048-41 Wyo. Code R. § 41-12

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Current through April 27, 2019

Section 41-12 - Extraordinary Care Committee

(a) The Extraordinary Care Committee has the following authority:

(i) Determining if a funding request for an emergency case or an emergency referral shall be funded.

(ii) Determining if a funding request due to a material change in circumstance, a potential emergency, or other condition justifying an increase in funding shall be funded.

(iii) Approving or denying rates for services that are not commensurate with the average rates as defined in the Adult DD Waiver document approved by Centers for Medicare and Medicaid Services.

(iv) Approving rate changes due to increased or decreased funding from legislative appropriations or under utilization of approved individualized budgeted amounts.

(b) The Extraordinary Care Committee shall review the requests to determine if the request meets criteria, has necessary documentation, and if funding is available.

(c) The Extraordinary Care Committee shall make the following determinations:

(i) Request further information.

(ii) Approve the request for one year or less.

(iii) Approve the request as a long term individually budgeted amount pursuant to Section 8(c)(ii).

(iv) Deny the request.

(d) The individually-selected service coordinators shall present funding requests due to a material change in circumstance, a potential emergency, or other conditions justifying an increase in funding to the Extraordinary Care Committee by conference call, compressed video, or physical presence. The individually-selected service coordinators shall have previously sent written documentation to their waiver specialist of the emergency criteria, material change in circumstance, or other conditions required for the case.

(e) Membership of the Extraordinary Care Committee shall include a representative of the Division, a representative of the State Medicaid Program and a representative of the Department's Fiscal Office.

(f) Decisions of the Extraordinary Care Committee shall be by majority and shall be rendered in writing.

(i) The Division shall notify the individually-selected service coordinator of the decision in writing within 10 business days of the decision.

048-41 Wyo. Code R. § 41-12