(a) The emergency criteria used by the Division includes: - (i) A substantial threat to a person's life or health caused by:
- (A) The loss of the person's primary caregiver.
- (C) Abuse or neglect that is either substantiated by the Wyoming Department of Family Services, or corroborated by the Division or Protection and Advocacy of Wyoming.
- (ii) Situations where the person's condition poses a substantial threat to a person's life or health and is documented, in writing, by a physician.
- (iii) Situations where a person:
- (A) Has caused serious physical harm to the person or someone else, or a person whose condition presents a substantial risk of physical threat to the person or others, and
- (B) The harm or threat of harm is verified, in writing, by a psychologist or a psychiatrist, and
- (C) The use of covered services would be an appropriate response to the person's condition, and
- (D) Other resources to provide appropriate services are not available.
(b) Identification of emergency referrals and emergency cases. - (i) Any person may request that the Division consider whether an individual has an emergency.
- (ii) The Division may identify persons on the waiting lists who have an emergency.
(c) Once a potential emergency case or emergency referral has been identified: - (i) The individually-selected service coordinator shall submit in the form specified by the Division specific information on the potential emergency. The information shall include:
- (A) Description of the factors or condition that have created an emergency and their expected duration.
- (B) Description of the covered services that are functionally necessary.
- (C) Copies of incident reports, physician reports, assessments, or other documentation that relate to the factors or conditions that have created an emergency.
- (D) A detailed plan of how the funds shall be spent, the expected outcome, and how the results shall be monitored with respect to the funds.
- (ii) For emergency referrals, determination of eligibility as defined in Section 6 of this Chapter, shall be completed within 14 calendar days after receipt of the Inventory for Client and Agency Planning and the psychological assessment.
(d) The Extraordinary Care Committee shall review specific information on the potential emergency referral or emergency case to determine if the case meets the emergency criteria as defined in (a) of this section. Such persons shall receive covered services, subject to available funding.
(e) An emergency plan may be submitted to the Division by the participant's individually-selected service coordinator to cover services until the complete individual plan of care is submitted and approved by the Division. - (i) The emergency plan shall include significant health and safety information and shall be approved by the Division in order for services to be reimbursed.
- (ii) The Division shall have 3 business days to review and approve the plan.
(f) In no event shall the Division be required to provide or fund covered services in the absence of available funding or in the absence of clinical and financial eligibility.
048-42 Wyo. Code R. § 42-14