Wyoming Administrative Code
Agency 048 - Health, Department of
Sub-Agency 0037 - Medicaid
Chapter 47 - CHILDREN'S MENTAL HEALTH WAIVER (CMHW) AND CARE MANAGEMENT ENTITY (CME) RULES
Section 47-5 - Eligibility
Universal Citation: WY Code of Rules 47-5
Current through September 21, 2024
(a) Enrollment for CME 1915(b) services is mandatory for the following populations:
(i) Youth qualifying under Section 1931 of
the Social Security Act and related populations, to include poverty-level
related groups and optional groups of older youth;
(ii) Blind/Disabled youth and related
populations, to include beneficiaries, generally under age 18, who are eligible
for Medicaid due to blindness or disability;
(iii) Youth in Foster Care in the State of
Wyoming, or youth receiving adoption assistance under Title IV-E, or are
otherwise in out-of-home placement.
(iv) Targeting Criteria for the populations
includes:
(A) Medicaid youth ages four to
twenty (4-20) at risk of out-of-home placement (defined and identified as youth
with two hundred (200) days or more of behavioral health services within one
State fiscal year);
(B) Medicaid
youth ages four to twenty (4-20) who currently meet Psychiatric Residential
Treatment Facility (PRTF) level of care as outlined in Chapter 40, Psychiatric
Residential Treatment Facilities;
(C) Medicaid youth ages four to twenty (4-20)
who currently meet acute psychiatric stabilization hospital level of care as
determined by a licensed clinician; had an acute hospital stay for mental or
behavioral conditions in the last three hundred sixty-five (365) days; or are
currently placed in an acute hospital stay for mental or behavioral health
conditions;
(D) Youth enrolled in
the Children's Mental Health Waiver (Section 1915(c) WY Waiver #0451);
or
(E) Medicaid youth ages four to
twenty (4-20) referred to the pre-paid ambulatory health plan (PAHP) and who
meet defined eligibility, including clinical eligibility and SED
criteria.
(v) Medical
Eligibility Criteria is a condition for enrollment in the CME after initial
targeting criteria is met. The Medical Eligibility Criteria includes:
(A) Youth ages six to twenty (6-20) who have
a minimum CASII composite score of twenty (20), and youth ages four (4) and
five (5) who have an ECSII score of eighteen (18) to thirty (30) or the
appropriate social and emotional assessment information provided to illustrate
level of service needs; and
(I) CASIIs
administered for the purpose of establishing medical eligibility shall not be
administered by the CME but instead be administered by a neutral third party to
ensure conflict free case management.
(B) Youth who have a DSM Axis 1 or
International Classification of Disease (ICD) diagnosis that meets the State's
diagnostic criteria.
(b) Enrollment for CME 1915(c) services is mandatory for the following populations:
(i)
Targeting Criteria for the populations includes:
(A) Medicaid youth ages four to twenty-one
(4-21) at risk of out-of-home placement (defined and identified as youth with
two hundred (200) days or more of behavioral health services within one State
fiscal year);
(B) Medicaid youth
ages four to twenty-one (4-21) who currently meet PRTF level of care as
outlined in Chapter 40, Psychiatric Residential Treatment Facilities or are
placed in a PRTF;
(C) Medicaid
youth ages four to twenty-one (4-21) who currently meet acute psychiatric
stabilization hospital level of care as determined by a licensed clinician; had
an acute hospital stay for mental or behavioral conditions in the last three
hundred sixty-five (365) days; or are currently placed in an acute hospital
stay for mental or behavioral health conditions; or
(D) Medicaid youth ages four to twenty-one
(4-21) referred to the PAHP and who meet defined eligibility, including
clinical eligibility and SED/SMI criteria.
(ii) Medical Eligibility Criteria is a
condition for enrollment in the CME after initial targeting criteria is met.
The Medical Eligibility Criteria includes:
(A)
Youth ages six to twenty-one (6-21) who have a minimum CASII composite score of
twenty (20), and youth ages four (4) and five (5) who have an ECSII score of
eighteen (18) to thirty (30) or the appropriate social and emotional assessment
information provided to illustrate level of service needs; and
(I) CASIIs administered for the purpose of
establishing medical eligibility shall not be administered by the CME but
instead be administered by a neutral third party to ensure conflict free case
management.
(B) Youth
who have a DSM Axis 1 or primary ICD diagnosis that meets the State's
diagnostic targeting criteria as specified above.
(c) Those listed as "Excluded Populations" in Section 4(f) of this Rule are not eligible for the CME or CMHW Program.
(d) A person is not considered financially eligible when the Department expects the costs of HCBS furnished to the individual would exceed the per member, per month (PMPM) amount specified by the Department in the 1915 (c) waiver's cost neutrality equation.
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.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
