Wyoming Administrative Code
Agency 048 - Health, Department of
Sub-Agency 0037 - Medicaid
Chapter 45 - DD WAIVER PROVIDER STANDARDS, CERTIFICATION, AND SANCTIONS
Section 45-22 - Transition Process

Universal Citation: WY Code of Rules 45-22

Current through September 21, 2024

(a) The participant or legally authorized representative may choose to change any provider at any time and for any reason.

(b) A provider who is terminating services with a participant shall notify the participant and the Division in writing at least thirty (30) calendar days prior to ending services, unless the Division approves a shorter transition period in advance. Failure to provide services during this thirty (30) calendar day period shall be considered abandonment of services and may result in decertification of the provider.

(c) When a participant or legally authorized representative chooses to change providers, they shall inform the case manager of the decision. The case manager shall notify the provider of a participant's or legally authorized representative's decision to discontinue services within three (3) business days.

(d) When a transition is requested, the case manager shall notify the Division of the request for change within three (3) business days of the request.

(i) If the participant or legally authorized representative requests a change of case manager, the case manager shall review choice and make provider lists available to the participant and legally authorized representative.

(ii) If the participant or legally authorized representative requests a change of a provider other than the case manager, the case manager shall review choice and provider lists with the participant or legally authorized representative.

(e) When a transition occurs, the case manager shall complete the transition checklist(s) as required by the Division, and schedule a transition meeting with the plan of care team.

(i) Notify all current and new providers, the participant, legally authorized representative, and the Division at least two (2) weeks prior to the meeting.

(ii) Team meetings may be scheduled sooner than two (2) weeks due to an emergency situation. The case manager shall notify the Division of any emergency requiring a faster transition schedule.

(f) After the transition meeting, the case manager shall complete and submit plan of care modifications to the Division at least seven (7) business days prior to the scheduled start date of the new services.

(g) All providers on the individualized plan of care shall share pertinent information with the case manager and the plan of care team in a timely manner.

(h) If a community living services provider requires a participant to move to another service setting, the participant shall be given the opportunity to choose from all available options, without limitation to that provider's settings.

(i) The participant may choose from other setting options that are appropriate for the participant, which may include a new provider.

(ii) The provider shall notify the participant, family, case manager, and any legally authorized representative of the move at least thirty (30) calendar days in advance so the participant can exercise the choice to find a new residence or provider.

(i) It is the responsibility of the case manager to ensure providers have received training on all participant information, including health and safety, behavioral concerns, and the individualized plan of care.

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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