048-29 Wyo. Code R. §§ 29-4 - Case Management

(a) The Department may subject a client to case management if the Department determines the client requires assistance in using covered services appropriately for any reason, including:

(i) The client appears unfamiliar with the Medicaid program or the delivery of services;

(ii) The client has a severe medical problem; or

(iii) The client is receiving high-cost services.

(b) If the Department subjects a client to case management, the Department need not notify the client.

(c) Case management includes the following actions:

(i) Monitoring the utilization of covered services to ensure that they are medically necessary and appropriate;

(ii) Conducting reviews of services while the client is at a facility;

(iii) Conducting on-site reviews with clients or providers to determine whether the provided services are medically necessary and appropriate; and

(iv) Taking any other action relevant to the coordination and facilitation of covered services in an efficient manner or setting consistent with the appropriate care for the client.

Notes

048-29 Wyo. Code R. §§ 29-4

Amended, Eff. 8/13/2020.