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 47-7 - Participant Disenrollment Process
Universal Citation: WY Code of Rules 47-7
Current through September 21, 2024
(a) The Department will review and approve all requests by the CME to disenroll youth based on the medical necessity of the HFWA service plan. An individual may be disenrolled from the CME if:
(i) The youth is no longer
Medicaid eligible;
(ii) The youth
moves out of the State;
(iii) The
youth ages out of the program;
(iv)
The youth is incarcerated;
(v) The
youth is no longer financially eligible;
(vi) The youth is no longer clinically
eligible;
(vii) The youth is
determined eligible for any excluded program/population pursuant to Section
4;
(viii) The youth is in
out-of-home placement longer than one hundred eighty (180) days;
(ix) The youth needs related services (for
example a cesarean section and tubal ligation) to be performed at the same
time; not all related services are available within the network; and the
youth's Primary Care Provider (PCP) or another provider determines that
receiving the services separately would subject the youth to unnecessary risk;
or
(x) Other reasons, including but
not limited to, poor quality of care, lack of access to services covered under
the contract, or lack of access to providers experienced in dealing with the
youth's specific health care needs.
(b) A participant may voluntarily disenroll from the CME without cause at any time.
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