Current through September 21, 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.
(ii) The individual shall need services that
qualify for a nursing facility level of care as measured by the level of care
assessment approved by the Department and conducted pursuant to Wyoming
Medicaid Rules Chapter 22.
(A) The
individual's need for nursing facility level of care must have been evaluated
no more than three hundred sixty-five (365) days prior to enrollment in CCW and
re-evaluated at least annually thereafter.
(B) An individual who has lost eligibility
based on not meeting a nursing facility level of care, upon new application may
be re-evaluated within three hundred sixty-five (365) days of their last
assessment if the individual documents a change in condition sufficient to
warrant a new evaluation.
(b) The individual shall be eligible, and
maintain continuous eligibility, for the Wyoming Medicaid program pursuant to
Wyoming Medicaid Rules Chapter 18.
(c) Individuals who reside in a nursing
facility, hospital, intermediate care facility for individuals with
intellectual disabilities, or other institutional setting shall be ineligible
to receive CCW services.
(i) During a
declared emergency this ineligibility may not apply to certain temporary
services available to support the individual's transition from an institutional
setting, for which services are limited to thirty (30) consecutive
days.
(ii) Participants admitted to
an institutional setting for a period greater than thirty (30) consecutive days
shall be terminated from the CCW.
(iii) Individuals residing in an
institutional setting may receive transitional services for a period of six (6)
months prior to transitioning to HCBS in accordance with the Department's
standards and requirements.
(d) Individuals denied enrollment or
continued participation in the CCW pursuant to the provisions of this Section
shall be issued a written notice of adverse action and informed of their right
to request an administrative hearing in accordance with Wyoming Medicaid Rules
Chapter 4.
