Wyoming Administrative Code
Agency 048 - Health, Department of
Sub-Agency 0037 - Medicaid
Chapter 42 - CHILDREN'S DEVELOPMENTAL DISABILITIES HOME & COMMUNITY BASED WAIVER
Section 42-7 - Covered Services, Service Requirements and Restrictions
Universal Citation: WY Code of Rules 42-7
Current through September 21, 2024
(a) The services listed in this section are covered services if they are functionally necessary and part of a current individual plan of care approved by the Division.
(i) Case management
services.
(A) Case management is a stand
alone service. A participant (or guardian, if applicable) may choose any
individually-selected service coordination provider, and shall not be expected
or required to receive any other service from that provider.
(B) Individually-selected service
coordinators shall be required to provide a minimum of 60 minutes per calendar
month of person-to-person contact with the participant or guardian.
(I) This may include face-to-face meetings
and telephone conversations between the individually-selected service
coordinator, the participant, and/or the guardian.
(II) Individually-selected service
coordinators shall be required to complete one monthly visit to participant in
his or her home.
(C)
Individually-selected service coordinators shall schedule and facilitate six
month review team meetings and annual individual plan of care meetings,
including:
(I) Notifying all individual plan
of care team members of the scheduling of the meetings at least 30 days in
advance unless a shorter notification time is approved by the
Division.
(II) Notifying the
Division in writing of the scheduling of the meetings at least 30 days in
advance unless a shorter notification time is approved by the
Division.
(III) Following Division
requirements for facilitating team meetings; and for documenting minutes of the
team meetings in the form and manner prescribed by the Division in provider
manuals and bulletins issued by the Division.
(D) Individually-selected service
coordinators shall facilitate other team meetings when requested by the
participant, guardian, member of the team, or the Division.
(ii) Dietician.
(A) Dietician services shall be supported by
a formal assessment completed by a registered dietician.
(B) Providers of dietician services may seek
Medicaid reimbursement for providing such services to a group of up to three
participants at a time.
(iii) Environmental modification.
(A) Environmental modifications shall be
approved pursuant to Chapter 44.
(iv) Habilitation services.
(A) For all habilitation services:
(I) Participants shall be in attendance in
service areas in order for providers to bill for services.
(II) Purposes of the habilitation service
codes shall be met, including assisting participants in acquiring, retaining,
and improving the self-help, socialization, adaptive, and safety skills
necessary to reside successfully in home and community-based
settings.
(III) Habilitation
providers shall work with participant on objectives as stipulated in the
individual plan of care and document the results in the form and manner
established by the individual plan of care team.
(IV) Reimbursement for habilitation services
shall not be made directly or indirectly to a parent, stepparent, spouse, or
guardian of a participant.
(B) For residential habilitation services.
(I) Residential habilitation services may be
provided for participants who are 18 through 20 years old.
(II) Habilitation rates shall include
personal care and respite services, except in the cases listed under (III) of
this section.
(III) Residential
habilitation and respite services may appear on the same individual plan of
care when:
(a) The participant is
transitioning into a residential setting such as a group home, or
(b) Unpaid caregivers need respite when the
participant spends time at home visiting on weekends or vacations, or
(c) When residential habilitation providers
who are not required to obtain and maintain CARF accreditation pursuant to
Chapter 45 require respite for vacations, sick days, or other emergencies. In
these cases, a maximum of 1,344 units of respite shall be allowed during a plan
year.
(IV) Habilitation
rates for each participant shall include the cost for routine transportation
when it is provided by the provider regardless of the number of
trips.
(V) Residential habilitation
services shall not be provided in residential settings other than the home of
the participant or the community.
(VI) Residential habilitation services and
residential habilitation training services shall not appear on the same
individual plan of care unless the participant is transitioning into a
residential setting such as a group home.
(C) For special family habilitation home
services.
(I) Special family habilitation
home services may be provided for participants who are birth through 20 years
old.
(II) Special family
habilitation home services and respite services may be on the same plan and may
be billed for the same day.
(D) For residential habilitation training
services.
(I) Providers of residential
habilitation training services shall not seek reimbursement for providing any
services to more than one participant at the same time unless approved in
advance by the Division.
(II)
Residential habilitation training services shall not be reimbursed for persons
receiving special family habilitation home services.
(III) Residential habilitation training
services shall be provided in the participant's home, provider home, or in the
community.
(v) Homemaker Services.
(A) Providers of homemaker services shall
provide a maximum of three hours of homemaker services per week per
participant, unless more hours are approved by the Division.
(B) Providers of homemaker services shall not
be responsible for supervision of a participant while completing homemaker
services.
(C) The Division shall
not approve homemaker services that are provided in residential habilitation
settings except for homemaker services provided to special family habilitation
home providers and residential habilitation providers who are not required to
obtain and maintain CARF accreditation pursuant to Chapter 45.
(vi) Personal care services.
(A) The participant shall be present when
personal care services are provided.
(B) Personal care services may include the
preparation of meals, exclusive of the cost of the meals.
(C) When specified in the individual plan of
care, personal care services may also include such housekeeping chores as bed
making, dusting, and vacuuming, which are incidental to the care furnished, or
which are essential to the health and welfare of the participant, rather than
that individual's family.
(D)
Personal care providers may include members of the family of the participant,
except that Medicaid shall not reimburse a parent or a spouse for providing
such services to the child or the other spouse.
(E) Providers certified to provide personal
care services who are family members of the participant shall meet the same
standards as providers certified to provide personal care services who are
unrelated to the participant.
(F)
Providers of personal care services shall not seek Medicaid reimbursement for
providing such services to more than one participant at a time.
(vii) Respiratory therapy.
(A) Reimbursement for respiratory therapy
services shall require a treatment letter or recommendation plus a physician's
order.
(viii) Respite
services.
(A) Respite services shall be
covered if provided in one of the following locations:
(I) The residence of the
participant.
(II) A foster
home.
(III) A group home.
(IV) Certified provider location,
or
(V) The community, including
parks, stores, and recreation centers.
(B) A respite service provider or provider
staff providing respite services:
(I) Shall
serve no more than two participants at a given time, unless approved by the
Division.
(II) May also provide
supervision to other children under the age of 12 or other individuals
requiring support and supervision, and
(III) Shall limit the total combined number
of persons in (I) and (II) to no more than three persons, unless approved by
the Division.
(C)
Respite services shall not take the place of residential or day habilitation
services.
(D) Respite services
shall accommodate each family's living routine.
(E) Respite services shall accommodate the
needs of the participant.
(F) The
respite site and services shall be matched to the identified needs of each
participant and family.
(G) A
respite provider shall not provide respite services to adults and children at
the same time except to participants who are 18 to 20 years of age who may
receive respite services with adults. In exceptional cases, such as when
participants are members of the same family, respite may be provided to adults
and children at the same time with Division approval.
(H) A child shall not receive respite during
the designated school hours, unless such services are provided due to illness
of the child limiting school attendance.
(I) Respite services shall not exceed 7,280
units per year unless more are approved by the Division.
(ix) Skilled nursing.
(A) Shall be prescribed by a
physician.
(B) May include
preventative and rehabilitative procedures.
(C) Shall be listed on a form required by the
Division and identified in the individual plan of care.
(D) Shall involve direct patient
care.
(x) Specialized
equipment.
(A) Shall be provided pursuant to
Chapter 44.
(b) Services otherwise covered by Medicaid, EPSDT, or the Department of Education shall not be covered services under this Chapter.
(c) Extended state plan services shall be funded to the maximum allowable amount under the state plan before these services are paid for under the waiver.
(d) Parents, step parents, and/or spouses shall not be reimbursed by waiver funding for any waiver services.
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.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
