048-46 Wyo. Code R. §§ 46-10 - Waiver Services, Service Requirements, and Restrictions
(a) Waiver services
specified in the individualized plan of care shall be based on the
participant's assessed needs; meet the service definition(s); be considered
medically or functionally necessary; align with the participant's preferences
for services, supports, and providers; and be prioritized based on the
availability of funding in the participant's individual budget
amount.
(b) Services shall have
prior authorization before being provided to a participant.
(c) Waiver services shall support and assist
the participant in acquiring, retaining, and improving the skills necessary for
the individual to function with as much independence as possible, exercise
choice and self-management, and participate in the rights and responsibilities
of community membership.
(d) The
individualized plan of care shall reflect the services and actual units that
providers agree to provide over the plan year. The individualized plan of care
shall also include details regarding the specific support, settings, times of
day, and activities requiring more support than others.
(e) Providers shall not serve children under
age eighteen (18) and adults at the same time unless authorized in writing by
the Division.
(f) Waiver services
shall not be used to duplicate the same service or a similar service that is
available to the participant through one of the following programs:
(i) Section 110 of the Rehabilitation Act of
1973;
(ii) Section 504 of the
Rehabilitation Act of 1973;
(iii)
Individuals with Disabilities Education Act (IDEA) (
20
U.S.C. 1401 et seq.); or
(iv) Medicaid State Plan.
(g) Participants may request an
exemption from subsection (f) by submitting a third party liability form as
part of the participant's individualized plan of care. This form shall document
that the service is not available through another program or agency to meet the
individual participant's assessed needs. Exemptions may be granted at the
direction of the Division.
(h)
Routine transportation for activities provided during the service is included
in the reimbursement rate for the service regardless of the number of trips.
The provider shall not charge a participant separately for transportation
during these waiver activities unless the special activity is outside of the
participant's community or normal routine.
(i) Participants receiving levels three (3)
through six (6) community living services may receive up to an average of
thirty-five (35) hours of day services per week, which include adult day,
community support, and companion services.
(j) Waiver services are outlined in the
Comprehensive and Supports Waiver Service Index, which is incorporated by
reference.
Notes
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