Welcome to the page for Case Managers. You will find all of the forms and documents you need to complete the IPC. New training handouts and other information can also be found on this page.
Link to Provider Support Call Notes – Provider Support Call Notes 2014 to Current
Case Manager Plan, Monitoring, and Billing Forms
- Aces$ Referral Form for Self Directed Services – Posted 6-1-2018
- Home Visit and Service Observation Signature Form Posted 1-10-2017
- Case Management Guidance for Billing and Documentation Posted 12-09-2014
- Community Integration Schedule Form Posted 10-27-2014
- Case Management 15 Minute Unit Tracking Form Posted 10-21-2014
- Third Party Liability Form Word Posted 1-5-2018 · Third Party Liability Form PDF Posted 1-5-2018
- Positive Behavior Support Plan Revised 5-2018
- Behavioral Support Service Form Revised 5-2018 – PDF
- Behavioral Support Service Form Revised 5-2018 – Fillable Word Format
- Crisis Intervention Service Request Form Revised 5-2018 – PDF
- Transportation Mileage Log Posted 4-2-2014
- Case Manager Selection Form Updated 7.5.2018
- Case Management Monthly Review Form (effective 7-1-2012) Case Management Quarterly – Effective September 2012, this form submitted electronically in Electronic Medicaid Waiver System (EMWS)
- Team Verification and Signature Form – Revised 5-2018 Fillable Word Format
- Team Verification and Signature Form – Revised 5-2018 PDF
- Paricipant/Guardian Verification Form Word
- Participant/Guardian Verification Form PDF
- Planning Workbook for IPC
- “About Me” worksheet (Revised September 2012)
- Medication Assistance Record
- Medication Consent Form Word Revised 3-2018
- My Medical Services Worksheet
- Participant Specific Training Form
- Request for Goods for Self Directed Care Process Flow
- Request for Goods Form – Revised 5-2018 – Fillable Word Format
- Request for Goods Form – Revised 5-2018 – PDF
Case Manager Handouts
NEW – Case Manager Training Handouts from November 2015 – posted 12-16-2015
Conflict Free Case Management Information
- Conflict Free Case Management Information – Posted 2/15/2018
Chapter 45 Rules Training PPT
Chapter 45 Rules Training PPT – PDF Posted 1.5.2018
Crisis Management Team
The Crisis Management Team (CMT) is an internal Department of Health workgroup comprised of representatives from the Developmental Disability Section, Wyoming Life Resource Center, Wyoming State Hospital, and the Division of Healthcare Financing. The CMT has been established to provide recommendations to the plan of care team regarding urgent issues related to a waiver applicant or participant’s current therapeutic placement, programs, behavior management, and health and safety.
A Crisis Intervention Screening Tool has been developed to help the plan of care team identify support options and recommendations when a participant is in crisis.
Prior to presenting a case to the CMT, the Case Manager and the participant’s support team are expected to work with the Participant Support Specialist at the ground level to ensure all options and available resources have been exhausted for serving the participant in a community setting. The CMT does not take the place of an Extraordinary Care Committee request.
Electronic Medicaid Waiver System (EMWS)
For more information on employment planning, please contact your local Participant Support Specialist.
HCBS and the Case Manager Role
What is the role of the Case Manager and HCBS (PowerPoint Section from CM Training 11/2016)
Independent and Supported Living Guide
**NEW REVISED IPC eGuide- Rev. 8/2017 (Revisions will occur to guide over the course of the next several months as processes and new rules are changed/added) IPC eGuide Revised and Posted 10.3.2017
IPC Documents and Related Materials
- Individualized Plan of Care Worksheet for EMWS
- Non Compliance Form
- Relative Disclosure Form – Posted 7-2-2018
- Reconsideration Requests Process Flow
- Example of Completed Objective & Schedule
- Employment Objectives
- Habilitation Objectives (For Supported Living, Res & Day Hab, Special Family Hab Home, Child Hab Srvs)
- Personal Care Schedule
- Respite Schedule
- Special Family Hab Home Schedule
- Sample Day Habilitation Schedule (With behavior plan and objective data collection components)
- Sample Residential Habilitation Schedule
- Sample Task Analysis Sheet
For services included on a Participant’s IPC, a supplemental form is completed by the provider and sent to the Case Manager before the IPC is submitted to the Division. Objectives are required for habilitation services, but do not need to be sent to the Division with the IPC. · Specialized Equipment Request Worksheet · Specialized Equipment Request · Environmental Modifications · Skilled Nursing -physician’s order form posted 7-23-2013 ·
- Team Meeting Checklist revised 4-2018
Rights and Restriction Information
Effective April 1, 2018 the Division will not require a doctor’s letter for restrictions due to a permanent physical or medical condition ifthe condition is substantiated in the neuropsychological, psychological, or ICAP assessments.
The Rights screen will be updated in the next few weeks to give the case manager the option of clicking a check box that says “Is the medical condition specified in the neuropsychological/psychological assessment or ICAP?” For example, if a participant has quadriplegia and will always require assistance with personal hygiene, the assessments should substantiate the condition and need for support. When the case manager clicks the button confirming that the medical condition is specified in the assessments, the system won’t require a doctor’s letter. However, if the condition is not substantiated in one of the assessments, the case manager will still be required to obtain and upload a doctor’s letter.
Please remember that an intellectual disability does not qualify as a medical condition which would justify a restriction to a person’s right to privacy through a lifelong support. For now, if an assessment substantiates the medical condition, the case manager can create and upload a word document that says: “The medical condition that requires lifelong supports for personal hygiene can be substantiated within the assessments.” The Division will send out an email to let you know when the Rights screen has been updated in EMWS.
Recorded Training on Rights and the Plan of Care