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.

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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