048-3 Wyo. Code R. § 3-6

Current through April 27, 2019

Section 3-6 - Review of Eligibility

The Provider shall determine the eligibility of a person as developmentally disabled. However, nothing precludes the Division from altering eligibility decisions as a result of on-site reviews. Such alterations of eligibility shall be subject to these rules.

a) Upon notification to the client regarding his or her eligibility determination, the Provider shall inform the client of the right to request a Division review of the Providers decision.

b) The Clients request for the Divisions review must be made within twenty (20) calendar days of the eligibility notice. The review request must be accompanied by an authorized client information release form, and if available, documents, evaluation reports, and/or other information may be submitted at that time.

c) The Office shall constitute a committee which shall determine the eligibility of a person as developmentally disabled.

• 1) The Office shall review all documents provided by the Client or Advocate to support or clarify the determination of eligibility;

• 2) May request additional information or clarification of information from the Client or Advocate prior to making a determination of eligibility;

• 3) May contract with one or more independent reviewers to review appropriate documents and recommend a determination of eligibility to the Administrator; or

• 4) May purchase independent evaluations as is necessary to render a determination of eligibility.

d) The Division will provide a written notice of the disposition of its review within forty-five (45) days after receiving the Providers written request. Said time limit may be extended upon stipulation of agreement by the Administrator and the Client/Advocate.

e) Should the client be aggrieved by the decision of the committee regarding eligibility, the Client may appeal the decision in accordance with Chapter XI of the Division Rules as a contested case.

048-3 Wyo. Code R. § 3-6