Wyo. Code R. 048-0077-5
Chapter 5: Behavioral Health Centers: Professional Standards for Personnel and Service Quality
Effective Date: 09/18/2024 to Current
Rule Type: Current Rules & Regulations
Reference Number: 048.0077.5.09182024
(a) This Chapter:
(i) Establishes professional standards for personnel providing behavioral health services purchased in whole or in part by the Department in a behavioral health center; and
(ii) Prescribes standards for the quality of behavioral health services provided by behavioral health centers purchased in whole or in part by the Department.
(b) This Chapter applies to all behavioral health centers whose services are purchased by the Department, in whole or in part, under the Community Human Services Act, Wyoming Statutes § 35-1-611 to -627.
(a) A behavioral health center shall employ an executive director on a full-time basis.
(b) A behavioral health center shall ensure that:
(i) Only qualified clinical staff provide the clinical services purchased in whole or in part by the Department; and
(ii) All qualified clinical staff receive training necessary for billing services to Wyoming Medicaid and all other health insurers.
(a) A behavioral health center shall:
(i) Be certified according to Chapter 2 of these Rules;
(ii) Utilize evidence-based practices and promising practices;
(iii) Guarantee each client’s right to an individualized plan of appropriate services which provides for treatment in the least restrictive environment that may reasonably be expected to benefit the client;
(iv) Develop processes to manage wait lists or practice same day access;
(v) Develop practices which result in high quality services as demonstrated in positive, cost effective client outcomes that are determined by the Department in collaboration with providers;
(vi) Provide integrated mental health or substance use disorder treatment services that are coordinated with primary care as applicable;
(vii) Gather and use client feedback to improve the quality of care; and
(viii) Not deny eligibility to clients or individuals seeking services based on the behavioral health center’s inability to deliver services.
(a) The Department shall establish payment policies for Department-funded services in accordance with W.S. § 35-1-620(b)(iii).
(b) Any payment which exceeds the behavioral health center allowable payment for the service may be recovered by the Department.
(c) A behavioral health center may not request an administrative hearing regarding a recovery of payment which exceeds the behavioral health center allowable payment.
(d) Except as otherwise specified by the Department, the behavioral health center allowable payment shall not exceed the Department’s established fee schedule in effect on the date services were provided. The fee schedule is available upon request from the Department.
(a) A behavioral health center may not seek payment from the Department for services delivered to a client until payment from third parties is sought and exhausted.
(b) A behavioral health center may not request, receive or attempt to collect any payment from the client or the client’s family for services covered by the BHC-Full or BHC-Screen benefit plans. The behavioral health center shall accept the allowable payment as payment in full for the services.
(c) A behavioral health center that provides services not covered by the BHC-Full or BHC-Screen benefit plans to a client may seek payment from the client if the behavioral health center informed the client in writing of the client’s potential liability before providing the service, and the client agreed in writing to pay for such services before they were furnished.
(d) All health insurers, including all self-insured plans, group health plans as defined in section 607(1) of the Employee Retirement Income Security Act of 1974, service benefit plans, managed care organizations, pharmacy benefit managers, or other parties that are, by statute, contract, or agreement, legally responsible for payment of a claim for a health care item or service, shall agree, as a condition of doing business in the state of Wyoming, to provide, with respect to the individuals who are eligible for behavioral health services purchased by the Department pursuant to W.S. § 35-1-620 et. seq., information to determine the period during which the individual or the individuals' spouses or dependents may be or may have been covered by a health insurer and the nature of the coverage provided, including the name and address of the insurer and identifying number of the plan, in a manner prescribed by the Department.
(a) A behavioral health center may be granted a waiver from the Department of any standard imposed under Section 2 of this Chapter if the Administrator determines that requiring immediate compliance with a particular standard would create undue hardship and that temporary noncompliance would not impair the quality of services being provided.
(b) A request for a waiver must be made in writing and may be made to the Administrator at any time the behavioral health center deems a standard represents an undue hardship.
(c) Prior to or as a condition of granting a waiver, the Administrator may:
(i) Set a time limit on the effective duration of the waiver; and
(ii) Require the behavioral health center to submit a written plan to the Administrator setting forth proposed methods of achieving compliance with the standard within the time frame of the waiver.
(d) The Administrator reserves absolute discretion in considering and granting a request for a waiver.
(i) The Administrator shall communicate to the provider in writing the Administrator's decision on a waiver request and if denied, the grounds for denial.
(ii) If the Administrator grants a waiver request, the requesting behavioral health center shall keep a copy of the Administrator's decision as part of the behavioral health center's records.
(iii) If the Administrator denies a waiver request, the Administrator's denial is final and not subject to administrative review.
(a) A behavioral health center may request a variance from the Department of any standard imposed under Section 2 of this Chapter.
(i) A request for variance must be made in writing and signed by the chair of the governing board.
(ii) A request for variance must establish how the variance will maintain or enhance the quality of a center’s operations and client services.
(b) The Administrator reserves absolute discretion in considering and granting a request for variance.
(i) The Administrator shall communicate to the provider, their decision in writing on a variance request and if denied, grounds for denial.
(ii) If the Administrator grants a variance request, the requesting provider shall keep a copy of the Administrator’s decision as part of the provider’s records.
(iii) If the Administrator denies a variance request, the Administrator’s denial is final and not subject to administrative review.