This chapter establishes eligibility criteria and renewal processes for Behavioral Health Center (BHC) benefit plans in Wyoming. It defines two benefit plan tiers (BHC-Screen and BHC-Full) based on income and priority population status, outlines individual responsibilities for participating in the eligibility process, and sets rules for eligibility periods, redeterminations, and retroactive benefits. Facility operators at BHCs must screen individuals, bill the Department for screenings, notify individuals of eligibility decisions in writing, and conduct annual eligibility reviews.
View official sourceHealth, Department of Mental Health and Substance Use Disorder Services Chapter 7: Behavioral Health Center Benefit Plan Eligibility Effective Date: 09/18/2024 to Current Rule Type: Current Rules & Regulations Reference Number: 048.0077.7.09182024 Download Chapter 7 Behavioral Health Center Benefit Plan Eligibility Section 1. Purpose and Applicability . (a) This Chapter has been adopted to establish the criteria for Behavioral Health Center (BHC) benefit plans eligibility and renewal processes. (b) This Chapter applies to individuals seeking treatment services through a BHC benefit plan. (c) The Department may issue manuals, bulletins, or policies to interpret this Chapter. Such manuals, bulletins, or policies shall be consistent with and reflect the rules contained in this Chapter. The provisions contained in manuals, bulletins, or policies shall be subordinate to this Chapter. Section 2. Behavioral Health Center Benefit Plan Eligibility . (a) An individual may present at a BHC seeking treatment services or be referred by sources set forth in W.S. 35-1-611 through W.S. 35-1-627 to be screened for BHC benefit plan eligibility. (b) The BHC shall assess the individual to determine BHC benefit plan eligibility and will bill the Department for screening. If an individual does not qualify for the BHC-Full benefit plan, the individual may receive treatment services with insurance or self-pay. BHCs may not seek other payment sources for BHC-Screen benefit plan assessments. (c) An individual is eligible for the following BHC benefit plans when: (i) BHC-Screen Benefit Plan. Individuals who are not eligible for statutorily defined priority populations at W.S. 35-1-620(b)(ix). (ii) BHC-Full Benefit Plan. (A) Household income is less than or equal to two hundred percent (200%) of the federal poverty level; or (B) The individual meets criteria for one or more of the statutorily defined priority populations at W.S. 35-1-620(b)(ix). (d) The individual shall be notified in writing of the reasons for the approval, denial, reduction, or closure; the specific regulation supporting the action; the effective date of action; and an explanation of the right to request a hearing. (e) Responsibilities for Individuals Seeking Services. (i) Individuals seeking services shall participate in the eligibility process by providing all information and documentation requested by the BHC, including, but not limited to, intake documentation, clinical assessment, income, and financial resources. (ii) Individuals seeking services who fail or refuse to participate or provide the information requested by the BHC shall not be considered for eligibility. (iii) Individuals seeking services may be required by BHCs to provide Wyoming Medicaid financial eligibility determination. (f) Eligibility Period and Redeterminations. (i) BHC Benefit Plan eligibility begins the first day of the month in which the individual is eligible. Eligibility shall be reviewed by the Department for continued eligibility every twelve (12) months. (ii) The Department shall send a written BHC benefit plan renewal notice sixty (60) calendar days before the expiration of eligibility. (g) Clients shall be allowed to receive retroactive benefits not to exceed ninety (90) calendar days prior to the intake documentation if the individual received benefit covered services at any time during that period and would have been eligible had they applied, unless restricted by other federal or state laws and regulations. For questions regarding the content or application of a specific rule, please contact the agency responsible for the rule. A directory of agencies is also available online. For questions about the rulemaking process, please send your questions and comments to Rules@wyo.gov .