048-34 Wyo. Code R. §§ 34-9 - Provider Participation Standards and Decertification
(a) A CCW provider must offer and render
services without discrimination based on race, religion, political affiliation,
gender, national origin, age, sexual orientation, gender expression, or
disability, except as allowed by law.
(b) A CCW provider shall identify in writing
their potential conflicts of interest, including those of their employees, with
the participant, other service providers on the participant's service plan,
relatives of the participant, or any legal guardian of the participant, and
address how a conflict of interest shall be mitigated. The provider shall share
this information with a participant and/or their legal guardian and the case
manager prior to being added to the participant's service plan.
(c) A CCW provider shall not place
restrictions or criteria on the services it will make available, the type of
health conditions it will accept, or the persons it will accept for care or
treatment, unless the provider applies those restrictions or criteria to all
individuals seeking the provider's services.
(d) A CCW provider shall institute policies
and procedures as required by the Department to assure the safe and effective
delivery of waiver services.
(e) A
CCW provider shall deliver services that meet the service definitions
established in the CCW Service Index and align with the participant's service
plan.
(f) A CCW provider shall only
agree to provide services to a participant if the provider has the adequate
administrative and staffing resources and emergency backup systems necessary to
render services as described and agreed to in the participant's service plan,
and in accordance with all applicable state and federal service standards. A
CCW provider shall make all reasonable efforts to avoid disruptions of service
delivery that would jeopardize the participant's health and welfare.
(g) A CCW provider shall notify the
participant and the Department in writing thirty (30) calendar days prior to
ending services with the participant. All transitions occurring from this
decision shall follow standards and requirements established by the
Department.
(h) If acting as an
employer or contractor of personnel, a provider entity shall ensure:
(i) Personnel operate within the limits and
scope of practice allowed under the individual's professional licensure or
certification and within the limits of the entity's licensure or certification,
if applicable; and
(ii) Routine
confirmation that it complies with the U.S. Department of Health and Human
Services, Office of Inspector General's regulations and guidance on employment
of individuals excluded from participation in federally funded health care
programs.
(i) A provider
shall comply with all applicable state and federal laws in safeguarding
information about applicants and participants.
(j) The Department shall conduct monitoring
and enforcement activities as necessary to assure compliance with its
established CCW provider qualifications and participation standards.
(k) The Department may attempt to resolve any
suspected noncompliance with this Chapter by issuing technical assistance or
corrective action. Technical assistance and corrective action are not
considered an adverse action and are not subject to the fair hearing process
pursuant to Medicaid Rules Chapter 4.
(i) When
requested, providers shall submit corrective action plans that address each
area of suspected noncompliance to the Department's satisfaction. Corrective
action plans include identification of the area of noncompliance, the actions
that will be taken to address the area of noncompliance, the individual(s)
responsible for each action, and anticipated due dates of each
action.
(ii) If an approved
corrective action plan is not submitted and implemented to address all areas of
suspected noncompliance, the Department may take adverse action against the
provider.
(l) A CCW
provider is subject to an inspection by the Department at any time to ensure
compliance with provider requirements.
(m) The Department shall decertify a CCW
provider upon termination of the provider's Medicaid enrollment pursuant to
Wyoming Medicaid Rules Chapter 3.
(n) The Department may take adverse action
against a CCW provider that fails to meet standards established by the
Department.
(o) The Department may
decertify a CCW provider for any violation of standards established by the
Department.
(p) A CCW provider that
is subject to adverse action pursuant to this Chapter shall be provided a
notice of adverse action and an opportunity for due process pursuant to Wyoming
Medicaid Rules Chapters 4 and 16.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
(a) A CCW provider must offer and render services without discrimination based on race, religion, political affiliation, gender, national origin, age, sexual orientation, gender expression, or disability, except as allowed by law.
(b) A CCW provider shall identify in writing their potential conflicts of interest, including those of their employees, with the participant, other service providers on the participant's service plan, relatives of the participant, or any legal guardian of the participant, and address how a conflict of interest shall be mitigated. The provider shall share this information with a participant and/or their legal guardian and the case manager prior to being added to the participant's service plan.
(c) A CCW provider shall not place restrictions or criteria on the services it will make available, the type of health conditions it will accept, or the persons it will accept for care or treatment, unless the provider applies those restrictions or criteria to all individuals seeking the provider's services.
(d) A CCW provider shall institute policies and procedures as required by the Department to assure the safe and effective delivery of waiver services.
(e) A CCW provider shall deliver services that meet the service definitions established in the CCW Service Index and align with the participant's service plan.
(f) A CCW provider shall only agree to provide services to a participant if the provider has the adequate administrative and staffing resources and emergency backup systems necessary to render services as described and agreed to in the participant's service plan, and in accordance with all applicable state and federal service standards. A CCW provider shall make all reasonable efforts to avoid disruptions of service delivery that would jeopardize the participant's health and welfare.
(g) A CCW provider shall notify the participant and the Department in writing thirty (30) calendar days prior to ending services with the participant. All transitions occurring from this decision shall follow standards and requirements established by the Department.
(h) If acting as an employer or contractor of personnel, a provider entity shall ensure:
(i) Personnel operate within the limits and scope of practice allowed under the individual's professional licensure or certification and within the limits of the entity's licensure or certification, if applicable; and
(ii) Routine confirmation that it complies with the U.S. Department of Health and Human Services, Office of Inspector General's regulations and guidance on employment of individuals excluded from participation in federally funded health care programs.
(i) A provider shall comply with all applicable state and federal laws in safeguarding information about applicants and participants.
(j) The Department shall conduct monitoring and enforcement activities as necessary to assure compliance with its established CCW provider qualifications and participation standards.
(k) The Department may attempt to resolve any suspected noncompliance with this Chapter by issuing technical assistance or corrective action. Technical assistance and corrective action are not considered an adverse action and are not subject to the fair hearing process pursuant to Medicaid Rules Chapter 4.
(i) When requested, providers shall submit corrective action plans that address each area of suspected noncompliance to the Department's satisfaction. Corrective action plans include identification of the area of noncompliance, the actions that will be taken to address the area of noncompliance, the individual(s) responsible for each action, and anticipated due dates of each action.
(ii) If an approved corrective action plan is not submitted and implemented to address all areas of suspected noncompliance, the Department may take adverse action against the provider.
(l) A CCW provider is subject to an inspection by the Department at any time to ensure compliance with provider requirements.
(m) The Department shall decertify a CCW provider upon termination of the provider's Medicaid enrollment pursuant to Wyoming Medicaid Rules Chapter 3.
(n) The Department may take adverse action against a CCW provider that fails to meet standards established by the Department.
(o) The Department may decertify a CCW provider for any violation of standards established by the Department.
(p) A CCW provider that is subject to adverse action pursuant to this Chapter shall be provided a notice of adverse action and an opportunity for due process pursuant to Wyoming Medicaid Rules Chapters 4 and 16.