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

Universal Citation: WY Code of Rules 34-9

Current through September 21, 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.

(i) A provider shall comply with all applicable state and federal laws in safeguarding information about applicants and participants.

(j) The Department shall conduct monitoring and enforcement activities as necessary to assure compliance with its established CCW provider qualifications and participation standards.

(k) The Department may attempt to resolve any suspected noncompliance with this Chapter by issuing technical assistance or corrective action. Technical assistance and corrective action are not considered an adverse action and are not subject to the fair hearing process pursuant to Medicaid Rules Chapter 4.

(i) When requested, providers shall submit corrective action plans that address each area of suspected noncompliance to the Department's satisfaction. Corrective action plans include identification of the area of noncompliance, the actions that will be taken to address the area of noncompliance, the individual(s) responsible for each action, and anticipated due dates of each action.

(ii) If an approved corrective action plan is not submitted and implemented to address all areas of suspected noncompliance, the Department may take adverse action against the provider.

(l) A CCW provider is subject to an inspection by the Department at any time to ensure compliance with provider requirements.

(m) The Department shall decertify a CCW provider upon termination of the provider's Medicaid enrollment pursuant to Wyoming Medicaid Rules Chapter 3.

(n) The Department may take adverse action against a CCW provider that fails to meet standards established by the Department.

(o) The Department may decertify a CCW provider for any violation of standards established by the Department.

(p) A CCW provider that is subject to adverse action pursuant to this Chapter shall be provided a notice of adverse action and an opportunity for due process pursuant to Wyoming Medicaid Rules Chapters 4 and 16.

Disclaimer: These regulations may not be the most recent version. Wyoming may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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