048-45 Wyo. Code R. § 45-31

Current through April 27, 2019

Section 45-31 - Relative Providers

(a) The Division shall allow a participant's relative to become a certified waiver provider and receive reimbursement for services provided to the related participant.

(b) A participant's legally authorized representative shall not directly or indirectly receive reimbursement for providing waiver services for their ward except as indicated in this Section. Direct or indirect reimbursement shall include, but is not limited to, providing direct services at or serving as the owner or officer of a provider organization serving the ward, residing in a provider owned facility serving the ward, or being married to a person providing waiver services to the ward.

(c) A participant's spouse may receive direct or indirect reimbursement only if they present the Division with a certified copy of a court order establishing another party as the legally authorized representative of the participant.

(d) To provide waiver services to a related participant, the relative shall:

• (i) Form a Limited Liability Company (LLC) or other corporation, and

• (ii) Maintain provider certification in accordance with this chapter.

(e) No parent, step-parent, or legally authorized representative shall be hired to provide services through self-direction.

(f) Services that a relative provider may provide include residential habilitation and supported living for participants over the age of 18, personal care, specialized equipment, any supported employment service, prevocational services, and environmental modifications with the following limitations:

• (i) For residential habilitation and supported living services, the relative shall not live in same residence as the participant.

• (ii) Personal care services reimbursed to a relative provider shall not exceed four (4) hours per day, and can only be reimbursed if the provider lives in the same residence as the participant.

• (iii) A provider who is the parent, stepparent, or legally authorized representative of a participant age zero through seventeen shall only be reimbursed for providing personal care services up to four (4) hours per day and for extraordinary care purposes only. No other waiver services are reimbursable.
  • (A) Extraordinary care personal care services shall align with the needs and supports specified in the individualized plan of care which demonstrate the need for extraordinary care; and
  • (B) The participant's Adaptive Behavior Quotient shall be 0.35 or lower on the Inventory for Client and Agency Planning (ICAP) assessment; and meet one of the following criteria:
    • (I) The participant needs assistance with Activities of Daily living (ADLs) or Instrumental Activities of Daily Living (IADLs) exceeding the range of expected activities that a legally responsible individual would ordinarily perform in the household on behalf of a person without a disability or chronic illness of the same age, and which are necessary to assure the health and welfare of the participant and avoid institutionalization; or
    • (II) The participant requires care from a person with specialized medical skills relating to the participant's diagnosis or medical condition as determined appropriate by the participant's licensed medical professional and the Behavioral Health Division.

(g) If a parent, stepparent, or legally authorized representative is providing personal care to his or her ward, the individualized plan of care shall be developed and monitored by a case manager without a conflict of interest.

(h) If the relative provider is not providing services in the best interest of the participant, the case manager shall work with the participant, appropriate team members, and the Division as needed to choose other providers as appropriate and modify the individualized plan of care to better suit the needs of the participant.

(i) Payment to any relative specified in subsections (f) and (g) shall only be made when the service provided is not a function that the relative would normally provide for the individual without charge as a matter of course in the usual relationship among family members, and the service would otherwise need to be provided by a qualified provider.

(j) Any relative who provides services either as an owner, employee, officer of a provider or who intends to provide services to a related waiver participant shall disclose the relationship in the participant's team meeting and acknowledge and address the safeguards set forth in documentation required by the Division.

(k) If a provider permits the hiring of a legally authorized representative of a participant receiving services from the provider, or if a provider permits the hiring of relatives of provider employees working for the organization, the provider shall have a written policy on how it addresses potential conflicts that arise from these relationships and how the conflict of interest is mitigated. The policy shall be shared with the participant and legally authorized representative(s).

048-45 Wyo. Code R. § 45-31

Amended, Eff. 6/21/2017.

Amended, Eff. 7/26/2018.