Wyoming Administrative Code
Agency 048 - Health, Department of
Sub-Agency 0037 - Medicaid
Chapter 45 - DD WAIVER PROVIDER STANDARDS, CERTIFICATION, AND SANCTIONS
Section 45-31 - Relative Providers

(a) The Division shall allow a participant's relative, as defined in Section 3 of this Chapter, to become a certified waiver provider and receive reimbursement for services provided to the related participant.

(b) A participant's legally authorized representative shall not directly or indirectly receive reimbursement for providing waiver services for their ward, except as indicated in the Comprehensive and Supports Waiver Service Index, which is incorporated by reference. Direct or indirect reimbursement shall include, but is not limited to, providing direct services for, or serving as the owner or officer of, a provider organization, residing in a provider owned service setting, or being married to a person providing waiver services to the participant.

(c) A participant's spouse may receive direct or indirect reimbursement only if they present the Division with a certified copy of a court order establishing another party as the legally authorized representative of the participant.

(d) To provide waiver services to a related participant, the relative provider shall:

(e) A relative provider, spouse, or legally authorized representative shall not be hired to provide services through self-direction.

(f) Services that may be furnished by a relative provider are identified in the Comprehensive and Supports Waiver Index, which is incorporated by reference.

(g) If a relative provider or legally authorized representative is providing personal care to his or her ward, the individualized plan of care shall be developed and monitored by a case manager without a conflict of interest.

(h) If the relative provider is not providing services in the best interest of the participant, the case manager shall work with the participant, appropriate team members, and the Division as needed to choose other providers as appropriate and modify the individualized plan of care to better suit the needs of the participant.

(i) Payment to a relative provider specified in subsections (f) and (g) of this Section shall only be made when the service provided is not a function that the relative would normally provide for the individual without charge as a matter of course in the usual relationship among family members, and the service would otherwise need to be provided by a qualified provider.

(j) A relative who provides services either as an owner, employee, or officer of a provider or who intends to provide services to a related waiver participant shall disclose the relationship in the participant's team meeting and acknowledge and address the safeguards set forth in documentation required by the Division.

(k) If a provider permits the hiring of a legally authorized representative of a participant receiving services from the provider, or if a provider permits the hiring of relatives of provider employees working for the organization, the provider shall have a written policy on how it addresses potential conflicts that arise from these relationships and how the conflict of interest is mitigated. The policy shall be shared with the participant and legally authorized representative(s).