Wyoming Administrative Code
Agency 048 - Health, Department of
Sub-Agency 0037 - Medicaid
Chapter 46 - MEDICAID SUPPORTS AND COMPREHENSIVE WAIVERS
Section 46-10 - Waiver Services, Service Requirements, and Restrictions

Universal Citation: WY Code of Rules 46-10

Current through September 21, 2024

(a) Waiver services specified in the individualized plan of care shall be based on the participant's assessed needs; meet the service definition(s); be considered medically or functionally necessary; align with the participant's preferences for services, supports, and providers; and be prioritized based on the availability of funding in the participant's individual budget amount.

(b) Services shall have prior authorization before being provided to a participant.

(c) Waiver services shall support and assist the participant in acquiring, retaining, and improving the skills necessary for the individual to function with as much independence as possible, exercise choice and self-management, and participate in the rights and responsibilities of community membership.

(d) The individualized plan of care shall reflect the services and actual units that providers agree to provide over the plan year. The individualized plan of care shall also include details regarding the specific support, settings, times of day, and activities requiring more support than others.

(e) Providers shall not serve children under age eighteen (18) and adults at the same time unless authorized in writing by the Division.

(f) Waiver services shall not be used to duplicate the same service or a similar service that is available to the participant through one of the following programs:

(i) Section 110 of the Rehabilitation Act of 1973;

(ii) Section 504 of the Rehabilitation Act of 1973;

(iii) Individuals with Disabilities Education Act (IDEA) ( 20 U.S.C. 1401 et seq.); or

(iv) Medicaid State Plan.

(g) Participants may request an exemption from subsection (f) by submitting a third party liability form as part of the participant's individualized plan of care. This form shall document that the service is not available through another program or agency to meet the individual participant's assessed needs. Exemptions may be granted at the direction of the Division.

(h) Routine transportation for activities provided during the service is included in the reimbursement rate for the service regardless of the number of trips. The provider shall not charge a participant separately for transportation during these waiver activities unless the special activity is outside of the participant's community or normal routine.

(i) Participants receiving levels three (3) through six (6) community living services may receive up to an average of thirty-five (35) hours of day services per week, which include adult day, community support, and companion services.

(j) Waiver services are outlined in the Comprehensive and Supports Waiver Service Index, which is incorporated by reference.

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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