reglab/statecodes huggingface dataset:
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 32 - REIMBURSEMENT OF DISPROPORTIONATE SHARE HOSPITALS › Section 32-2 - Purpose and Applicability

Current through July 13, 2024
(a) This Chapter
				has been adopted to govern disproportionate share payments made on or after its
				effective date. This Chapter is intended to implement the Departments
				responsibility to make disproportionate share payments under Section 1923 of
				the Social Security Act, codified at
				42 U.S.C. §
										1396 r-4. Hospital services are also subject
				to the provisions of Chapters 4, 8, 31 and 33 of the Rules and Regulations for
				Medicaid, except as otherwise specified in this Chapter.
(b) The requirements of Title XIX of the
				Social Security Act, 42
				C.F.R. §
										1396 r-4, and the Medicaid
				State Plan apply to Medicaid and are incorporated by this reference as of the
				effective date of this Chapter, and may be cross-referenced throughout this
				Chapter where applicable. This incorporation by reference does not include any
				later amendments or editions of the incorporated matter. The incorporated rules
				and regulations may be viewed at http://www.ecfr.gov/cgi-bin/ECFR and
				http://www.health.wyo.gov/healthcarefin/medicaid/spa.html, or may be obtained
				at cost from the Department.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 32 - REIMBURSEMENT OF DISPROPORTIONATE SHARE HOSPITALS › Section 32-3 - 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 healthcare, Medicaid, and Medicare.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 32 - REIMBURSEMENT OF DISPROPORTIONATE SHARE HOSPITALS › Section 32-4 - General Provisions

Current through July 13, 2024
(a) General
				methodology. Disproportionate share hospitals (DSHs) shall receive an annual
				payment after the year end settlement of the hospitals cost report. The
				hospitals eligibility for and the amount of any disproportionate share payment
				shall be determined pursuant to this Chapter.
(b) Disproportionate share payments shall not
				be redetermined because of changes that result from a reopening,
				redetermination, administrative hearing, settlement agreement, or other change
				in a hospitals allowable costs.
(c)
				The Department shall calculate disproportionate share payments after the state
				fiscal year end and make payments prior to the end of that same calendar
				year.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 32 - REIMBURSEMENT OF DISPROPORTIONATE SHARE HOSPITALS › Section 32-5 - Disproportionate Share Payment

Current through July 13, 2024
(a) In addition to
				the payment rates established pursuant to State Plan Amendments 4.19A, Part 1,
				Addendum 1, and 4.19B, Addendum 1-Page 24A, a DSH shall be entitled to a
				disproportionate share payment computed pursuant to this section.
(b) Determination of eligibility for
				disproportionate share payment. To be eligible for disproportionate share
				payment a hospital shall meet both of the following criteria:
(i) Have a Wyoming Medicaid utilization rate
				of not less than five percent (5%), defined as the percentage resulting from
				dividing Medicaid patient days by total patient days, based on the most current
				available information; and
(ii)
				Have at least two (2) obstetricians with staff privileges at the hospital who
				have agreed to provide obstetric services to individuals entitled to such
				services under the Medicaid State Plan. In the case of a hospital located in a
				rural area (that is, an area located outside of a Metropolitan Statistical Area
				as defined by the Executive Office of Management and Budget), the obstetrician
				includes any physician with staff privileges at the hospital to perform
				nonemergency obstetric procedures.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 32 - REIMBURSEMENT OF DISPROPORTIONATE SHARE HOSPITALS › Section 32-6 - Provider Records

Current through July 13, 2024
(a) A hospital
				shall comply with the provider record provisions of Chapter 3.
(b) Out-of-state records. If a provider
				maintains financial records or medical records in a state other than Wyoming,
				when requested, the provider shall either transfer the records to an in-state
				location that is suitable for the Department or reimburse the Department for
				reasonable costs, including travel, lodging and meals, incurred in performing
				the audit in an out-of-state location, unless otherwise agreed by the
				Department.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 32 - REIMBURSEMENT OF DISPROPORTIONATE SHARE HOSPITALS › Section 32-9 - Reconsideration

Current through July 13, 2024
A provider may request reconsideration of the denial or
				  calculation of disproportionate share payments pursuant to Chapter
				  16.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 32 - REIMBURSEMENT OF DISPROPORTIONATE SHARE HOSPITALS › Section 32-11 - Limitations on Payments

Current through July 13, 2024
Disproportionate share payments shall not exceed the
				  disproportionate share hospital state allotment, except as otherwise required
				  by the Social Security Act. In no event shall the Department be obligated to
				  use State Medicaid funds to pay more than the State Medicaid percentage of
				  disproportionate share payments due a provider.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 32 - REIMBURSEMENT OF DISPROPORTIONATE SHARE HOSPITALS › Section 32-12 - 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 32 - REIMBURSEMENT OF DISPROPORTIONATE SHARE HOSPITALS › Section 32-13 - Superseding Effect

Current through July 13, 2024
This Chapter supersedes all prior rules or policy statements
				  issued by the Department, including manuals and bulletins, which are
				  inconsistent with this Chapter.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 33 - REIMBURSEMENT OF OUTPATIENT HOSPITAL SERVICES › Section 33-1 - Authority

Current through July 13, 2024
This Chapter is promulgated by the Wyoming Department of
				  Health pursuant to 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 33 - REIMBURSEMENT OF OUTPATIENT HOSPITAL SERVICES › Section 33-2 - Purpose and Applicability

Current through July 13, 2024
(a) This Chapter has been adopted to
				establish the scope of Medicaid reimbursement of outpatient hospital services
				furnished to individuals admitted on or after its effective date.
(b) The requirements of XVIII and XIX of the
				Social Security Act, 42 C.F.R. Ch. IV, Subch. B, Pt. 413 and 419, 42 C.F.R. Ch.
				IV, Subch. C, Pt. 447, and the Medicaid State Plan also apply to Medicaid and
				are incorporated by this reference.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 33 - REIMBURSEMENT OF OUTPATIENT HOSPITAL SERVICES › Section 33-3 - Definitions

Current through July 13, 2024
Except as otherwise specified in Chapter 1, or as defined
				  herein, the terminology used in this rule is the standard terminology and has
				  the standard meaning used in health care, Medicaid and Medicare.
(a) "Chapter" used herein refers to the
				specified Chapter in the Wyoming Department of Health, Medicaid
				Rules.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 33 - REIMBURSEMENT OF OUTPATIENT HOSPITAL SERVICES › Section 33-4 - Provider Participation

Current through July 13, 2024
(a) Payments only to providers. No provider
				that furnishes outpatient hospital services to a client shall receive Medicaid
				funds unless the provider is enrolled.
(b) Compliance with Chapter 3. A provider
				that wishes to receive Medicaid reimbursement for outpatient hospital services
				furnished to a client shall meet the requirements of Chapter 3.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 33 - REIMBURSEMENT OF OUTPATIENT HOSPITAL SERVICES › Section 33-5 - Medicaid Allowable Payment for Outpatient Hospital Services

Current through July 13, 2024
(a) Generally. Payment to facilities for
				outpatient hospital services shall be provided pursuant to
				42
				C.F.R. §
										413.65. State-developed fee
				schedule rates for services described in this section shall be the same for
				public and private providers. The fee schedule and any periodic adjustments to
				the fee schedule shall be published at the Department's fiscal agent's website.
				Medicaid allowable payments for outpatient hospital services shall be made
				according to one of the following fee schedules depending on the type of
				service:
(i) Medicaid Ambulatory Payment
				Classification (APC) fee schedule. The APC fee schedule shall be based on
				services that are included and excluded in Medicare's outpatient prospective
				payment system pursuant to
				42
				C.F.R. §§
											419.21 and
				419.22.
(A) Services included under the APC fee
				schedule:
(I) Significant outpatient
				procedures, e.g., a procedure or surgery provided to a patient that constitutes
				the primary reason for the visit to the hospital;
(II) Ancillary Services;
(III) Emergency Services;
(IV) Observation;
(V) Drugs;
(VI) Laboratory services not included in
				Medicare's clinical laboratory fee schedule;
(VII) Durable medical equipment, prosthetics
				and orthotics;
(VIII) Radiology;
				and
(IX) Vaccines and
				immunizations.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 33 - REIMBURSEMENT OF OUTPATIENT HOSPITAL SERVICES › Section 33-11 - 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 33 - REIMBURSEMENT OF OUTPATIENT HOSPITAL SERVICES › Section 33-12 - Superseding Effect

Current through July 13, 2024
This Chapter supersedes all prior rules or policy statements
				  issued by the Department, including manuals and bulletins, which are
				  inconsistent with this Chapter.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 33 - REIMBURSEMENT OF OUTPATIENT HOSPITAL SERVICES › Section 33-14 - 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 34 - HOME AND COMMUNITY BASED SERVICES COMMUNITY CHOICES WAIVER PROGRAM › Section 34-1 - Authority

Current through July 13, 2024
(a) The Wyoming Department of Health
				(Department) promulgates this Chapter pursuant to the Wyoming Medical
				Assistance and Services Act at Wyoming Statute
				42-4-101 through-124.
(b) The services offered under the Community
				Choices Waiver program are authorized by the Medical Assistance and Services
				Act at W.S.
				42-4-103(a)(xvii).
(c) The Community Choices Waiver program is
				federally authorized by waiver of the amount, scope, and duration requirements
				contained in §
									1902(a)(10)(B) of the
				Social Security Act governing Medicaid. This Waiver has been granted to Wyoming
				by the United States Department of Health and Human Services under §
									1915(c) of the Social
				Security Act and approved by the Centers for Medicare and Medicaid Services
				(CMS).
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 34 - HOME AND COMMUNITY BASED SERVICES COMMUNITY CHOICES WAIVER PROGRAM › Section 34-2 - Purpose and Applicability

Current through July 13, 2024
(a) The Department adopts this Chapter to
				govern the Community Choices Waiver program (CCW) for covered home and
				community-based services (HCBS) provided to eligible individuals who would
				otherwise qualify for and require the services and level of care provided in a
				nursing facility.
(b) This Chapter
				shall apply to all HCBS provided and reimbursed under the CCW not otherwise
				available under the Wyoming Medicaid State Plan.
(c) The Department may issue manuals and
				bulletins to interpret this Chapter. Such manuals and bulletins shall be
				consistent with and reflect the rules contained in this Chapter. The provisions
				contained in manuals and bulletins shall be subordinate to this
				Chapter.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 34 - HOME AND COMMUNITY BASED SERVICES COMMUNITY CHOICES WAIVER PROGRAM › Section 34-3 - Definitions

Current through July 13, 2024
(a) Except as otherwise specified in Wyoming
				Medicaid Rules Chapter 1, or this Section, the terminology used in this Chapter
				is the standard terminology and has the standard meaning as used in accounting,
				health care, Medicaid, and Medicare.
(b) "Chemical restraint" means "Drug used as
				a restraint" as defined in Wyoming Medicaid Rules Chapter 1.
(c) "Physical restraint" means "personal
				restraint" as defined in Wyoming Medicaid Rules Chapter 1.
(d) "Restrictive intervention" means a
				limitation or restriction of a participant's rights.
(e) "Room and Board" means any shelter-type
				expenses, including all property-related costs such as rental or purchase of
				real estate, and basic furnishing, maintenance, utilities, and related
				administrative services, as well as three meals per day or any other full
				nutritional regimen.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 34 - HOME AND COMMUNITY BASED SERVICES COMMUNITY CHOICES WAIVER PROGRAM › Section 34-4 - Application Process

Current through July 13, 2024
(a) Applicants shall submit a CCW application
				in the manner and form prescribed by the Department. The application shall be
				completed, dated, and signed by the applicant or a legal guardian who is
				assisting the applicant.
(b)
				Applicants may be accompanied, assisted, or represented by an individual or
				individuals of their choice during the application process.
(i) Applicants may request assistance from a
				case manager for completing the application or obtaining required
				verification.
(ii) A case manager
				assisting the applicant shall submit all required documentation within thirty
				(30) calendar days of receipt.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 34 - HOME AND COMMUNITY BASED SERVICES COMMUNITY CHOICES WAIVER PROGRAM › Section 34-5 - Waiver Program Eligibility

Current through July 13, 2024
(a) The Department shall offer CCW enrollment
				only to those individuals determined by the Department to meet all applicable
				eligibility requirements of Wyoming Medicaid Rules Chapter 18 and of this
				Chapter.
(i) The individual shall be a member
				of one (1) of the following CCW target groups:
(A) The individual is aged sixty-five (65)
				years or older; or
(B) The
				individual is between the ages of nineteen (19) and sixty-four (64) years and
				has been determined disabled by the Social Security Administration or by the
				Department pursuant to Wyoming Medicaid Rules Chapter 18.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 34 - HOME AND COMMUNITY BASED SERVICES COMMUNITY CHOICES WAIVER PROGRAM › Section 34-6 - Reserved Capacity and Waiting List

Current through July 13, 2024
(a) The Department may manage participant
				enrollment capacity on a statewide basis.
(b) If participant enrollment reaches the
				maximum capacity of the CCW, eligible individuals who cannot be served within
				the program's capacity limits shall be eligible for placement on a waiting
				list.
(i) The waiting list shall be
				maintained by the Department.
(ii)
				An individual's position on the waiting list shall be based upon the date the
				individual was determined eligible pursuant to this Chapter.
(iii) As capacity for additional enrollments
				becomes available, individuals on the waiting list shall be enrolled in
				chronological order; however, the Department may reserve capacity for the
				prioritized enrollment of individuals included in a priority group specified in
				the CCW.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 34 - HOME AND COMMUNITY BASED SERVICES COMMUNITY CHOICES WAIVER PROGRAM › Section 34-7 - Loss of Eligibility

Current through July 13, 2024
(a) A participant is no longer eligible for
				the CCW, and the Department shall terminate the participant's enrollment and
				provision of services, if any of the following occur:
(i) The participant does not meet target
				group requirements;
(ii) The
				participant does not meet financial eligibility;
(iii) The participant changes residence to
				another state;
(iv) The participant
				voluntarily does not receive at least one (1) waiver service, for thirty (30)
				consecutive calendar days, and a reevaluation conducted pursuant to Medicaid
				Rules Chapter 22 demonstrates the participant no longer needs an institutional
				level of care;
(v) A re-evaluation
				using the level of care assessment approved by the Department demonstrates the
				participant no longer needs an institutional level of care; or
(vi) The participant is in a nursing home,
				hospital, residential treatment facility, in-patient hospice, or other
				institutional setting, or is incarcerated for thirty (30) or more consecutive
				calendar days.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 34 - HOME AND COMMUNITY BASED SERVICES COMMUNITY CHOICES WAIVER PROGRAM › Section 34-8 - CCW Provider Certification and Recertification

Current through July 13, 2024
(a) The Department shall not pay CCW funds to
				any individual or entity that provides services to a participant unless the
				individual or entity is a party to a fully executed provider agreement and is
				enrolled as a Medicaid provider and certified as a CCW provider by the
				Department.
(b) The Department
				shall establish CCW provider qualifications and participation standards to
				assure that CCW services are delivered in a safe and effective manner. These
				qualifications and standards shall:
(i)
				Ensure providers 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;
(ii) Be
				appropriate to the type of each CCW service provided;
(iii) Ensure providers have the sufficient
				training, experience, and education necessary to reasonably assure the health
				and welfare of participants;
(iv)
				Ensure any applicable state licensure or certification requirements are met by
				the entities or individuals furnishing services; and
(v) Ensure the settings and manner in which
				CCW services are rendered support the participant's full access to the greater
				community and do not have the effect of isolation or
				segregation.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 34 - HOME AND COMMUNITY BASED SERVICES COMMUNITY CHOICES WAIVER PROGRAM › Section 34-9 - Provider Participation Standards and Decertification

Current through July 13, 2024
(a) A CCW provider must offer and render
				services without discrimination based on race, religion, political affiliation,
				gender, national origin, age, sexual orientation, gender expression, or
				disability, except as allowed by law.
(b) A CCW provider shall identify in writing
				their potential conflicts of interest, including those of their employees, with
				the participant, other service providers on the participant's service plan,
				relatives of the participant, or any legal guardian of the participant, and
				address how a conflict of interest shall be mitigated. The provider shall share
				this information with a participant and/or their legal guardian and the case
				manager prior to being added to the participant's service plan.
(c) A CCW provider shall not place
				restrictions or criteria on the services it will make available, the type of
				health conditions it will accept, or the persons it will accept for care or
				treatment, unless the provider applies those restrictions or criteria to all
				individuals seeking the provider's services.
(d) A CCW provider shall institute policies
				and procedures as required by the Department to assure the safe and effective
				delivery of waiver services.
(e) A
				CCW provider shall deliver services that meet the service definitions
				established in the CCW Service Index and align with the participant's service
				plan.
(f) A CCW provider shall only
				agree to provide services to a participant if the provider has the adequate
				administrative and staffing resources and emergency backup systems necessary to
				render services as described and agreed to in the participant's service plan,
				and in accordance with all applicable state and federal service standards. A
				CCW provider shall make all reasonable efforts to avoid disruptions of service
				delivery that would jeopardize the participant's health and welfare.
(g) A CCW provider shall notify the
				participant and the Department in writing thirty (30) calendar days prior to
				ending services with the participant. All transitions occurring from this
				decision shall follow standards and requirements established by the
				Department.
(h) If acting as an
				employer or contractor of personnel, a provider entity shall ensure:
(i) Personnel operate within the limits and
				scope of practice allowed under the individual's professional licensure or
				certification and within the limits of the entity's licensure or certification,
				if applicable; and
(ii) Routine
				confirmation that it complies with the U.S. Department of Health and Human
				Services, Office of Inspector General's regulations and guidance on employment
				of individuals excluded from participation in federally funded health care
				programs.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 34 - HOME AND COMMUNITY BASED SERVICES COMMUNITY CHOICES WAIVER PROGRAM › Section 34-10 - Background Screening Requirements

Current through July 13, 2024
(a) All CCW providers, associated staff
				members, and adult volunteers shall be required to complete a background
				screening in accordance with this Section. This requirement applies to any
				person who may have unsupervised access to waiver participants during the
				provision of services, including managers, supervisors, direct-care staff, and
				workers hired through participant-direction.
(b) Individuals who fail a background
				screening shall not have access to waiver participants, supervise staff, or
				provide or bill for waiver services on behalf of a CCW provider.
(c) Volunteers under the age of eighteen (18)
				shall be under the direct supervision of a provider or staff member who has
				passed a background screening. An individual convicted of a sexual offense
				shall not be a volunteer.
(d) To
				satisfy the requirements of this Section, a background screening must include
				the following:
(i) A Wyoming Department of
				Family Services Central Registry Screening;
(ii) A United States Department of Health and
				Human Services, Office of Inspector General's Exclusions Database search
				result;
(iii) A national, name and
				social security based criminal history database screening; and
(iv) A United States Department of Justice,
				National Sex Offender Public Website search.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 34 - HOME AND COMMUNITY BASED SERVICES COMMUNITY CHOICES WAIVER PROGRAM › Section 34-11 - Provider Training Standards

Current through July 13, 2024
(a) Prior to the delivery of services,
				providers and direct care staff shall receive training in all areas established
				by the Department.
(b) Providers
				shall maintain documentation of participant-specific and Department established
				training that demonstrates staff members are qualified to provide waiver
				services. Documentation shall include verification of completed trainings, date
				training was completed, who conducted the training, and how the staff member
				demonstrated understanding.
(c)
				Providers shall designate one staff member to receive training on the service
				plan by the participant's case manager.
(d) Providers and direct care workers shall
				receive participant-specific training prior to the service plan start date or
				before any changes to the service plan occur in accordance with Department
				standards.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 34 - HOME AND COMMUNITY BASED SERVICES COMMUNITY CHOICES WAIVER PROGRAM › Section 34-12 - Covered Waiver Services

Current through July 13, 2024
(a) CCW services, as outlined in the CCW
				Service Index, supplement but do not supplant other services available to
				participants, such as: Wyoming Medicaid State Plan services; services available
				through other federal, state, or local public programs; or the supports that
				families and other community resources provide. The categories of services
				furnished under the CCW program include:
(i)
				Caregiver Support;
(ii) Case
				Management;
(iii) Community
				Transition Services;
(iv) Day
				Services;
(v) Equipment,
				Technology, Modifications;
(vi)
				Home-Based Services;
(vii)
				Home-Delivered Meals;
(viii)
				Non-Medical Transportation;
(ix)
				Nursing; and,
(x) Round-the-clock
				services.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 34 - HOME AND COMMUNITY BASED SERVICES COMMUNITY CHOICES WAIVER PROGRAM › Section 34-13 - Freedom of Choice

Current through July 13, 2024
(a) In selection of services, the participant
				has the freedom to choose:
(i) Between
				receiving services in an institutional setting or through the CCW;
(ii) From among all allowable service
				alternatives and service delivery options offered under the CCW; and
(iii) From among all willing and qualified
				providers enrolled and accepting referrals for services in the participant's
				county of residence.
(A) In areas where
				availability of case management providers is limited, the participant may
				choose a case management agency from a different county, as long as the agency
				is certified to provide case management services in the participant's county of
				residence.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 34 - HOME AND COMMUNITY BASED SERVICES COMMUNITY CHOICES WAIVER PROGRAM › Section 34-14 - Participant Rights and Safeguards

Current through July 13, 2024
(a) A participant has the same legal rights
				and responsibilities guaranteed to all U.S. citizens under the United States
				and Wyoming Constitutions and federal and state laws.
(b) A participant's rights shall not be
				restricted except in accordance with state or federal law and Department
				requirements.
(c) A participant's
				right to be free from physical, mechanical, and chemical restraints shall not
				be restricted unless authorized in writing by the participant or the
				participant's legal guardian. Any use of restraints shall meet the following
				conditions:
(i) Restraints shall not be used
				for the purposes of discipline or convenience to the provider.
(ii) Restraints shall not be authorized
				unless:
(A) The participant receives services
				in an assisted living or skilled nursing facility; and
(B) The restraint is supported by a specific
				assessed need and justified in the participant's service
				plan.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 34 - HOME AND COMMUNITY BASED SERVICES COMMUNITY CHOICES WAIVER PROGRAM › Section 34-15 - Incident Reporting and Complaints

Current through July 13, 2024
(a) A provider shall develop and maintain
				incident reporting policies and procedures, and shall review internal incident
				data in accordance with Department requirements.
(b) After assuring the health and safety of
				the participant, a provider shall immediately report the following critical
				incidents to the Department, the participant's case manager, and legal guardian
				in accordance with Department requirements:
(i) Suspected abuse as defined by
				W.S.
				35-20-102;
(ii) Suspected neglect as defined by
				W.S.
				35-20-102;
(iii) Suspected self-neglect as defined by
				W.S.
				35-20-102;
(iv) Suspected abandonment as defined by
				W.S.
				35-20-102;
(v) Suspected exploitation, including sexual
				exploitation and medication diversion, as defined by
				W.S.
				35-20-102;
(vi) Suspected intimidation as defined by
				W.S.
				35-20-102;
(vii) Suspected sexual abuse as defined by
				W.S.
				35-20-102; and
(viii) Death that is not the result of an
				expected medical diagnosis.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 34 - HOME AND COMMUNITY BASED SERVICES COMMUNITY CHOICES WAIVER PROGRAM › Section 34-16 - Home and Community-Based Settings Standards

Current through July 13, 2024
(a) All home and community-based settings
				must meet the following criteria and standards:
(i) Ensure the participant's right to
				privacy, dignity and respect, freedom from coercion and restraint, and receipt
				of services in settings that are physically accessible to the participant shall
				never be restricted.
(ii) Be
				integrated in and support the participant's full access to the greater
				community, including opportunities to seek employment and work in competitive
				integrated settings, engage in community life, control personal resources, and
				receive services in the community to the same degree as individuals not
				receiving waiver services.
(iii) Be
				selected by the participant from among settings options, including
				non-disability specific settings. The settings options and selection shall be
				identified and documented as part of the service planning process described in
				Section 17 and based upon the
				participant's needs and preferences.
(iv) Optimize, but not regiment, the
				participant's initiative, autonomy, and independence in making life choices,
				including but not limited to choices regarding daily activities, physical
				environment, and with whom to interact.
(v) Facilitate the participant's choice
				regarding services and supports, and who provides them.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 34 - HOME AND COMMUNITY BASED SERVICES COMMUNITY CHOICES WAIVER PROGRAM › Section 34-17 - Case Management and Service Planning Requirements

Current through July 13, 2024
(a) Upon application, participants shall
				select a case management agency from a list of all CCW qualified agencies
				serving the participant's county of residence, unless availability is limited.
				The participant's selected case management agency shall assign one (1) person
				to serve as the primary case manager, based on the participant's
				preferences.
(b) Case managers
				shall assist the participant with:
(i)
				Accessing CCW and Wyoming Medicaid State Plan services;
(ii) Identifying and coordinating access to
				medical, social, educational, employment and other services, regardless of the
				funding source; and
(iii)
				Identifying and coordinating natural supports.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 34 - HOME AND COMMUNITY BASED SERVICES COMMUNITY CHOICES WAIVER PROGRAM › Section 34-18 - Participant Direction of CCW Services

Current through July 13, 2024
(a) The participant, legal guardian, or
				another appropriate individual designated by the participant may serve as the
				Employer of Record (EOR) and assume responsibility for managing the activities
				associated with the direction of CCW services.
(b) The EOR must sign an agreement of
				understanding that they are willing and able to assume the EOR responsibilities
				and comply with established EOR standards.
(c) The EOR cannot delegate or assign the
				responsibilities of the EOR to another person or entity and cannot be
				reimbursed to provide CCW services to the participant.
(d) The EOR shall carry out the duties and
				responsibilities associated with participant direction of CCW services, such
				as:
(i) Recruiting employees;
(ii) Verifying that employees meet the
				minimum qualifications established by the Department;
(iii) Specifying, verifying, and maintaining
				documentation of any additional employee qualifications;
(iv) Hiring employees as the common law
				employer;
(v) Determining employee
				duties consistent with the service scope and limitations;
(vi) Determining employee wages within the
				limits established by the Department;
(vii) Scheduling employees;
(viii) Orienting and instructing employees in
				their duties;
(ix) Supervising
				employees;
(x) Evaluating employee
				performance;
(xi) Verifying the
				time worked by employees and approving time sheets; and
(xii) Terminating
				employees.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 34 - HOME AND COMMUNITY BASED SERVICES COMMUNITY CHOICES WAIVER PROGRAM › Section 34-19 - CCW Service Authorization and Reimbursement

Current through July 13, 2024
(a) CCW service authorization and
				reimbursement for service claims shall meet the same standards and requirements
				established in Wyoming Medicaid Rules Chapter 3.
(b) The provider shall make billing
				information available to the case manager by the tenth (10th) business day of
				the month following the month the claim was submitted for payment.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 34 - HOME AND COMMUNITY BASED SERVICES COMMUNITY CHOICES WAIVER PROGRAM › Section 34-20 - Service Documentation Standards

Current through July 13, 2024
(a) A provider shall document the following
				information whenever a service is provided:
(i) The location of services;
(ii) The date of service, including year,
				month, and day;
(iii) The time
				services begin and end, using either AM and PM or military time, with
				documentation for each calendar day, even when services span a period longer
				than one calendar day;
(iv) An
				initial or signature of the staff member performing the service; and
(v) A detailed description of services
				provided in accordance with Department standards and
				requirements.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 34 - HOME AND COMMUNITY BASED SERVICES COMMUNITY CHOICES WAIVER PROGRAM › Section 34-21 - Statewide Information System

Current through July 13, 2024
(a) All individuals who have been determined
				eligible for Medicaid waiver services shall be included in the statewide
				information system used by the Department for planning, monitoring, and
				analysis of the Medicaid waiver program. Information in the system is
				considered confidential and shall not be released without proper authorization,
				or otherwise as required by law.
(b) Providers shall submit data on programs,
				participant outcomes, costs, and other information as required by the
				Department.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 35 - MEDICAID BENEFIT RECOVERY › Section 35-2 - Purpose and Applicability

Current through July 13, 2024
(a) This Chapter shall apply to and govern
				all Medicaid third party liability and estate benefit recoveries.
(b) The requirements of Title V and Title XIX
				of the Social Security Act,
				42 U.S.C. §
										1396(a)(25), 42 U.S.C.
				§ 1396K(a)(1)(A),
				42
				U.S.C. §
										1396p, 42 C.F.R. Ch, IV
				§§ 433.135 - 433.154,
				42 C.F.R. §
										433.36, and the Wyoming Medicaid State Plan
				under Title XIX of the Social Security Act also apply to Medicaid
				herein.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 35 - MEDICAID BENEFIT RECOVERY › Section 35-3 - General Provisions

Current through July 13, 2024
(a) This Chapter is intended to implement and
				to be read in conjunction with W.S. §§
									
										42-4-114,
				42-4-201
				through
				42-4-208,
				42-4-122,
				14-2-1001
				through -
										14-2-1008, and
				applicable federal law.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 35 - MEDICAID BENEFIT RECOVERY › Section 35-5 - Assignment of Benefits and Third Party Liability

Current through July 13, 2024
(a) Assignment of Benefits, Third Party
				Liability, and Estate Recovery.
(i) By
				signing an application, an applicant shall be deemed to have made an assignment
				to the Department [the right to medical support or payment of medical expenses]
				on the applicant's behalf and on behalf of any relative, ward, or legal
				dependent for whom application is made.
(ii) The assignment of benefits is effective
				upon a determination of eligibility and remains in effect with respect to
				services provided during the period of eligibility for Medicaid, including any
				period of retroactive eligibility.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 35 - MEDICAID BENEFIT RECOVERY › Section 35-6 - Duties of Applicants and Clients

Current through July 13, 2024
(a) Notification of third party liability. An
				applicant or client shall notify the Social Security Administration or the
				Department of the possibility of third party liability at the time of
				application, at the time of an eligibility redetermination, and within ten (10)
				days after any event creating third party liability or any change in potential
				third party payers.
(b) Notice to
				providers. A client shall present the client's eligibility card to a provider
				at the time the client requests services. A client shall also inform a provider
				of the existence or possible existence of a third party payer at the time the
				client requests services from the provider and upon request from the
				provider.
(c) Cooperation in
				establishing paternity and obtaining medical support. As a condition of
				eligibility or continued eligibility, an applicant or client shall cooperate
				with the Department and local agency in establishing paternity of a child
				eligible for Medicaid or applying for Medicaid, and identifying and collecting
				from any third party payer. Cooperation includes:
(i) Appearing at the Department or local
				agency office to provide information or evidence regarding paternity;
(ii) Appearing as a witness at a court or
				other proceeding to testify regarding paternity;
(iii) Paying to the Department any medical
				support or medical payments received that are covered by the assignment of
				benefits;
(iv) Upon request from
				the Department or local agency, taking any other reasonable steps to assist in
				establishing paternity, determining third party liability and securing payment
				from third party payers; and
(v)
				Cooperating with the Department and the Department of Family Services in
				establishing paternity for applicable Medicaid births for the purposes of
				recovery of birth cost pursuant to W.S. §§
										
											42-4-122 and
				14-2-1001
				through
				14-2-1008.
				Pursuant to W.S. §
										
											14-2-1003, not more than sixty (60) days
				after an unmarried client of Medicaid gives birth to a child, the Department
				shall notify the Department of Family Services of the total birth cost. Total
				birth cost shall include:
(A) Maternity
				related expenditures including prenatal and postpartum care from nine (9)
				months prior to delivery through two (2) months after delivery, but not to
				exceed the average birth cost paid by Wyoming Medicaid.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 35 - MEDICAID BENEFIT RECOVERY › Section 35-7 - Duties of Providers

Current through July 13, 2024
(a) Verify and obtain information. At the
				time a client requests services from a provider, the provider shall review the
				client's eligibility card for information regarding third party payers. The
				provider shall ask the client if the information on the card is current and
				whether there are or may be additional third party payers. If the provider
				learns of a potential third party payer that is not listed on the eligibility
				card, the provider shall notify the Department in writing of that information
				within thirty (30) calendar days.
(b) Notify the Department of requests for
				information. Release of information by providers for casualty related third
				party resources not known to the State may be identified through requests for
				medical reports and bills received by providers from attorneys, insurance
				companies, and other parties. Providers shall contact the Department before
				responding to such requests.
(c)
				Notification of death.
(i) An institutional
				provider shall notify the Department, in writing, of any client's death which
				occurs in the facility or which occurs after the client is transported from the
				provider's facility to another facility, such as a hospital or
				hospice.
(ii) Time of notice. The
				notification shall be sent to the Department on or before the end of the third
				working day after the client's death.
(iii) Contents of notice. The notification
				shall be in the form and contain the information required by the Department, as
				specified in the Provider Manual.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 35 - MEDICAID BENEFIT RECOVERY › Section 35-8 - Payment or Rejection of Medicaid Claims Subject to Third Party Liability

Current through July 13, 2024
(a) Probable existence of liability of third
				party payer established at time of Medicaid claim. If the Department has
				established the probable existence of liability of a third party payer at the
				time a provider submits a Medicaid claim, the Department shall reject the
				Medicaid claim and return it to the provider for a determination of the amount
				of such liability.
(b) Establishing
				probable existence of liability of a third party payer. The probable existence
				of liability of a third party payer is established when the Department receives
				information from any source confirming the existence and extent of liability of
				a third party payer. When the amount of liability is established, the
				Department shall process and pay Medicaid claims involving third party
				liability only to the extent that the Medicaid payment allowed by the
				Department's normal procedures and standards exceeds the amount of the third
				party payer's liability.
(c)
				Unavailability of third party payments. Third party payments are not available
				at the time of the submission of a Medicaid claim if the existence and extent
				of third party payer liability is still disputed. If third party payments are
				not available, the Department shall process Medicaid claims subject to its
				normal procedures.
(d)
				Reconsideration. A provider may request that the Department reconsider a
				decision to recover payments because of third party liability. Such request
				shall be made and shall be handled pursuant to the reconsideration provisions
				as set forth in Chapter 3, Section
				14, of the Wyoming Medicaid
				Rules.
(e) Denial of improper
				claims. The Department shall deny claims which are improperly submitted or
				which contain errors of any kind. Denied claims may be resubmitted, subject to
				applicable federal and state requirements, including Chapter 1 and Chapter
				16.
Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 35 - MEDICAID BENEFIT RECOVERY › Section 35-9 - Duties of Attorneys

Current through July 13, 2024
(a) Attorneys shall be obligated to cooperate
				with the Department to recover under this Section in accordance with W.S.
				§§
									
										42-4-201 through
				42-4-208.
(b) An attorney representing a Medicaid
				client shall not disburse any insurance proceeds to the Medicaid client or
				retain any portion as attorney's fees prior to submitting a statement of net
				recovery distribution and payment to the Department.