048-47 Wyo. Code R. §§ 47-9 - Availability of Services/Accessibility

(a) Any youth enrolled with the CME who meets the eligibility criteria as outlined in Section 5 of this Chapter is eligible for HFWA and respite services. Each enrollee maintains full access to all Medicaid state plan services. Special health care needs shall be identified and treated through primary and specialty care providers in Medicaid fee for service.

(b) Appropriately trained, credentialed, and Medicaid-enrolled providers may contract with the CME as part of the CME's provider network for the provision of HFWA and respite services.

(i) HFWA and respite is available to all enrolled youth statewide.

(c) Respite service shall accommodate the needs of the youth and his or her family. Prior to the authorization of respite services, the youth's plan of care shall document how respite would support HFWA service goals.

(d) Service settings are either based in the provider's residence, the youth's residence, or in community locations that are not institutional. Respite providers who choose to use their home shall have their home approved for respite prior to providing services.

(e) Respite shall only be provided for one youth at a time unless the CME reviews and approves additional youth.

(f) Respite services shall be restricted to a maximum of four hundred sixteen (416) hours per calendar year for each enrolled and qualified youth.

(g) To determine clinical eligibility, youth accessing the CME through the CMHW Program shall complete an application containing all pertinent demographic and identifying information, including the LOC determination as recommended by a qualified licensed mental health professional, and the CASII/ESCII assessment completed by a qualified third party evaluator.

(i) The CASII, ESCII and LOC evaluation shall be completed upon initial application and annually thereafter prior to the plan of care development and approval. Ongoing eligibility determinations shall be made using the same criteria as the initial assessment.

(ii) If the youth meets the clinical criteria, information is uploaded into Electronic Medicaid Waiver System (EMWS) and the applicant is notified. The applicant shall then complete the financial eligibility application.

(A) Youth that are financially able are notified of either their assignment to the wait list or notification of a funding opportunity.

(I) Youth are scored and ranked on the wait list using the following criteria to determine applicants with the highest level of care scores:

(1.) Eligibility qualification acuity (CASII/ESCII score);

(2.) Threat for custody relinquishment - being denied care because of custody status;

(3.) Child in Need of Supervision (CHINS) petition is being recommended or considered;

(4.) DFS is involved;

(5.) Threat to home/school situation - expulsion or placement from school or homelessness; or

(6.) Youth who are part of a household where other members are already receiving wraparound services.

(iii) Youth may be denied if wraparound services are already being provided to immediate family.

(h) Reapplication is an option at any time, and the CME and the State reserve the right to deny reapplication if the youth's previous CME enrollment ended due to non-participation, refusal of essential plan services, or goals of their plan have been met and there has not been a subsequent change or transition in the applicant's assessed needs.

(i) Enrollment in the program for the purposes of accessing institutional care or receiving financial assistance to cover medical services or co-pays and deductibles related to insurance coverage is not a valid reason for enrollment in HFWA.

(i) Program participants may select any willing and qualified provider to furnish waiver services included in the service plan as long as they are not financially affiliated with the assessor who is performing the ECSII or CASII evaluation for that participant's enrollment process.

Notes

048-47 Wyo. Code R. §§ 47-9

Adopted, Eff. 9/23/2019.