048-45 Wyo. Code R. §§ 45-5 - Provider Qualifications for Each Waiver Service

(a) All individual waiver providers, subcontractors, and provider employees offering direct services to waiver participants shall meet the following requirements unless otherwise specified in this Section:

(i) Be eighteen (18) years or older;

(ii) Be certified by the Division to provide the indicated service;

(iii) Maintain current CPR and First Aid Certification, which includes hands-on training from a trainer certified with a curriculum consistent with training standards set forth by the American Heart Association or the American Red Cross;

(iv) Have a valid email address, internet access, and the means to upload documentation into a Division designated portal; and

(v) If assisting with medications, maintain a current certificate in medication assistance training offered through the Division.

(b) A provider shall also meet the following specific requirements for the service in which they want to receive and maintain certification:

(i) Behavioral Support Services. A Behavioral Support Services provider or provider staff shall meet credentials as outlined in the Comprehensive and Supports Waiver Service Index, which is incorporated by reference.

(ii) Case Management.

(A) All providers of case management services shall have one (1) of the following:

(I) A Master's degree from an accredited college or university in one (1) of the following related human service fields:

(1.) Counseling;

(2.) Education;

(3.) Gerontology;

(4.) Human Services;

(5.) Nursing;

(6.) Psychology;

(7.) Rehabilitation;

(8.) Social Work;

(9.) Sociology; or

(10.) A related degree, as approved by the Division.

(II) A Bachelor's degree in one (1) of the related fields from subsection (b)(ii)(A)(I) of this Section from an accredited college or university, and one (1) year work experience as a case manager or in a related human services field.

(III) An Associate's degree in a related field from subsection (b)(ii)(A)(I) of this Section from an accredited college, and four (4) years of work experience as a case manager or in a related human services field.

(B) A case manager shall obtain and maintain his or her own National Provider Identifier (NPI) number for case management services through the Medicaid enrollment process.

(C) A case manager shall obtain and provide evidence of eight (8) hours of continued education relating to the delivery of case management services during each year of certification.

(D) A provider agency certified to provide case management services shall:

(I) Identify a back-up case manager from the list of Division certified case managers for each participant, and have policies and procedures for backup case management for each person's caseload, which include a process for how and when the case manager will notify the plan of care team that the backup case manager should be the primary contact. Case managers shall meet with their designated backup to review all participant cases on a quarterly basis. The review shall be documented in case notes.

(II) Document on the individualized plan of care that they have no conflict of interest with the participant or family.

(III) Meet all of the following conflict of interest requirements.

(1.) The case management agency and any managing employee shall not own, operate, be employed by, or have a financial interest in or financial relationship with any other person or entity providing services to a participant.

(2.) The case management agency may be certified in other waiver services, but shall not provide case management services to any participant to whom they are providing any other waiver services, including self-directed services.

(3.) The owner, operator, or managing employee of a case management agency shall not be related within the third degree by blood or marriage to the owner, operator, or managing employee of any other waiver service provider on the participant's individualized plan of care. A relationship within the third degree includes the spouse; biological, step, or adoptive parent; mother, father, brother, or sister-in-law; biological, step, or adoptive child; biological, step, or adoptive sibling; grand or great grand-parent or child; or aunt, uncle, niece, or nephew.

(4.) Any employee of a guardianship agency shall not provide case management to any participant who is receiving any services from the guardianship agency.

(5.) The case management agency shall not:

a. Employ case managers that are related to the participant, the participant's guardian, or a legally authorized representative, within the third degree, served by the agency. If the case management agency is a sole proprietor, the case manager shall not be related to the participant, the participant's guardian, or a legally authorized representative, within the third degree, served by the agency;

b. Make financial or health-related decisions on behalf of the participant receiving services from that agency, including but not limited to a guardian, representative payee, power of attorney, or conservator; or

c. Provide case management services to, or live in the same residence of, any provider on a participant's individualized plan of care in which they provide case management services.

(E) If a rural area of the State does not have a case manager without a conflict of interest for a participant, the participant or legally authorized representative may request to have a case manager with a conflict. If the Division confirms that there are no other case managers available in the region or a nearby region to provide case management, then the conflicted case manager may be approved on an annual basis. A third party entity without a conflict shall be involved in the participant's team to mediate, advocate for the participant as needed, and address unresolved grievances for any conflicts that are approved.

(F) All case managers shall notify the provider of a participant's or legally authorized representative's decision to discontinue services within three (3) business days.

(iii) Child Habilitation. A Child Habilitation provider, if operating a day care while also providing child habilitation services, shall follow the Department of Family Services licensing rules in addition to meeting the Medicaid waiver provider rules.

(iv) Cognitive Retraining. A Cognitive Retraining provider shall:

(A) Be certified in Cognitive Retraining from an accredited institution of higher learning;

(B) Be a certified Brain Injury Specialist through the Brain Injury Association of America; or

(C) Be a licensed professional with one year of acquired brain injury training or Bachelor's degree in related field and three (3) years of experience in working with acquired brain injuries.

(v) Dietician. A Dietician provider or provider staff shall have a license to provide dietician services by the Wyoming Dietetics Board and have a current National Provider Identifier (NPI).

(vi) Environmental Modification. Environmental Modification providers shall have all applicable building, construction, and engineer license and certifications that may be required to work as a contractor at the location where services will be provided. Employees do not have to be certified in CPR or First aid, complete a background check, or have participant specific training. The provider shall report critical incidents as defined in Section 20.

(vii) Individual Habilitation Training. Within one (1) year of being certified in this service, and annually thereafter, the provider or staff providing the service shall successfully complete at least eight (8) hours of continued education in any of the following areas: specific disabilities or diagnosed conditions relating to the population served, writing measurable objectives, gathering and using data to develop better training programs, or training modules posted by the Division.

(viii) Homemaker. A provider of Homemaker services shall be at least eighteen (18) years old but does not have to be certified in CPR and First Aid.

(ix) Occupational Therapy. An Occupational Therapy provider or provider staff shall have a current license to practice occupational therapy by the Wyoming Board of Occupational Therapy and have a current NPI.

(x) Physical Therapy. A Physical Therapy provider or provider staff shall have a current license to practice physical therapy by the Wyoming Board of Physical Therapy and have a current NPI.

(xi) Skilled Nursing. A skilled nursing provider or provider staff shall be licensed to practice nursing by the Wyoming Board of Nursing, and have a current NPI.

(xii) Special Family Habilitation Home. A Special Family Habilitation Home provider shall be at least 21 years of age.

(xiii) Specialized Equipment. A Specialized Equipment provider shall have the applicable license or certification for the type of equipment purchased, and does not have to be certified in CPR or First Aid.

(xiv) Speech, Hearing, and Language Services. A Speech, Hearing, and Language Service provider or provider staff shall have a current license to practice Speech, Hearing and Language Services by the Wyoming Board of Speech Pathology and Audiology, and have a current NPI.

(xv) Transportation. A Transportation provider shall have a current, valid driver's license; automobile insurance; and additional liability insurance for transporting people for business purposes.

Notes

048-45 Wyo. Code R. §§ 45-5

Amended, Eff. 6/21/2017. Amended, Eff. 7/26/2018. Amended, Eff. 12/20/2019.