048-41 Wyo. Code R. §§ 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.
Notes
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