Current through September 21, 2024
(a) The emergency
criteria used by the Division includes:
(i) A
substantial threat to a person's life or health caused by:
(A) The loss of the person's primary
caregiver.
(B)
Homelessness.
(C) Abuse or neglect
that is either substantiated by the Wyoming Department of Family Services or
corroborated by the Division or Protection and Advocacy of Wyoming.
(ii) Situations where the person's
condition poses a substantial threat to a his or her life or health and is
documented, in writing, by a physician.
(iii) Situations where a person:
(A) Has caused serious physical harm to
himself or someone else, or a person whose condition presents a substantial
risk of physical threat to himself or others, and
(B) The harm or threat of harm is verified,
in writing, by a psychologist or a psychiatrist, and
(C) The use of covered services would be an
appropriate response to the person's condition, and
(D) Other resources to provide appropriate
services are not available.
(b) Identification of emergency referrals and
emergency cases.
(i) Any person may request
that the Division consider whether an individual has an emergency.
(ii) The Division may identify persons on the
waiting lists who have an emergency.
(c) Once a potential emergency case or
emergency referral has been identified:
(i)
The individually-selected service coordinator shall submit in the form
specified by the Division specific information on the potential emergency. The
information shall include:
(A) Description of
the factors or condition that have created an emergency and their expected
duration.
(B) Description of the
covered services that are functionally necessary.
(C) Copies of incident reports, physician
reports, assessments, or other documentation that relate to the factors or
conditions that have created an emergency.
(D) A detailed plan of how the funds shall be
spent, the expected outcome, and how the results shall be monitored with
respect to the funds.
(ii) For emergency referrals, determination
of eligibility as defined in Section 6 of this Chapter, shall be completed
within 14 calendar days after receipt of the Inventory for Client and Agency
Planning and the neuropsychological assessment.
(d) The Extraordinary Care Committee shall
review specific information on the potential emergency referral or emergency
case to determine if the case meets the emergency criteria as defined in (a) of
this section. Such persons shall receive covered services, subject to available
funding.
(e) An emergency plan may
be submitted to the Division by the participant's individually-selected service
coordinator to cover services until the complete individual plan of care is
submitted and approved by the Division.
(i)
The emergency plan shall include significant health and safety information and
shall be approved by the Division in order for services to be
reimbursed.
(ii) The Division shall
have 3 business days to review and approve the plan.
(f) In no event shall the Division be
required to provide or fund covered services in the absence of available
funding or in the absence of clinical and financial eligibility.
