (CMHW) AND CARE MANAGEMENT ENTITY (CME) RULES › Section 47-18 - Provider Training and Certification Requirements

Current through July 13, 2024
(a) Any willing and qualified agency or
				individual can enter into a contract with the CME for the provision of HFWA and
				respite services.
(b) All HFWA
				provider requirements are detailed in the Medicaid state plan, Targeted Case
				Management for Youth with SED/SMI.
(c) All HFWA providers shall comply with
				Department requirements for obtaining initial credentialing as a HFWA provider
				and shall recertify their credentials annually.
(d) To be a FCC, the individual shall:
(i) Have a Bachelor's degree in a human
				service area (or related field), or two years of work or personal experience in
				providing direct services or linking of services for youth experiencing
				SED/SMI;
(ii) Be at least
				twenty-one (21) years of age;
(iii)
				Complete all Department and CME-required training components;
(iv) Possess a valid driver's license,
				automobile insurance coverage that complies with the Wyoming Department of
				Insurance's required liability coverage limits, and car;
(v) Maintain current CPR and First Aid
				Certification;
(vi) Complete the
				HFWA credentialing processes as specified by Medicaid;
(vii) Be enrolled as a Wyoming Medicaid
				provider;
(viii) Be under contract
				(or have an employment agreement) with the CME; and
(ix) Successfully pass all background
				screenings as required by Medicaid.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 47 - CHILDREN'S MENTAL HEALTH WAIVER (CMHW) AND CARE MANAGEMENT ENTITY (CME) RULES › Section 47-19 - Marketing

Current through July 13, 2024
(a) All marketing materials produced by the
				CME shall be approved by the Department before disseminating.
(b) The CME may participate in indirect
				marketing as follows:
(i) The CME may attend
				health fairs, sponsor community forums, obtain radio spots, print media, and
				provide general outreach so long as the entity does not target its material
				directly to Medicaid beneficiaries.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 47 - CHILDREN'S MENTAL HEALTH WAIVER (CMHW) AND CARE MANAGEMENT ENTITY (CME) RULES › Section 47-20 - Transition Process

Current through July 13, 2024
(a) Transition of youth who exceed the
				maximum age limitation shall occur before the end of the month of their
				twenty-first (21st) birthday:
(i) Any and all pertinent POC shall initiate
				development of a plan to address transition goals before transition is expected
				to occur.
(A) Transition plans shall include,
				but not be limited to, detailed, measurable objectives to be followed by the
				team in support of the youth and family during the transition.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 47 - CHILDREN'S MENTAL HEALTH WAIVER (CMHW) AND CARE MANAGEMENT ENTITY (CME) RULES › Section 47-21 - Non-English Languages

Current through July 13, 2024
(a) Potential enrollee and enrollee materials
				shall be translated into the prevalent non-English languages, which is defined
				as any language spoken by approximately four percent (4%) or more of the
				potential enrollee/enrollee population.
(b) The Department shall maintain an active
				contract with a translation service. If an enrollee or provider needs
				translation services, he or she shall contact the CME to set an appointment
				with the translation service, and the cost shall be billed to the
				Department.
(c) All marketing and
				education materials shall be available in prevalent non-English languages. For
				language needs, other than prevalent non-English languages, the Department
				shall allow the enrollee or provider to use the translation service at the
				expense of the Department.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 47 - CHILDREN'S MENTAL HEALTH WAIVER (CMHW) AND CARE MANAGEMENT ENTITY (CME) RULES › Section 47-22 - Grievance and Complaints

Current through July 13, 2024
(a) The CME shall have a system in place for
				enrollees or providers acting on behalf of enrollees to access a grievance
				process, an appeal process, and access to the Department's fair hearing system.
				The CME's grievance procedure shall meet the following requirements:
(i) Notice of the CME's grievance procedure
				shall be sent to enrollees once the Department informs the CME of the youth's
				eligibility as a program enrollee;
(ii) The CME's grievance and one-level appeal
				process must adhere to the timeframes specified in
				42
				C.F.R. §
											438.400 and §
										438.424.
(iii) An enrollee has sixty (60) calendar
				days from the date on the adverse action notice to file an oral or written
				request
(iv) The CME shall
				acknowledge in writing, via certified mail, the receipt of a written or oral
				grievance or complaint within five (5) working days of receipt;
(v) The CME shall prepare and present a
				proposed resolution to the complaint within forty-five (45) calendar days from
				the date the CME receives the grievance. If the CME's proposed resolution is
				not accepted by the enrollee or entity acting on behalf of the enrollee they
				may file a request for continuation of benefits within ten (10) calendar days
				of receipt of the proposed resolution or the intended effective date of the
				adverse action notification, whichever is later. The CME has thirty (30)
				calendar days to review and respond to the appeal.
(vi) An enrollee may request a State fair
				hearing after receiving notice under
				42
				C.F.R. §
											438.408 that the adverse
				benefit determination is upheld by the CME.
(vii) If the CME fails to adhere to the
				notice and timing requirements in § 438.408, the enrollee is deemed to
				have exhausted the CME's appeals process. The enrollee may initiate a State
				fair hearing.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 47 - CHILDREN'S MENTAL HEALTH WAIVER (CMHW) AND CARE MANAGEMENT ENTITY (CME) RULES › Section 47-24 - Payment of Claims

Current through July 13, 2024
(a) The CME is paid using per member, per
				month (PMPM) administrative services rate for HFWA service
				administration.
(b) The PMPM paid
				to the CME for administrative services is contractually negotiated.
(c) The CME network providers are paid on a
				fee for service basis for the HFWA and waiver services specified in the
				contract.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 47 - CHILDREN'S MENTAL HEALTH WAIVER (CMHW) AND CARE MANAGEMENT ENTITY (CME) RULES › Section 47-25 - 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 various provisions
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 47 - CHILDREN'S MENTAL HEALTH WAIVER (CMHW) AND CARE MANAGEMENT ENTITY (CME) RULES › Section 47-26 - Superseding Effect

Current through July 13, 2024
This Chapter supersedes all prior rules or policy statements
				  issued by Department, or its designee, including manuals and bulletins which
				  are inconsistent with this Chapter.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 47 - CHILDREN'S MENTAL HEALTH WAIVER (CMHW) AND CARE MANAGEMENT ENTITY (CME) RULES › Section 47-27 - Severability

Current through July 13, 2024
If any portion of these rules is found invalid or
				  unenforceable, the remainder shall continue in effect.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 47 - CHILDREN'S MENTAL HEALTH WAIVER (CMHW) AND CARE MANAGEMENT ENTITY (CME) RULES › Section 47-28 - 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 49 - NURSING FACILITY INVOLUNTARY DISCHARGE OR TRANSFER HEARINGS › Section 49-1 - Authority

Current through July 13, 2024
This Chapter is promulgated pursuant to the Wyoming Medical
				  Assistance and Services Act at Wyoming Statutes §
									
										42-4-101
				  through - 122.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 49 - NURSING FACILITY INVOLUNTARY DISCHARGE OR TRANSFER HEARINGS › Section 49-2 - Purpose and Applicability

Current through July 13, 2024
(a) This Chapter is
				intended to comply with federal law directives under applicable provisions of
				42 U.S.C. §
										1396r, which require notice and opportunity
				to be heard in cases of involuntary transfers or discharges of residents of
				nursing care facilities.
(b) The
				Department may issue manuals and bulletins to providers and other affected
				parties to interpret the sections of this Chapter. Such manuals and bulletins
				shall be consistent with and reflect the requirements outlined in this Chapter.
				The provisions contained in manuals and provider bulletins shall be subordinate
				to the sections of this Chapter.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 49 - NURSING FACILITY INVOLUNTARY DISCHARGE OR TRANSFER HEARINGS › Section 49-3 - Involuntary Discharge or Transfer of a Resident

Current through July 13, 2024
(a)
				Pursuant to
				42 CFR
				483.15(c), the facility
				shall permit each resident to remain in the facility, and not transfer or
				discharge the resident from the facility unless one of the following conditions
				is met:
(i) The transfer or discharge is
				necessary for the resident's welfare and the resident's needs cannot be met in
				the facility;
(ii) The transfer or
				discharge is appropriate because the resident's health has improved
				sufficiently so the resident no longer needs the services provided by the
				facility;
(iii) The safety of
				individuals in the facility is endangered due to the clinical or behavioral
				status of the resident;
(iv) The
				resident has failed, after reasonable and appropriate notice, to pay for (or to
				have paid under Medicare or Medicaid) a stay at the facility. Non-payment
				applies if the resident does not submit the necessary paperwork for third party
				payment or after third party, including Medicare or Medicaid, denies the claim
				and the resident refuses to pay for his or her stay. For a resident who becomes
				eligible for Medicaid after admission to a facility, the facility may charge a
				resident only allowable charges as outlined in Chapter 7, Wyoming Nursing Home
				Reimbursement System;
(v) The
				facility ceases to operate; or
(vi)
				The health of individuals in the facility would otherwise be
				endangered.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 49 - NURSING FACILITY INVOLUNTARY DISCHARGE OR TRANSFER HEARINGS › Section 49-4 - Hearing Request

Current through July 13, 2024
(a) A resident
				eligible for an administrative hearing under this Chapter shall submit the
				request in accordance with Chapter 4 of the Wyoming Department of Health,
				Medicaid Rules, within thirty (30) calendar days after a notice of transfer or
				discharge has been given by the facility. Failure to timely submit the request
				shall deprive the individual of a right to a hearing.
(b) The facility may not transfer or
				discharge the resident while the appeal is pending, unless failure to discharge
				or transfer would endanger the health or safety of the resident or other
				individuals in the facility. The facility shall document the danger that
				failure to transfer or discharge would pose.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 49 - NURSING FACILITY INVOLUNTARY DISCHARGE OR TRANSFER HEARINGS › Section 49-5 - Administrative Hearings

Current through July 13, 2024
(a) The hearing and
				all other affiliated processes will be conducted in accordance with Chapter 4
				of the Wyoming Department of Health, Medicaid Rules.
(b) The hearing shall be held within forty
				(40) days of the receipt of the request.
(c) The burden of proof shall be placed upon
				the party contesting a determination to involuntarily transfer or discharge a
				resident.
(d) The party contesting
				a facility determination shall show by a preponderance of the evidence just
				cause why the proposed transfer or discharge does not comply with the grounds
				established by Section 3 of this chapter.
(e) The Wyoming Department of Health shall
				not be a party to the proceedings under this Chapter.
(f) The Department shall facilitate all
				correspondence between the resident, the facility, and the Office of
				Administrative Hearings for purposes of carrying out the proceedings.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 50 - STATE SUPPLEMENTAL PAYMENTS › Section 50-2 - Purpose

Current through July 13, 2024
This Chapter has been adopted to provide uniform procedures
				  used to determine eligibility for State Supplemental payments. In order to
				  receive a federal match for the Medicaid program, these payments are required
				  by
				  20 C.F.R §
										416.2001 and Public Law 93-66, as amended by
				  Public Law 93-233. These payments are intended to complement the federal
				  benefit amount, thereby increasing the amount of income available to meet a
				  client's needs.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 50 - STATE SUPPLEMENTAL PAYMENTS › Section 50-3 - Definitions

Current through July 13, 2024
Except as otherwise specified in Chapter 1, the terminology
				  used in this Chapter is the standard terminology and has the standard meaning
				  used in health care, Medicaid, and Medicare.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 50 - STATE SUPPLEMENTAL PAYMENTS › Section 50-4 - Application Process

Current through July 13, 2024
An application for Supplemental Security Income (SSI) shall
				  be submitted to the Social Security Administration. In order to determine
				  eligibility, the Social Security Administration shall provide the applicant's
				  information to the Department of Health.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 50 - STATE SUPPLEMENTAL PAYMENTS › Section 50-5 - Eligibility Factors

Current through July 13, 2024
A client who receives an SSI payment as a sole source of
				  income and is a resident of Wyoming, as determined by the Social Security
				  Administration, shall be eligible to receive a State Supplemental
				  payment.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 50 - STATE SUPPLEMENTAL PAYMENTS › Section 50-10 - 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 51 - KID CARE CHILD HEALTH INSURANCE PROGRAM › Section 51-1 - Authority

Current through July 13, 2024
The Wyoming Department of Health (Department) promulgates
				  this Chapter pursuant to the Child Health Insurance Program Act at Wyoming
				  Statutes 35-25-101 through
				  35-25-108 (The
				  Act)
.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 51 - KID CARE CHILD HEALTH INSURANCE PROGRAM › Section 51-2 - Purpose and Applicability

Current through July 13, 2024
(a) The Department adopts this Chapter to
				govern the Kid Care Child Health Insurance Program ("CHIP") including
				eligibility, basic level of benefits, and cost-sharing.
(b) This Chapter applies to all applicants
				and clients for all CHIP services.
(c) The Department may issue manuals and
				bulletins to interpret this Chapter. Such manuals and bulletins shall be
				consistent with and reflect this Chapter. The provisions contained in manuals
				and newsletters shall be subordinate to this Chapter.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 51 - KID CARE CHILD HEALTH INSURANCE PROGRAM › Section 51-3 - Definitions

Current through July 13, 2024
(a) Except as otherwise specified in Wyoming
				Medicaid Rules Chapter 1, the terminology used in this Chapter is the standard
				terminology and has the standard meaning used in health care, health insurance,
				Medicare, and Medicaid. For the purposes of this Chapter, the following shall
				apply:
(i) "Benefit year" means a year of
				benefits coverage that begins January 1 of each year and ends December 31 of
				the same year.
(ii) "Federal funds"
				means the Federal funds received by the Department pursuant to
				42 C.F.R. §
											457 Subpart F.
(iii) "Targeted low income child" means a
				child who has a household income, as determined according to
				42 CFR §
											457.315, at or below 200 percent of the
				Federal poverty level for a family of the applicable size.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 51 - KID CARE CHILD HEALTH INSURANCE PROGRAM › Section 51-4 - Application Process, Applicant Rights and Responsibilities

Current through July 13, 2024
(a) Application Process.
(i) An applicant shall submit an application
				in the manner and form prescribed by the Department. The application shall be
				completed, dated, and signed by the applicant or by any person who is assisting
				the applicant.
(ii) The Department
				shall act upon an application within forty-five (45) days from the date the
				application was submitted.
(iii)
				The Department shall notify the applicant in writing of its application
				determination along with the reasons and regulations supporting its
				decision.
(iv) If the application
				is denied or not acted upon by the Department within forty-five (45) days, the
				applicant may request an administrative hearing in accordance with Medicaid
				Rules Chapter 4.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 51 - KID CARE CHILD HEALTH INSURANCE PROGRAM › Section 51-5 - General Eligibility Requirements

Current through July 13, 2024
(a) Applicants shall meet the following
				requirements to be eligible for Medicaid:
(i)
				Applicants shall be citizens or qualified non-citizens of the United States,
				and provide documentation of such;
(ii) Applicants shall provide proof of
				identity;
(iii) Applicants shall
				reside in Wyoming; and
(iv)
				Applicants who are citizens or nationals of the United States shall provide
				record of a social security number.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 51 - KID CARE CHILD HEALTH INSURANCE PROGRAM › Section 51-6 - CHIP Eligibility Requirements

Current through July 13, 2024
(a) Applicants shall meet the following
				additional requirements to be eligible for CHIP:
(i) Applicants must be below age nineteen
				(19);
(ii) Countable family income
				shall be between one hundred thirty-four percent (134%) and two hundred percent
				(200%) of the Federal Poverty Level (FPL) and calculated using the modified
				adjusted gross income of the household;
(iii) Applicants cannot reside in a public
				institution;
(iv) Applicants cannot
				be covered by any health insurance plan, including the State of Wyoming
				employee health insurance group plan; and
(v) Applicants cannot have been covered by a
				health insurance plan for a minimum period of one (1) month before the date of
				application. The minimum period can be waived when allowable exceptions exist,
				including the applicant's out-of-pocket health insurance premium
				costs.
(vi) Applicants and enrolled
				clients shall immediately report any changes in any of the following
				circumstances to the Department:
(A)
				Income;
(B) Household
				composition;
(C) Health insurance;
				and
(D) Address.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 51 - KID CARE CHILD HEALTH INSURANCE PROGRAM › Section 51-7 - Basic Level of Benefits

Current through July 13, 2024
(a) The covered services provided to CHIP
				clients, at a minimum, shall include the following services:
(i) Inpatient hospital services;
(ii) Outpatient hospital services;
(iii) Physician services;
(iv) Surgical services;
(v) Clinic services and other ambulatory
				health care services;
(vi)
				Prescription drugs;
(vii)
				Laboratory and radiological services;
(viii) Prenatal care and pre-pregnancy family
				planning services and supplies;
(ix) Inpatient mental health
				services;
(x) Outpatient mental
				health services;
(xi) Durable
				medical equipment, prosthetics and orthotics;
(xii) Abortion, only if necessary to save the
				life of the mother or if the pregnancy is the result of rape or
				incest;
(xiii) Dental
				services;
(xiv) Medically necessary
				orthodontia;
(xv) Inpatient
				substance abuse treatment services;
(xvi) Outpatient substance abuse treatment
				services;
(xvii) Preventive care,
				screening and immunization;
(xviii)
				Hospice care;
(xix) Emergency
				medical transportation where care is administered during
				transportation;
(xx) Vision
				services;
(xxi) Dietician
				services;
(xxii) Hearing
				services;
(xxiii) Home health
				services;
(xxiv) Interpretation
				services;
(xxv) Nurse practitioner
				and nurse midwife services;
(xxvi)
				Organ transplant services;
(xxvii)
				Occupational, physical and speech therapy services;
(xxviii) Rehabilitation services;
(xxix) Non-emergency medical transportation
				services; and
(xxx) Any other
				services determined to be medically necessary as defined in Medicaid Rules
				Chapter 1.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 51 - KID CARE CHILD HEALTH INSURANCE PROGRAM › Section 51-8 - Denial, Termination, Reduction, or Suspension of Eligibility or Services

Current through July 13, 2024
An applicant or enrolled client who is denied or terminated
				  from eligibility, or whose services are reduced or suspended shall be notified
				  by the Department in writing, and may request an administrative hearing in
				  accordance with Medicaid Rules Chapter 4.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 51 - KID CARE CHILD HEALTH INSURANCE PROGRAM › Section 51-9 - Cost Sharing Maximums

Current through July 13, 2024
(a) Cost sharing shall not exceed five
				percent (5%) of a family's gross household income for the length of the
				client's eligibility period. Each family shall be notified of their cost
				sharing maximum for the eligibility period.
(b) Clients may request Department review of
				cost sharing totals if they believe their maximum has been reached.
(c) If the Department determines the family
				has paid more than their five percent (5%) annual cost sharing maximum the
				family shall be reimbursed for the excess.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 51 - KID CARE CHILD HEALTH INSURANCE PROGRAM › Section 51-10 - Co-payments

Current through July 13, 2024
(a) The Department shall determine the
				benefit year for cost sharing co-payments for particular services. Co-payment
				amounts shall be determined according to the family income reported at the time
				of application.
(b) Clients who are
				American Indians or Alaskan Natives as defined in
				42 CFR
				457.10 shall not have any cost sharing
				co-payments imposed.
(c) The
				Department shall include the benefit year maximum amounts for co-payments in
				the Client Handbook which shall be made available to each CHIP
				client.
(d) The Department shall
				not impose co-payments, coinsurance, deductibles or any other cost sharing for
				well-baby or well-child services, including but not limited to, immunizations
				and preventive services.
(e) The
				Department shall not terminate a client because of the failure to make
				co-payments.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 51 - KID CARE CHILD HEALTH INSURANCE PROGRAM › Section 51-11 - Provider Participation

Current through July 13, 2024
No person or entity that provides services to a client shall
				  receive CHIP funds unless the person or entity is a Medicaid enrolled provider
				  pursuant to Medicaid Rules Chapter 3.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 51 - KID CARE CHILD HEALTH INSURANCE PROGRAM › Section 51-12 - Availability of Funding

Current through July 13, 2024
(a) If Department projections indicate
				expenditures may exceed the federal and state funds available under the Act,
				the Department may limit participation in the CHIP program as follows:
(i) The Department may impose a partial or
				total moratorium on new CHIP enrollments until funds are available to meet the
				needs of new clients;
(ii) For
				existing clients, the Department shall give priority for available funding to
				those families with the lowest incomes.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 52 - SCHOOL-BASED SERVICES › Section 52-1 - Authority

Current through July 13, 2024
The Wyoming Department of Health (Department) promulgates
				  this Chapter pursuant to the Medical Assistance and Services Act at Wyoming
				  Statutes §§
									
										42-4-101
				  through 124.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 52 - SCHOOL-BASED SERVICES › Section 52-2 - Purpose of Applicability

Current through July 13, 2024
(a) The Department adopts this Chapter to
				govern the School-Based Services (SBS) Program covered by Medicaid, the
				enrollment and participation of local education agencies and providers of
				covered school based services, and the methods and standards for reimbursement
				of such services.
(b) This Chapter
				shall apply to all SBS provided on or after its effective date.
(c) The Department may issue manuals or
				bulletins to interpret this Chapter. Such manuals and bulletins shall be
				consistent with and reflect the policies contained in this Chapter. The
				provisions contained in manuals or bulletins shall be subordinate to this
				Chapter.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 52 - SCHOOL-BASED SERVICES › Section 52-4 - School District and Provider Participation

Current through July 13, 2024
(a) To participate in the SBS Program, both
				the participating district and the providers shall enroll with Medicaid
				pursuant to Wyoming Medicaid Rules Chapter 3.
(b) Participating districts will act as the
				billing agent for affiliated providers. Providers may not provide SBS except
				under the participating districts. Providers may enroll under more than one
				participating district.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 52 - SCHOOL-BASED SERVICES › Section 52-5 - Provider Qualifications

Current through July 13, 2024
(a) To qualify for enrollment as a provider
				of SBS, an individual shall at a minimum, satisfy the following criteria:
(i) Meet applicable licensing and
				certification standards found in Wyoming statutes and rules, or in the statutes
				and regulations of the state in which the provider is located.
(ii) Not be excluded from participation in
				federally funded health care programs by the U.S. Department of Health and
				Human Services, Office of Inspector General; and,
(iii) Be assigned a National Provider
				Identifier (NPI) number by the National Plan and Provider Enumeration System,
				as applicable.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 52 - SCHOOL-BASED SERVICES › Section 52-6 - Covered Services

Current through July 13, 2024
(a) School health services will be covered
				for Medicaid enrolled clients under the age of 21. Services shall be medically
				necessary as defined by Wyoming Medicaid Rules Chapter 1, and rendered as part
				of the student client's IEP or IFSP.
(b) School health services shall be provided
				in accordance with the client's individual needs and shall not be subject to
				limitations as to scope, amount, or duration.
(c) School health services may be performed
				in the school, at the client's home, or at another appropriate site in the
				community.
(d) The following
				service categories and providers are covered services under the SBS Program as
				further defined in the Department's School-Based Services Program Manual:
(i) Speech and audiology services
(A) Speech-Language Pathologist;
				and
(B) Speech-Language Pathology
				Aide/Assistant.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 52 - SCHOOL-BASED SERVICES › Section 52-7 - Excluded Services

Current through July 13, 2024
(a) Services billed under the SBS program are
				subject to the limitations and coverage restrictions that exist for other
				Wyoming Medicaid services pursuant to Wyoming Medicaid Rules Chapter 26 and the
				applicable Medicaid Provider Manuals. Wyoming Medicaid shall not cover the
				following services:
(i) Services classified as
				educational, such as services or activities involving academic assessment,
				student instruction or curriculum, and supervision of students;
(ii) Services billed by a practitioner
				outside his or her area of expertise;
(iii) Vocational training that is related
				solely to specific employment opportunities, work skills, or work
				settings;
(iv) Services not
				identified in the client's IEP or IFSP;
(v) Evaluations that do not result in an IEP
				or IFSP;
(vi) Transportation
				services;
(vii) Communication and
				consultation with parents, other providers, and educators.
(A) Attendance at meetings;
(B) Instructional assistant
				contact;
(C) Parental
				contact;
(D) Parental
				consultation;
(E) Preparation and
				distribution of correspondence to parents or other professionals;
(F) Professional consultation; and
(G) Teacher contact.
(viii) Free care services.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 52 - SCHOOL-BASED SERVICES › Section 52-8 - Requirements for Obtaining Reimbursement

Current through July 13, 2024
(a) LEAs must adhere to SBS Program
				requirements that may exceed educational requirements.
(i) The LEA must deliver and document the
				service provided, based upon the needs of the client.
(ii) LEAs must authorize each client's
				related service needs by including the nature and extent of required services
				in the student's IEP or IFSP.
(iii)
				Schools may only provide medically necessary services and must ensure that all
				services meet Wyoming requirements for demonstrating medical necessity, as
				documented in Medicaid Rule Chapter 26.
(iv) LEAs must obtain and document consent
				from the client's parent or guardian to bill covered services to
				Medicaid.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 52 - SCHOOL-BASED SERVICES › Section 52-9 - Documentation Requirements

Current through July 13, 2024
(a) A provider must maintain all records
				necessary to fully disclose the nature, quality, amount, and medical necessity
				of services billed to a client currently receiving Medicaid services. Payment
				for services billed to Wyoming Medicaid that are not substantiated in the
				client's records are subject to recoupment. Documentation must be retained for
				at least six years from the date of payment or until ongoing audit issues are
				resolved, whichever is longer, as detailed in Wyoming Medicaid Rules Chapter
				3.
(b) For services covered under
				this Chapter, complete copies of the client's IEP or IFSP must be maintained as
				part of the participating district's records. The records must clearly indicate
				that the school-based services are required by the client's IEP or
				IFSP.
(c) As part of the
				participating district's required records, the client's file must include:
(i) The IEP or the IFSP;
(ii) An evaluation performed by the provider,
				or the annual and current present level of performance;
(iii) Treatment notes describing the IEP or
				IFSP goals and objectives specific to each client met by their school-based
				services;
(iv) Billing information
				recorded in units of time, as specified in Wyoming Medicaid Rules Chapter 3;
				and,
(v) A copy of the signed
				consent form from a parent or legal guardian.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 52 - SCHOOL-BASED SERVICES › Section 52-13 - Recovery of Overpayments

Current through July 13, 2024
The Department shall recover overpayments pursuant to Wyoming
				  Medicaid Rules Chapter 16. In addition to using its own internal processes for
				  recovery of overpayments, the Department may refer a matter involving suspected
				  overpayments to the Medicaid Fraud Control Unit at any time.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0039 - Mental Health Division › Chapter 1 - PSYCHIATRIC ADVANCE DIRECTIVES & PAD FORM › Section 1-1 - Purpose

Current through July 13, 2024
The Department of Health has promulgated these regulations
				  relating to psychiatric advance directives to ensure the timely and appropriate
				  implementation and application of the Wyoming Psychiatric Advance Directives
				  Statute.
(a) Any adult who has
				decisional capacity to provide informed consent to or refusal of psychiatric
				restabilization measures or any other person who is, pursuant to the laws of
				this state or any other state, authorized to consent to or refuse psychiatric
				restabilization measures on behalf of a person who lacks the decisional
				capacity, may execute a psychiatric advance directive. The principles of
				autonomy and personal dignity of the person having capacity are morally and
				ethically binding for physicians and other health care providers.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0039 - Mental Health Division › Chapter 1 - PSYCHIATRIC ADVANCE DIRECTIVES & PAD FORM › Section 1-2 - Reason

Current through July 13, 2024
To directly involve individuals in addressing health care
				  decisions should they lose capacity due to symptoms subsequent to a serious and
				  persistent mental illness. To insure compliance with Wyoming Statute on
				  Psychiatric Advance Directives, W.S. §
									
										35-22-301 through W.S. §
				  35-2-308.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0039 - Mental Health Division › Chapter 1 - PSYCHIATRIC ADVANCE DIRECTIVES & PAD FORM › Section 1-5 - Procedure

Current through July 13, 2024
(a) Persons admitted to psychiatric health
				care facilities such as hospitals, group homes, or long-term care facilities
				must be offered information about psychiatric advance directives and how to
				complete such directives.
(b) A
				mental health professional will review this material with the individual and
				his/her desires regarding execution of a psychiatric advance
				directive.
(c) If the person
				desires to create a psychiatric advance directive, assistance will be offered
				by a mental health professional in completing the directive.
(d) The Division shall prepare a standard
				form for use by those wishing to prepare and execute a psychiatric advance
				directive. The Division shall provide the form to anyone requesting a copy.
				Such forms shall be kept at the Mental Health Division, the Wyoming State
				Hospital, and the Division shall make copies available to community mental
				health centers and other health care facilities, at their request.
i. Any form for a psychiatric advance
				directive must include the following data:
A.
				The person's name, date of birth, and sex.
B The person's eye and hair color.
C. The person's race or ethnic
				background.
D. The person's social
				security number.
E. The name of the
				current and last treating facility.
F. The name, address and telephone number of
				the persons attending physician and/or primary mental health
				professional(s).
G. The person's
				signature or mark, or, if applicable, the signature of a person authorized by
				law to execute a psychiatric advance directive.
H. The date on which the psychiatric advance
				directive was signed.
I. The
				person's directive concerning the administration or refusal of psychiatric
				restabilization measures, countersigned by the persons attending physician or
				mental health professional.
J. The
				name, address and telephone number of the person designated as an agent, if
				applicable, to consent to or refuse psychiatric restabilization measures for
				the person who has executed a psychiatric advance directive and the signature
				of that person indicating acceptance of this appointment.
K. Information that a psychiatric advance
				directive may be revoked at any time by the person who is the subject of the
				directive unless he/she is mentally incapacitated, as attested to by two mental
				health professionals, one of whom is the persons attending physician; or at any
				time by any other person who is, pursuant to state law, authorized to consent
				to or refuse psychiatric restabilization measures on behalf of the person who
				is the subject of the directive.
L.
				Completed advance directives will be witnessed by two persons who are not
				family members or employees of the psychiatric facility where the person is
				being treated.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0039 - Mental Health Division › Chapter 13 - BEREAVEMENT COUNSELING › Section 13-1 - Authority

Current through July 13, 2024
These rules and regulations are promulgated by the Department
				  of Health pursuant to 2006 Budget Session Law, Chapter 40, Section
				  5,
				  Enrolled Act No. 0021 to establish bereavement counseling rules for the payment
				  of bereavement counseling services provided to surviving family members of
				  deceased emergency responders who died while in the performance of their
				  official duties responding to a civil or military emergency, or natural or
				  human caused disaster.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0039 - Mental Health Division › Chapter 13 - BEREAVEMENT COUNSELING › Section 13-2 - Purpose and Applicability

Current through July 13, 2024
(a) These rules
				have been adopted to ensure the availability of bereavement counseling services
				to the target population. These rules will establish a process by which funds
				authorized for bereavement counseling may be distributed and ensure quality
				care is provided.
(b) The
				Department may issue provider manuals, provider bulletins, or both, to
				interpret the provisions of these rules and regulations. Such provider manuals
				and provider bulletins shall be consistent with and reflect the policies
				contained in these rules and regulations. The provisions contained in provider
				manuals or provider bulletins shall be subordinate to the provisions of these
				rules and regulations.
(c) The
				incorporation by reference of any external standard is intended to be the
				incorporation of that standard as it is in effect on the effective date of
				these rules and regulations.