Statutes, codes, and regulations
Wyoming Administrative Code
Agency 048 - Health, Department ofSubagency 0037 - Medicaid
Chapter 44 - ENVIRONMENTAL MODIFICATIONS, SPECIALIZED EQUIPMENT, AND SELF-DIRECTED GOODS FOR MEDICAID HOME AND COMMUNITY-BASED WAIVER SERVICES
Section 44-10 - Self-Directed Goods, Limits on the Amount, Frequency, or Duration

048-44 Wyo. Code R. § 44-10

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Current through April 27, 2019
Section 44-10 - Self-Directed Goods, Limits on the Amount, Frequency, or Duration

(a) Self-Directed Goods have a $2,000 annual limit, which includes all associated costs such as markups and fees.

(b) All goods under Section 9 shall be subject to prior authorization by the Division and shall not be available nor specifically excluded through Specialized Equipment or Environmental Modifications.

(c) The Extraordinary Care Committee may approve requests above the limit if the request meets the criteria outlined in Chapter 46of the Department of Health's Medicaid Rules, or the participant loses eligibility for other resources because of age and provides documentation that vocational rehabilitation services are not available to meet those needs.

(d) The Division may require an assessment for an equipment purchase by a Certified Specialized Equipment (CSE) professional. Assessment is funded as a part of the $2,000 cap.

(e) Electronic technology devices are only allowed once every five (5) years and like items shall not be purchased during those five (5) years. There are no exceptions. The Division shall limit the purchase of any general item, such as a computer or tablet, unless recommended by CSE professional.

(f) The Division, after approving the goods, will only pay for the actual cost of purchase.

  • (i) The Case Manager shall inquire with Medicaid, Medicare, or a participant's other insurance carrier to see if the requested equipment is covered under their plans.
  • (ii) The Medicaid Waiver is a payer of last resort, and shall not pay for goods that can be paid through another source.

(g) This service is only available for participants self-directing at least one (1) direct care service through the Fiscal Employer Agent. This service may be provided by a relative, excluding parents and stepparents. This service shall not duplicate any Medicaid State Plan service.

(h) Modifications to a residence that are not covered under the environmental modification service may be approved, if the cost of such modifications does not exceed the value of the improvement before the modification. Covered modifications of rented or leased homes shall be those extraordinary alterations that are uniquely needed by the individual and for which the property owner would not ordinarily be responsible. The approved cost does not include adaptations or improvements to the home, which are:

(i) Of general utility and are not of direct medical or remedial benefit;

(ii) Adaptations that add to the total square footage of the home; or

(iii) Adaptations that are covered as an environmental modification.

048-44 Wyo. Code R. § 44-10

Amended, Eff. 6/21/2017.

Amended, Eff. 7/26/2018.