TodaysDate
Ref: ReferenceNumber
GuardianParentOrPersonName
GuardianParentOrPersonAddressLine1
GuardianParentOrPersonAddressCityStateZip
Re: ParticipantNamePlan of care has not been approved
Please be advised that the Plan of Care for ParticipantName,which is supposed to begin on (Date) has not yet been approved. This may be because it was
☐Plan submitted late (Date initially submitted).
☐There were essential items missing from the plan submitted (Date).
☐There were corrections, which were not submitted until (Date).
☐Other issues (Date).
Please work closely with the Case Manager to ensurethat any outstanding items needed from you are submitted to the Case Manager immediately. There may be forms thatrequire your signature or documents requiring your input, such as the Positive Behavior Support Plan, objectives, or schedules, etc. If you are certain that you have met all of your responsibilities in the development and submission of this plan, please contact the Case Manager to learn why it has not been approved and distributed to you before the plan is to begin.
Services to be delivered during this plan year are in jeopardy. It is the expectation that plans are approved, distributed, and participant specific training has occurred prior to the start date of each annual plan. Due to the late date, it is unlikely that this plan will begin on (Date).
To obtainspecific information regarding what is missing from this plan, so that it can be approved to begin on time, please contact the Case Manager orthe Participant Support Specialist.
Sincerely,
PSS Name & Contact Info
cc:File, Electronic Medicaid Waiver System (EMWS), Document Library
<CaseManagerName>, Case Manager
Chris Newman, M.H.A., Senior Administrator
Alice Russler, Ed.D., Mental Health and Substance Abuse Services Administrator
Joe Simpson, M.S., Ed.S., Developmental Disabilities Administrator
Wyoming Department of Health, Behavioral Health Division
6101 Yellowstone Road – Suite 220 ▪ Cheyenne WY 82002
FAX (307) 777-5849 ▪ 800-535-4006 ▪ (307) 777-6494