048-46 Wyo. Code R. §§ 46-16 - Prohibited Use of Waiver Funds

(a) The following services are not eligible for waiver services reimbursement:

(i) The care of individuals residing in a hospital, nursing facility, ICF/IID, or other institutional placement;

(ii) Wavier services provided by:

(A) A spouse of the participant, if the spouse is also the participant's legally authorized representative;

(B) A legally authorized representative of a participant who is eighteen (18) years of age or older; or

(C) An owner or officer of a provider organization if the organization is serving a participant for whom they are the legally authorized representative;

(iii) Room and board, except when provided as part of respite in a facility, other than a private residence, approved by Medicaid;

(iv) Services currently covered under the Medicaid State Plan;

(v) Services to an individual if it is reasonably expected that the cost of these services would exceed the institutional cost limit specified in the most current Comprehensive Waiver application approved by CMS, which is incorporated by reference; or

(vi) Service settings reimbursed by another state agency, such as the Department of Family Services or Department of Education.

(b) No direct service that is the responsibility of the school system shall be authorized as a waiver service. The Division shall not authorize direct waiver services for the hours the child is attending school or in a vocational program.

(i) Regular school hours and days apply for a child who receives home schooling or an adjusted school day.

(ii) Waiver services may be used if an individualized educational plan identifies specific times when the school system shall not cover services for the individual.

(c) Any individual eligible for funding for specialized services under the Developmental Disabilities Services Act shall apply for and accept any federal Medicaid benefits for which they may be eligible and benefits from other funding sources within the Department of Health; the Department of Education; the Department of Workforce Services and Division of Vocational Rehabilitation; and other agencies to the maximum extent possible.

Notes

048-46 Wyo. Code R. §§ 46-16

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