Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 41 - ADULT DEVELOPMENTAL DISABILITIES HOME AND COMMUNITY BASED WAIVER › Section 41-9 - Development and Approval of the Individual Plan of Care

Current through July 13, 2024
(a)
				Development of the individual plan of care.
(i) After the targeted individualized budget
				amount is identified by the Division, the individual plan of care team,
				coordinated by the individually-selected service coordinator, shall assist the
				participant in determining the use of the targeted individualized budget amount
				in developing the individual plan of care.
(ii) The individual plan of care shall be
				completed in the form and manner prescribed by the Division in accordance with
				Section
				23
				of Chapter 1, Rules for Individually-selected Service Coordinators of the Rules
				of the Developmental Disabilities Division.
(iii) The individually selected service
				coordinator shall develop the individual plan of care that includes:
(A) A completed pre-approval page signed by
				the participant or guardian and the individually-selected service
				coordinator.
(B) Freedom of Choice
				Document or its successor.
(C)
				LT-MR-10 4 form or its successor.
(D) Medical report signed by a physician if
				the participant is eligible due to a diagnosis of a related condition. The
				medical report shall discuss the diagnosis and what the recommended treatments
				or services may be.
(E)
				Psychological report that is no more than 5 years old and signed by a
				psychologist.
(I) The psychological report
				shall specify a clinical diagnosis of mental retardation or a related
				condition.
(II) The psychological
				report shall provide recommendations that the individual plan of care team
				shall review and address through the individual plan of care.
(F) ICAP report that is no more
				than 5 years old.
(G) Objective
				pages as required by the Division for each habilitation service. The
				individually-selected service coordinator is responsible for ensuring that
				objective pages are completed. The objectives shall:
(I) Define the training activities of an
				individual and the methods used to train the activity.
(II) Be measurable and meaningful to the
				participant.
(III) Be reflected on
				the personal schedule.
(H) Identification of rights and rights
				restrictions in accordance with Appendix A of this Chapter, including the use
				of restraints as defined in Section
				4 of
				this Chapter, including:
(I) Why the
				restriction is imposed.
(II) How
				the restriction is imposed.
(III)
				The plan to restore the right being restricted.
(IV) Signature of the participant and/or
				guardian.
(V) Rights restrictions
				shall be reviewed at least every six months by the individual plan of care
				team.
(VI) Rights restrictions that
				occur that are not part of the individual plan of care shall be reported to the
				Division on a form designated by the Division.
(I) Skilled nursing information on the form
				required by the Division that includes all areas of skilled nursing required by
				the participant.
(J) Medication
				administration indicating the level of medication administration or monitoring
				required for the participant. Levels of support include:
(I) Medication administration.
(II) Medication management
				training.
(III) Medication
				monitoring.
(IV) Ability to
				self-medicate with no assistance.
(K) A behavior support plan, if applicable,
				that reflects and addresses maladaptive behaviors identified by the individual
				plan of care team, the psychological evaluations, and the Inventory for Client
				and Agency Planning, including maladaptive behaviors listed as moderate or
				above pursuant to Section 30 of Chapter 45.
(L) Schedules for habilitation, personal
				care, and respite services. The purpose of the schedule shall be to provide
				information about the services and supports needed throughout a participant's
				day and justify the rates for services. Schedules shall be personalized and
				shall:
(I) Reflect the purpose of the
				services.
(II) Reflect
				recommendations from therapists, physicians, psychologists, and other
				professionals.
(III) Reflect the
				participant's desires and goals.
(IV) Include all information required by
				Chapter 45.