§ 42-4-120 — Contracts for waiver services; authority of department; emergency case services; cost based payments; training and certification of specialists

Wyoming § 42-4-120

• Jurisdiction: Wyoming
• Title 42: Welfare
• Ch. 4: MEDICAL ASSISTANCE AND SERVICES
• Art. 1: IN GENERAL

Text

(a) The department is authorized to enter into contracts
with providers of services under a federal home and community
based waiver and to enforce the provisions of this section.
(b) The department shall adopt and enforce reasonable
rules and regulations for the certification of home and
community based waiver services, and shall include minimum
certification standards for each category of service provider.
(c) Before entering into a contract with a provider of
services under this section, the department shall ascertain that
the provider is in compliance with applicable regulations
regarding health care providers adopted pursuant to W.S.
35-2-908, with all applicable professional licensing statutes
and regulations and with regulations adopted pursuant to
subsection (b) of this section.
(d) In addition to other remedies, in the event of a
chronic failure to provide services or services that fail to
meet the applicable standard of care for the profession involved
or a continuing condition creating serious detriment to the
health, safety or welfare of recipients of home and community
based waiver services, the department may impose a civil penalty
upon the provider. For each day of continuing violation, the
civil penalty shall not exceed one thousand dollars ($1,000.00)
or one percent (1%) of the amount paid to the provider during
the previous twelve (12) months, whichever is greater, and any
administrative penalty assessed under this section shall be paid
over to the state treasurer who shall remit the monies to the
county treasurer to the credit of the public school fund of the
county in which the violation occurred, except as otherwise
provided by federal law for Medicaid certified nursing
facilities.
(e) The department shall have the same authority to place
conditions upon a provider, to impose a monitor or to revoke a
certification issued under this section in the manner described
in W.S. 35-2-905.
(f) The department, not later than April 1, 2008, shall
promulgate rules under which an emergency case shall be
determined to exist with respect to eligibility for federal home
and community based waiver services for persons with
developmental disabilities or adult brain injury under this act.
(g) The department shall establish by rule and regulation
a cost based reimbursement system to pay providers of services
and supplies under home and community based waiver programs for
persons with developmental disabilities or acquired brain
injury. The payment system shall:
(i) Use information provided to the department,
including but not limited to:
(A) Provider cost data;
(B) Provider claims data;
(C) Participant needs assessment data;
(D) Other relevant regional and national data.
(ii) Establish a new base period to be used in
calculating reimbursement rates to providers for fiscal year
2012 and at least once every four (4) years thereafter but not
more than once in any two (2) year period. When a new base
period is established, the department shall submit a biennial or
supplemental budget request to adjust provider reimbursement
rates based on the most current base period;
(iii) Be developed following consultation with
Wyoming developmental disability and acquired brain injury
waiver program service providers, developmental disability
waiver program clients and their families and an expert in cost
based waiver program payment systems, which the department is
authorized to retain by contract following competitive bidding;
(iv) Be implemented for services and supplies
provided under individual budget amounts established on and
after July 1, 2008;
(v) Be contingent upon approval by the center for
Medicare and Medicaid services of the United States department
of health and human services;
(vi) Require service and supply providers to provide
actual cost of service and supply data to the department and to
submit to reasonable audits of the submitted data, if requested
by the department.
(h) The department shall apply to the center for Medicare
and Medicaid services of the United States department of health
and human services for authorization to reimburse at an enhanced
rate direct care providers who have training and certification
as behavioral specialists in the care of persons dually
diagnosed with a developmental disability and a mental illness.
(j) The department, through the developmental disabilities
division and the mental health and substance abuse services
division, shall collaborate with the University of Wyoming
institute for disabilities and the community college commission
in developing a training program for behavioral specialists in
the care of persons dually diagnosed with a developmental
disability and a mental illness. The program shall provide for
timely testing and certification and shall include a required
curriculum and standards for certification and evaluation of
dual diagnosis behavioral specialists where certificants will
qualify for reimbursement under the requirements of subsection
(h) of this section.
(k) Department budget requests for the cost based
reimbursement system established pursuant to subsection (g) of
this section shall be calculated to reflect all service units
required in plans of care for recipients as of the preceding
June 30.
(m) The department shall ensure that state agencies
working with service providers receiving funds pursuant to this
section shall have established employment first policies,
including competitive employment in an integrated setting,
consistent with the requirements of W.S. 9-2-3207.
(n) For purposes of this section, "military service
member" means any person serving in the uniformed services as
defined in W.S. 8-1-102(a)(xxii). Military service members shall
have the following benefits if they meet the qualifications
listed:
(i) Active duty military service members who have
been assigned to serve in Wyoming may submit an application for
waiver services under this paragraph upon receiving military
orders to serve in Wyoming, provided that no qualifying
dependent shall receive services until the dependent is residing
in Wyoming;
(ii) Active duty military service members retiring or
separating from active duty military service may submit an
application for waiver services under this paragraph upon
receiving retirement or separation orders, provided that:
(A) The military member certifies on a form
provided by the department that he intends to reside in Wyoming
within eighteen (18) months after retiring or separating from
military service;
(B) The military service member claimed Wyoming
as his primary state of residency for not less than two (2)
years prior to his military service as proved by documentation
required by the department;
(C) The military service member claimed Wyoming
residency on his leave and earnings statements while serving in
the military; and
(D) No covered services shall be received
pursuant to this paragraph unless and until the qualifying
dependent and the military service member are residing in
Wyoming within eighteen (18) months after the military service
member retires or separates from active military service.
(iii) Military service members who qualified for and
received or were previously placed on the waiting list to
receive dependent waiver services under the home and community
based Medicaid waivers authorized by this section, and who left
the state for military reasons, shall upon their return to the
state for continued military service or upon military separation
or retirement be placed in a status identical to where they
would be if they had not left the state provided that:
(A) The military service member claimed Wyoming
residency on his leave and earnings statements while serving in
the military; and
(B) For retiring or separating military service
members, in no case shall covered services be received pursuant
to this paragraph unless and until the military service member
and the qualifying dependent are residing in Wyoming within
eighteen (18) months after the military service member retires
or separates from active military service.
(o) Applicants who are qualifying military service members
under subsection (n) of this section may also be considered for
funding made available to any other applicant under this section
and shall receive services from whatever source of funding for
which they first qualify. In consultation with the Wyoming
military department, the department of health shall promulgate
rules and regulations regarding applications and qualifications
for waiver services authorized by subsection (n) of this
section.