Wyoming Administrative Code
Agency 048 - Health, Department of
Sub-Agency 0037 - Medicaid
Chapter 45 - DD WAIVER PROVIDER STANDARDS, CERTIFICATION, AND SANCTIONS
Section 45-5 - Provider Qualifications for Each Waiver Service
Universal Citation: WY Code of Rules 45-5
Current through September 21, 2024
(a) All individual waiver providers, subcontractors, and provider employees offering direct services to waiver participants shall meet the following requirements unless otherwise specified in this Section:
(i) Be
eighteen (18) years or older;
(ii)
Be certified by the Division to provide the indicated service;
(iii) Maintain current CPR and First Aid
Certification, which includes hands-on training from a trainer certified with a
curriculum consistent with training standards set forth by the American Heart
Association or the American Red Cross;
(iv) Have a valid email address, internet
access, and the means to upload documentation into a Division designated
portal; and
(v) If assisting with
medications, maintain a current certificate in medication assistance training
offered through the Division.
(b) A provider shall also meet the following specific requirements for the service in which they want to receive and maintain certification:
(i) Behavioral
Support Services. A Behavioral Support Services provider or provider staff
shall meet credentials as outlined in the Comprehensive and Supports Waiver
Service Index, which is incorporated by reference.
(ii) Case Management.
(A) All providers of case management services
shall have one (1) of the following:
(I) A
Master's degree from an accredited college or university in one (1) of the
following related human service fields:
(1.)
Counseling;
(2.)
Education;
(3.)
Gerontology;
(4.) Human
Services;
(5.) Nursing;
(6.) Psychology;
(7.) Rehabilitation;
(8.) Social Work;
(9.) Sociology; or
(10.) A related degree, as approved by the
Division.
(II) A
Bachelor's degree in one (1) of the related fields from subsection
(b)(ii)(A)(I) of this Section from an accredited college or university, and one
(1) year work experience as a case manager or in a related human services
field.
(III) An Associate's degree
in a related field from subsection (b)(ii)(A)(I) of this Section from an
accredited college, and four (4) years of work experience as a case manager or
in a related human services field.
(B) A case manager shall obtain and maintain
his or her own National Provider Identifier (NPI) number for case management
services through the Medicaid enrollment process.
(C) A case manager shall obtain and provide
evidence of eight (8) hours of continued education relating to the delivery of
case management services during each year of certification.
(D) A provider agency certified to provide
case management services shall:
(I) Identify
a back-up case manager from the list of Division certified case managers for
each participant, and have policies and procedures for backup case management
for each person's caseload, which include a process for how and when the case
manager will notify the plan of care team that the backup case manager should
be the primary contact. Case managers shall meet with their designated backup
to review all participant cases on a quarterly basis. The review shall be
documented in case notes.
(II)
Document on the individualized plan of care that they have no conflict of
interest with the participant or family.
(III) Meet all of the following conflict of
interest requirements.
(1.) The case
management agency and any managing employee shall not own, operate, be employed
by, or have a financial interest in or financial relationship with any other
person or entity providing services to a participant.
(2.) The case management agency may be
certified in other waiver services, but shall not provide case management
services to any participant to whom they are providing any other waiver
services, including self-directed services.
(3.) The owner, operator, or managing
employee of a case management agency shall not be related within the third
degree by blood or marriage to the owner, operator, or managing employee of any
other waiver service provider on the participant's individualized plan of care.
A relationship within the third degree includes the spouse; biological, step,
or adoptive parent; mother, father, brother, or sister-in-law; biological,
step, or adoptive child; biological, step, or adoptive sibling; grand or great
grand-parent or child; or aunt, uncle, niece, or nephew.
(4.) Any employee of a guardianship agency
shall not provide case management to any participant who is receiving any
services from the guardianship agency.
(5.) The case management agency shall not:
a. Employ case managers that are related to
the participant, the participant's guardian, or a legally authorized
representative, within the third degree, served by the agency. If the case
management agency is a sole proprietor, the case manager shall not be related
to the participant, the participant's guardian, or a legally authorized
representative, within the third degree, served by the agency;
b. Make financial or health-related decisions
on behalf of the participant receiving services from that agency, including but
not limited to a guardian, representative payee, power of attorney, or
conservator; or
c. Provide case
management services to, or live in the same residence of, any provider on a
participant's individualized plan of care in which they provide case management
services.
(E) If a rural area of the State does not
have a case manager without a conflict of interest for a participant, the
participant or legally authorized representative may request to have a case
manager with a conflict. If the Division confirms that there are no other case
managers available in the region or a nearby region to provide case management,
then the conflicted case manager may be approved on an annual basis. A third
party entity without a conflict shall be involved in the participant's team to
mediate, advocate for the participant as needed, and address unresolved
grievances for any conflicts that are approved.
(F) All case managers shall notify the
provider of a participant's or legally authorized representative's decision to
discontinue services within three (3) business days.
(iii) Child Habilitation. A Child
Habilitation provider, if operating a day care while also providing child
habilitation services, shall follow the Department of Family Services licensing
rules in addition to meeting the Medicaid waiver provider rules.
(iv) Cognitive Retraining. A Cognitive
Retraining provider shall:
(A) Be certified
in Cognitive Retraining from an accredited institution of higher
learning;
(B) Be a certified Brain
Injury Specialist through the Brain Injury Association of America; or
(C) Be a licensed professional with one year
of acquired brain injury training or Bachelor's degree in related field and
three (3) years of experience in working with acquired brain
injuries.
(v) Dietician.
A Dietician provider or provider staff shall have a license to provide
dietician services by the Wyoming Dietetics Board and have a current National
Provider Identifier (NPI).
(vi)
Environmental Modification. Environmental Modification providers shall have all
applicable building, construction, and engineer license and certifications that
may be required to work as a contractor at the location where services will be
provided. Employees do not have to be certified in CPR or First aid, complete a
background check, or have participant specific training. The provider shall
report critical incidents as defined in Section
20.
(vii) Individual Habilitation Training.
Within one (1) year of being certified in this service, and annually
thereafter, the provider or staff providing the service shall successfully
complete at least eight (8) hours of continued education in any of the
following areas: specific disabilities or diagnosed conditions relating to the
population served, writing measurable objectives, gathering and using data to
develop better training programs, or training modules posted by the
Division.
(viii) Homemaker. A
provider of Homemaker services shall be at least eighteen (18) years old but
does not have to be certified in CPR and First Aid.
(ix) Occupational Therapy. An Occupational
Therapy provider or provider staff shall have a current license to practice
occupational therapy by the Wyoming Board of Occupational Therapy and have a
current NPI.
(x) Physical Therapy.
A Physical Therapy provider or provider staff shall have a current license to
practice physical therapy by the Wyoming Board of Physical Therapy and have a
current NPI.
(xi) Skilled Nursing.
A skilled nursing provider or provider staff shall be licensed to practice
nursing by the Wyoming Board of Nursing, and have a current NPI.
(xii) Special Family Habilitation Home. A
Special Family Habilitation Home provider shall be at least 21 years of
age.
(xiii) Specialized Equipment.
A Specialized Equipment provider shall have the applicable license or
certification for the type of equipment purchased, and does not have to be
certified in CPR or First Aid.
(xiv) Speech, Hearing, and Language Services.
A Speech, Hearing, and Language Service provider or provider staff shall have a
current license to practice Speech, Hearing and Language Services by the
Wyoming Board of Speech Pathology and Audiology, and have a current
NPI.
(xv) Transportation. A
Transportation provider shall have a current, valid driver's license;
automobile insurance; and additional liability insurance for transporting
people for business purposes.
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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