(a) Development of the individual plan of care. - (i) After the targeted individualized budget amount is identified by the Division, the individual plan of care team, coordinated by the individually-selected service coordinator, shall assist the participant in determining the use of the targeted individualized budget amount in developing the individual plan of care.
- (ii) The individual plan of care shall be completed in the form and manner prescribed by the Division in accordance with Section 23 of Chapter 1, Rules for Individually-selected Service Coordinators of the Rules of the Developmental Disabilities Division.
- (iii) The individually selected service coordinator shall develop the individual plan of care that includes:
- (A) A completed pre-approval page signed by the participant or guardian and the individually-selected service coordinator.
- (B) Freedom of Choice Document or its successor.
- (C) LT-MR-10 4 form or its successor.
- (D) Medical report signed by a physician if the participant is eligible due to a diagnosis of a related condition. The medical report shall discuss the diagnosis and what the recommended treatments or services may be.
- (E) Psychological report that is no more than 5 years old and signed by a psychologist.
- (I) The psychological report shall specify a clinical diagnosis of mental retardation or a related condition.
- (II) The psychological report shall provide recommendations that the individual plan of care team shall review and address through the individual plan of care.
- (F) ICAP report that is no more than 5 years old.
- (G) Objective pages as required by the Division for each habilitation service. The individually-selected service coordinator is responsible for ensuring that objective pages are completed. The objectives shall:
- (I) Define the training activities of an individual and the methods used to train the activity.
- (II) Be measurable and meaningful to the participant.
- (III) Be reflected on the personal schedule.
- (H) Identification of rights and rights restrictions in accordance with Appendix A of this Chapter, including the use of restraints as defined in Section 4 of this Chapter, including:
- (I) Why the restriction is imposed.
- (II) How the restriction is imposed.
- (III) The plan to restore the right being restricted.
- (IV) Signature of the participant and/or guardian.
- (V) Rights restrictions shall be reviewed at least every six months by the individual plan of care team.
- (VI) Rights restrictions that occur that are not part of the individual plan of care shall be reported to the Division on a form designated by the Division.
- (I) Skilled nursing information on the form required by the Division that includes all areas of skilled nursing required by the participant.
- (J) Medication administration indicating the level of medication administration or monitoring required for the participant. Levels of support include:
- (I) Medication administration.
- (II) Medication management training.
- (III) Medication monitoring.
- (IV) Ability to self-medicate with no assistance.
- (K) A behavior support plan, if applicable, that reflects and addresses maladaptive behaviors identified by the individual plan of care team, the psychological evaluations, and the Inventory for Client and Agency Planning, including maladaptive behaviors listed as moderate or above pursuant to Section 30 of Chapter 45.
- (L) Schedules for habilitation, personal care, and respite services. The purpose of the schedule shall be to provide information about the services and supports needed throughout a participant's day and justify the rates for services. Schedules shall be personalized and shall:
- (I) Reflect the purpose of the services.
- (II) Reflect recommendations from therapists, physicians, psychologists, and other professionals.
- (III) Reflect the participant's desires and goals.
- (IV) Include all information required by Chapter 45.
(b) Approval of the individual plan of care. - (i) The individually-selected service coordinator shall submit the individual plan of care to the Division with the Division's current technical checklist.
- (ii) The Division shall have 20 calendar days to review and approve an individual plan of care contingent upon the individually-selected service coordinator submitting all the requested information to the Division.
- (iii) The Division shall approve or make recommendations to modify the plan. This may result in an adjustment to the individualized budget amount.
- (iv) Upon approval and prior to implementation of the plan, the individually-selected service coordinator shall distribute copies of the individual plan of care to the participant, the guardian, advocates, or representatives designated by the participant or guardian, and to habilitation, respite, personal care, and therapy providers on the individual plan of care in accordance with applicable privacy and confidentiality law and regulation.
- (v) All other providers shall be given information from the individual plan of care pertinent to the provision of services.
- (vi) All services shall be provided pursuant to the individual plan of care.
- (vii) Medicaid reimbursement shall be limited to the covered services and the providers specified in the individual plan of care on the pre-approval form signed by the Division.
- (viii) The Division shall not reimburse for services in excess of those specified in an approved individual plan of care or to providers not so specified.
- (ix) The Division shall not approve an individual plan of care nor reimburse for services provided to a participant before clinical eligibility has been established pursuant to Section 6.
- (x) Any provider who submits a claim for payment for services that have been approved but not yet provided to the participant shall be subject to the requirements of Chapter 16 and Chapter 39 including any available sanctions.
- (xi) The Division shall review and approve Individual plans of care at least annually or more frequently at the option of the Division.
(c) Modification of individual plan of care requiring approval of the Division. - (i) Modifications to the pre-approval page of the individual plan of care shall be submitted for approval to the Division when there is a change in service rates, a change in service units, or a change in providers.
- (ii) If the change does not require an increase in the individualized budget amount the Division shall approve, deny, or make recommendations to modify the plan.
- (iii) If the change requires an increase in the individualized budget amount, the modification to the plan shall be due to an emergency, a material change in circumstance, a potential emergency, or other condition justifying an increase in funding and the modification shall be reviewed by the Extraordinary Care Committee in accordance with Section 12 of this Chapter.
- (iv) The Division shall have 7 calendar days to review and approve modifications to the pre-approval page of the individual plan of care contingent upon the individually-selected service coordinator submitting all the requested information to the Division.
- (v) The effective date of the modification shall be the date indicated on the pre-approval page by the signature of a Division representative.
- (vi) When the level or intensity of services is permanently decreased, modifications to the individual plan of care shall be submitted for approval to the Division. The rates on the modification shall reflect the decrease in need of services. The decrease in services may include but is not limited to decreases in staffing levels or decreases in total hours of service provided in a day.
(d) Modifications to the individual plan of care that do not require Division approval. - (i) The individual plan of care shall be updated by the individually-selected service coordinator whenever there are significant changes to the participant's needs, including:
- (A) Changes in health and safety needs.
- (B) Changes in employment status.
- (C) Changes in medication.
- (D) Changes in adaptive equipment.
- (E) Changes in diagnoses.
- (F) Changes in mealtime needs.
- (G) These changes do not need to be submitted to the Division unless the changes result in a change listed in (c) of this Section.
(e) Participant no longer receiving waiver services. - (i) The individually-selected service coordinator shall submit a modification ending the plan within 45 calendar days of the last date of service.
048-41 Wyo. Code R. § 41-9