(a) The services listed in this section are covered services if they are functionally necessary and part of a current individual plan of care approved by the Division. - (i) Case management services.
- (A) Case management is a stand alone service. A participant (or guardian, if applicable) may choose any individually-selected service coordination provider, and shall not be expected or required to receive any other service from that provider.
- (B) Individually-selected service coordinators shall be required to provide a minimum of 60 minutes per calendar month of person-to-person contact with the participant or guardian.
- (I) This may include face-to-face meetings and telephone conversations between the individually-selected service coordinator, the participant, and/or the guardian.
- (II) Individually-selected service coordinators shall be required to complete one monthly visit to participant in his or her home.
- (C) Individually-selected service coordinators shall schedule and facilitate six month review team meetings and annual individual plan of care meetings, including:
- (I) Notifying all individual plan of care team members of the scheduling of the meetings at least 30 days in advance unless a shorter notification time is approved by the Division.
- (II) Notifying the Division in writing of the scheduling of the meetings at least 30 days in advance unless a shorter notification time is approved by the Division.
- (III) Following Division requirements for facilitating team meetings; and for documenting minutes of the team meetings in the form and manner prescribed by the Division in provider manuals and bulletins issued by the Division.
- (D) Individually-selected service coordinators shall facilitate other team meetings when requested by the participant, guardian, member of the team, or the Division.
- (ii) Dietician.
- (A) Dietician services shall be supported by a formal assessment completed by a registered dietician.
- (B) Providers of dietician services may seek Medicaid reimbursement for providing such services to a group of up to three participants at a time.
- (iii) Environmental modification.
- (A) Environmental modifications shall be approved pursuant to Chapter 44.
- (iv) Habilitation services.
- (A) For all habilitation services:
- (I) Participants shall be in attendance in service areas in order for providers to bill for services.
- (II) Purposes of the habilitation service codes shall be met, including assisting participants in acquiring, retaining, and improving the self-help, socialization, adaptive, and safety skills necessary to reside successfully in home and community-based settings.
- (III) Habilitation providers shall work with participant on objectives as stipulated in the individual plan of care and document the results in the form and manner established by the individual plan of care team.
- (IV) Reimbursement for habilitation services shall not be made directly or indirectly to a parent, stepparent, spouse, or guardian of a participant.
- (B) For residential habilitation services.
- (I) Residential habilitation services may be provided for participants who are 18 through 20 years old.
- (II) Habilitation rates shall include personal care and respite services, except in the cases listed under (III) of this section.
- (III) Residential habilitation and respite services may appear on the same individual plan of care when:
- (a) The participant is transitioning into a residential setting such as a group home, or
- (b) Unpaid caregivers need respite when the participant spends time at home visiting on weekends or vacations, or
- (c) When residential habilitation providers who are not required to obtain and maintain CARF accreditation pursuant to Chapter 45 require respite for vacations, sick days, or other emergencies. In these cases, a maximum of 1,344 units of respite shall be allowed during a plan year.
- (IV) Habilitation rates for each participant shall include the cost for routine transportation when it is provided by the provider regardless of the number of trips.
- (V) Residential habilitation services shall not be provided in residential settings other than the home of the participant or the community.
- (VI) Residential habilitation services and residential habilitation training services shall not appear on the same individual plan of care unless the participant is transitioning into a residential setting such as a group home.
- (C) For special family habilitation home services.
- (I) Special family habilitation home services may be provided for participants who are birth through 20 years old.
- (II) Special family habilitation home services and respite services may be on the same plan and may be billed for the same day.
- (D) For residential habilitation training services.
- (I) Providers of residential habilitation training services shall not seek reimbursement for providing any services to more than one participant at the same time unless approved in advance by the Division.
- (II) Residential habilitation training services shall not be reimbursed for persons receiving special family habilitation home services.
- (III) Residential habilitation training services shall be provided in the participant's home, provider home, or in the community.
- (v) Homemaker Services.
- (A) Providers of homemaker services shall provide a maximum of three hours of homemaker services per week per participant, unless more hours are approved by the Division.
- (B) Providers of homemaker services shall not be responsible for supervision of a participant while completing homemaker services.
- (C) The Division shall not approve homemaker services that are provided in residential habilitation settings except for homemaker services provided to special family habilitation home providers and residential habilitation providers who are not required to obtain and maintain CARF accreditation pursuant to Chapter 45.
- (vi) Personal care services.
- (A) The participant shall be present when personal care services are provided.
- (B) Personal care services may include the preparation of meals, exclusive of the cost of the meals.
- (C) When specified in the individual plan of care, personal care services may also include such housekeeping chores as bed making, dusting, and vacuuming, which are incidental to the care furnished, or which are essential to the health and welfare of the participant, rather than that individual's family.
- (D) Personal care providers may include members of the family of the participant, except that Medicaid shall not reimburse a parent or a spouse for providing such services to the child or the other spouse.
- (E) Providers certified to provide personal care services who are family members of the participant shall meet the same standards as providers certified to provide personal care services who are unrelated to the participant.
- (F) Providers of personal care services shall not seek Medicaid reimbursement for providing such services to more than one participant at a time.
- (vii) Respiratory therapy.
- (A) Reimbursement for respiratory therapy services shall require a treatment letter or recommendation plus a physician's order.
- (viii) Respite services.
- (A) Respite services shall be covered if provided in one of the following locations:
- (I) The residence of the participant.
- (IV) Certified provider location, or
- (V) The community, including parks, stores, and recreation centers.
- (B) A respite service provider or provider staff providing respite services:
- (I) Shall serve no more than two participants at a given time, unless approved by the Division.
- (II) May also provide supervision to other children under the age of 12 or other individuals requiring support and supervision, and
- (III) Shall limit the total combined number of persons in (I) and (II) to no more than three persons, unless approved by the Division.
- (C) Respite services shall not take the place of residential or day habilitation services.
- (D) Respite services shall accommodate each family's living routine.
- (E) Respite services shall accommodate the needs of the participant.
- (F) The respite site and services shall be matched to the identified needs of each participant and family.
- (G) A respite provider shall not provide respite services to adults and children at the same time except to participants who are 18 to 20 years of age who may receive respite services with adults. In exceptional cases, such as when participants are members of the same family, respite may be provided to adults and children at the same time with Division approval.
- (H) A child shall not receive respite during the designated school hours, unless such services are provided due to illness of the child limiting school attendance.
- (I) Respite services shall not exceed 7,280 units per year unless more are approved by the Division.
- (ix) Skilled nursing.
- (A) Shall be prescribed by a physician.
- (B) May include preventative and rehabilitative procedures.
- (C) Shall be listed on a form required by the Division and identified in the individual plan of care.
- (D) Shall involve direct patient care.
- (x) Specialized equipment.
- (A) Shall be provided pursuant to Chapter 44.
(b) Services otherwise covered by Medicaid, EPSDT, or the Department of Education shall not be covered services under this Chapter.
(c) Extended state plan services shall be funded to the maximum allowable amount under the state plan before these services are paid for under the waiver.
(d) Parents, step parents, and/or spouses shall not be reimbursed by waiver funding for any waiver services.
048-42 Wyo. Code R. § 42-7