Current through September 21, 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.
(c) The case manager shall conduct a
comprehensive assessment of the participant's strengths, needs, goals,
preferences, and any potential health and safety risks using the Department's
prescribed methods, tools, and procedures.
(d) The case manager shall develop a
person-centered service plan using Department identified systems and processes.
The service plan shall:
(i) Assure the health
and welfare of the participant;
(ii) Acknowledge the participant's strengths,
and promote the participant's self-determined goals;
(iii) Address the participant's assessed
needs;
(iv) Include a plan to
mitigate identified risks;
(v)
Accommodate participant preferences to the extent possible;
(vi) Reflect the scope, frequency, and
duration of the services chosen by the participant;
(vii) Include a backup plan or identify an
alternate service or support to ensure the continuity of services;
and
(viii) Consider services and
supports available through the CCW, the Medicaid State Plan, other federal,
state, and local public programs, the participant's family or natural support
system, and any other relevant community resources.
(e) The case manager shall facilitate a
person-centered planning process which shall support and encourage the
participant to direct service plan development to the maximum extent possible.
(i) The case manager shall abide by the
participant's choice of individuals included and excluded from the service plan
development process. If the participant's decision-making authority has been
conferred to a legal guardian, the case manager shall involve the
representative in the service plan development process to the extent
authorized.
(ii) The case manager
shall provide education and information on the long-term care programs and
service options available to the participant.
(iii) The case manager shall provide the
participant a current list of all HCBS enrolled providers serving the
participant's county of residence. The case manager shall disclose any
ownership of, affiliation with, or financial interest in any potential waiver
service providers.
(iv) The case
manager shall provide information on participant-directed services to include
potential benefits, liabilities, risks, and responsibilities associated with
the service delivery option. The case manager shall provide this information
during the following times:
(A) Initial
service plan development;
(B) At
annual service plan reviews;
(C)
Whenever the service plan is updated due to a significant change in the
participant's condition; and
(D) At
any other time the participant requests.
(v) The case manager shall facilitate
discussion among the individuals participating in the service plan development
process in order to assist the participant in determining which services,
supports, and delivery options will be included in the service plan.
(vi) The case manager shall ensure service
planning activities are conducted at times and locations convenient to the
participant.
(vii) The case manager
shall ensure the service planning process reflects the cultural considerations
of the participant and shall provide information in plain language and in a
manner that is accessible to participants with disabilities or with limited
English proficiency.
(f)
The case manager shall hold a service plan team meeting to review and update
the service plan at least annually.
(g) The case manager shall hold a service
plan team meeting upon request by the participant or in response to a
significant change in the participant's condition or circumstances disclosed
through monitoring and evaluation activities.
(h) The case manager shall coordinate and
monitor all services and supports included in the service plan.
(i) The case manager shall coordinate
transitions when the participant changes, stops, or adds providers to the
service plan, including requested changes of a case manager.
(j) The case manager shall provide
participant-specific training to each provider delivering a direct service
listed in the service plan.
(k) The
Department may establish caseload limits to ensure case managers effectively
coordinate services for all participants on their caseloads.
(l) The Department shall establish conflict
of interest protections as necessary to safeguard against undue influence or
restrictions on the participant's freedom of choice. At minimum:
(i) The case manager must not be related by
blood or marriage to the participant, or to any person paid to provide CCW
services to the participant;
(ii)
The case manager must not share a residence with the participant or with any
person paid to provide CCW services to the participant;
(iii) The case manager and case management
agency must not be financially responsible for the participant;
(iv) The case manager and case management
agency must not be empowered to make financial or health-related decisions on
behalf of the participant; and
(v)
The case manager and case management agency must not own, operate, be employed
by, or have a financial interest in any entity that is paid to provide CCW
services to the participant. Financial interest includes a direct or indirect
ownership or investment interest or any direct or indirect compensation
arrangement.
(m) In the
event a conflict of interest exists between the participant's chosen case
manager and CCW service provider, the case manager shall document the conflict,
and shall assist the participant in selecting a new case manager, case
management agency, and/or CCW service provider as necessary to eliminate the
conflict of interest.
