048-44 Wyo. Code R. §§ 44-7 - Specialized Equipment Approval Process

(a) The team may submit requests for specialized equipment during the six-month or annual plan of care meeting. Specialized equipment requests submitted at other times during the plan of care year may be submitted if significant health, safety, or access concerns are identified.

(b) Approval for specialized equipment shall require:

(i) Prior authorization from the Division; and

(ii) A recommendation from a therapist or professional with expertise in the area of need. The recommendation shall include:

(A) A description of the functional need for the specialized equipment;

(B) How the specialized equipment will contribute to a person's ability to remain in or return to his or her home and out of an ICF/IID or other institutional setting;

(C) How the specialized equipment will increase the individual's independence and decrease the need for other services;

(D) How the specialized equipment addresses accessibility, health, or safety needs of the participant;

(E) Documentation that the participant has the capability to use the equipment;

(F) Documentation that the waiver is the payer of last resort;

(G) A description of how equipment shall be delivered and who will train the person and providers on the equipment; and

(H) Documentation of two (2) quotes for the purchase of the equipment, including a maximum markup on the equipment of 20%.

(I) The quotes may include a detailed description of the need and costs for expert assembly of the equipment in addition to the 20% markup.

(II) The quotes may include a detailed description of the need and cost for training on the specialized equipment in addition to the 20% markup.

(III) If two (2) quotes cannot be obtained, an explanation as to why only one (1) quote was submitted shall accompany the request.

(IV) The Division may review any request that does not include more than one (1) quote.

(c) The Division may schedule a review of the specialized equipment quote, including an evaluation of functional necessity, with appropriate professionals under contract with the Division. The review shall include a statement verifying that the request meets at least two (2) of the criteria pursuant to Section 6(a) of this Chapter.

(d) If the participant has an Individualized Education Plan (IEP) or Individual Family Service Plan (IFSP), the case manager shall submit a copy of that document, along with documentation as to why the equipment is not sent home with the participant, or a reason why the equipment is necessary at home but not at school.

(e) The Division may request documentation that a less expensive, comparable alternative to requested equipment or supplies is not available or practical. If a more cost-effective alternative is determined to be available, the Division shall deny the original request or specify that only the less costly equipment or supplies are approved.

(f) Equipment purchases shall not exceed $2,000 per year. If an item needed exceeds that amount, the team may request an exception to the cap through the ECC. The Division may require an assessment for specialized equipment needs by a Certified Specialized Equipment (CSE) professional. The assessment is funded as part of the $2,000 cap. Insurance on items is not covered by the waiver but may be purchased by the participant separately.

(g) Electronic technology devices are only allowed once every five (5) years and like items shall not be purchased during those five (5) years. Electronic technology devices used as augmentative and alternative communication devices are exempt from this five (5) year limitation if accompanied by a letter of necessity from a Speech Language Pathologist.

(h) In accordance with Chapter 45 of the Department of Health's Medicaid Rules, provider agencies shall be certified by the Division to provide specialized equipment.

Notes

048-44 Wyo. Code R. §§ 44-7

Amended, Eff. 6/21/2017. Amended, Eff. 7/26/2018. Amended, Eff. 12/20/2019.