CHAPTER 53

Home and Community-Based Services Pilot Program

 Section 1. Authority.

 The Wyoming Department of Health promulgates this Chapter pursuant to Wyoming Statutes §§ 42-4-104(a)(iv) and 42-4-107(c).

 Section 2.  Purpose. 

 (a) The Department adopts this Chapter to conduct a pilot program to pay general fund financial incentive payments to providers and case managers who provide specialized transitional Home and Community-Based Services.

 (b) The Program is designed to test a new model providing incentivized delivery of Transitional Services to a specific high-risk population.

 Section 3. General.

 (a) The Department will limit the number of providers and case managers authorized to provide Transitional Services and publish those limits in a bulletin and on its website.

 (b) The Department will issue a fee schedule for Transitional Services.

 (c) Transitional Services shall not become an entitlement to such services for any period of time either before or after the expiration of Program funding. 

 (d) A provider or case manager must submit claims in accordance with Chapter 3 of the Rules and Program manuals and bulletins.  If there is a conflict between Chapter 3 and a manual or bulletin requirement, the manual or bulletin governs.

 (e) Chapter 4 of the Rules does not apply to the Program.

 (f) The Department may issue manuals and bulletins to interpret the provisions of this Chapter. The contents of manuals and bulletins are subordinate to the provisions of this Chapter.

 Section 4. Definitions. Except as otherwise specified in the Wyoming Department of Health, Medicaid Rules, Chapter 1, Chapter 45, Chapter 46, or as otherwise defined in this Chapter, the terminology used in this chapter has the standard meaning used in healthcare, Medicaid, and Medicare.

 (a) "Program" means the pilot program described above.

 (b) "Rules" means the Wyoming Department of Health, Medicaid Rules.

 (c) "Transitional Services"

  (i) Transitional Services mean specialized Home and Community-Based Services that are provided to a client who is transitioning from the Wyoming State Hospital to home or community-based living.

  (ii) The meaning of Transitional Services may be expanded if the Director authorizes providing specialized Home and Community-Based Services to clients who transition from another state health institution to home or community-based living, in which case, clients from that population will be included in the meaning of Transitional Services.

 Section 5. Program Requirements.

 (a) To provide Transitional Services, a provider or case manager must meet and maintain the applicable qualifications stated in Chapter 45 of the Rules.

 (b) To provide Transitional Services, a provider or case manager must comply with all applicable standards and requirements stated in Chapter 45 of the Rules.

 Section 6. Payment.

 (a) Incentive payments are subject to the availability of funds and may be adjusted or discontinued by the Department at any time.

 (b) Upon completion of a transition period, incentive payments will cease.

 (c) To receive Program incentive payments, providers and case managers must complete and document milestones achieved during the transition period each month in accordance with the Program manuals and bulletins.

 (d) A provider, case manager, or client may appeal the denial of a payment to the Director.  The appeal must be submitted in writing within ten days of the denial.

 (e) The Department may remove any participant, provider, or case manager from the Program without cause by providing 30 days prior written notice. The Department may immediately remove any participant, provider, or case manager with cause by providing written notice and a statement of cause.