SKILLED NURSING SERVICES PROVIDER IN WYOMING

DELIVERING CLINICALLY SUPERVISED CARE TO INDIVIDUALS WITH COMPLEX MEDICAL NEEDS IN HOME AND COMMUNITY SETTINGS

Skilled Nursing Services in Wyoming provide essential, medically necessary care to individuals with chronic health conditions, disabilities, or post-acute medical needs. These services are performed by Registered Nurses (RNs) or Licensed Practical Nurses (LPNs) and are delivered in home or residential settings to help individuals avoid hospitalization or institutionalization. Skilled nursing is covered under Wyoming Medicaid’s State Plan and through various Home and Community-Based Services (HCBS) Waivers, including the Community Choices Waiver (CCW) and the Children’s Developmental Disability Waivers. Services must be ordered by a physician, justified in a care plan, and documented in accordance with state and federal guidelines.

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1. GOVERNING AGENCIES

Agency: Wyoming Department of Health – Division of Healthcare Financing

Role: Administers Medicaid State Plan and HCBS waiver nursing coverage policies and reimbursement.

Agency: Public Health Nursing (PHN) / Case Management Agencies

Role: Coordinate care plans, assess nursing needs, and authorize skilled nursing hours.

Agency: Wyoming Board of Nursing (BON)

Role: Licenses and regulates RNs, LPNs, and APRNs practicing in Wyoming.

Agency: Medicaid Provider Services

Role: Manages provider enrollment, billing processes, and prior authorization workflows.

2. SKILLED NURSING SERVICES OVERVIEW

Skilled Nursing refers to clinical services that require the professional expertise of a licensed nurse and are performed under physician orders.

Covered services may include:

• Medication administration (oral, IM, IV, subcutaneous)

• Wound care and dressing changes

• Tracheostomy care and ventilator support

• Tube feeding and catheter care

• Vital sign monitoring and chronic disease management

• Diabetes care and insulin injections

• Patient and caregiver education

• Delegation of tasks to unlicensed staff (under RN supervision)

• Documentation of clinical progress and coordination with physicians

Services may be intermittent or continuous and must be delivered in accordance with a physician-ordered Plan of Care (POC).

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register your business with the Wyoming Secretary of State

• Obtain a Federal EIN and Type 2 NPI

• Apply for Medicaid enrollment as a Skilled Nursing or Home Health provider

• Employ or contract licensed RNs and/or LPNs with valid Wyoming BON licensure

• Develop a Skilled Nursing Services Policy & Procedure Manual

• Maintain general liability, malpractice, and workers’ compensation insurance

• Establish RN supervision and documentation systems for LPNs (if used)

Medicare certification is optional but may be pursued for dual reimbursement under Medicare and Medicaid.

4. WYOMING PROVIDER ENROLLMENT PROCESS

Step 1: Register business and obtain EIN and NPI

Step 2: Apply to Wyoming Medicaid as a provider of skilled nursing or home health services

Step 3: Submit required documentation: licenses, policy manual, staff rosters, and credentials

Step 4: (Optional) Apply for Medicare certification if serving dual-eligible clients.

Step 5: Coordinate with waiver case managers (CCW, DD) for waiver-based authorization

Step 6: Begin services once Plan of Care is approved and prior authorization (if required) is issued

5. REQUIRED DOCUMENTATION

• Medicaid provider enrollment and credentialing forms

• Skilled Nursing Services Policy & Procedure Manual including:

  • Plan of Care (POC) development and review

  • Clinical assessment and shift documentation templates

  • Delegation, supervision, and RN visit logs

  • Infection control and universal precautions protocols

  • Emergency response and escalation procedures

  • HIPAA compliance and confidentiality safeguards

  • Medication administration logs and safety checklists

  • Incident reporting and follow-up documentation

  • Training and credentialing tracking for nurses

6. STAFFING REQUIREMENTS

Role: Registered Nurse (RN)

Requirements:

• Active Wyoming RN license from the Board of Nursing

• Develops care plans, conducts assessments, and supervises all clinical staff

• Trained in documentation, HIPAA, emergency procedures, and delegation

Role: Licensed Practical Nurse (LPN)

Requirements:

• Active Wyoming LPN license

• Works under the supervision of an RN

• Provides delegated clinical tasks (e.g., injections, catheter care, wound care)

All nursing staff must complete:

• CPR/First Aid and infection control training

• Annual skills validation and charting audits

• Abuse and neglect prevention training

• Continuing education as required by BON and Medicaid

7. MEDICAID PROGRAMS THAT COVER SKILLED NURSING SERVICES

• Medicaid State Plan: Covers skilled nursing services ordered by a physician for eligible individuals

• Community Choices Waiver (CCW): Covers intermittent skilled nursing for adults with physical disabilities or aging-related conditions

• Comprehensive and Supports Waivers (for I/DD): Covers skilled nursing for individuals with intensive medical needs

• Early and Periodic Screening, Diagnosis and Treatment (EPSDT): May cover pediatric skilled nursing when medically necessary

• Katie Beckett Program: Allows coverage of skilled nursing for children with complex medical conditions who do not otherwise qualify for Medicaid

Note: All services must be supported by physician orders, documented within a Plan of Care, and provided by licensed professionals. Certain high-need cases require prior authorization.

8. TIMELINE TO LAUNCH

Phase: Business Registration & Policy Development

Timeline: 2–3 weeks

Phase: Staff Hiring & Credential Verification

Timeline: 30–60 days

Phase: Medicaid Enrollment & Waiver Registration

Timeline: 2–4 months

Phase: Launch of Services

Timeline: Upon Plan of Care approval and credentialing completion

9. CONTACT INFORMATION

Wyoming Medicaid Provider Services

Website: https://health.wyo.gov/healthcarefin/medicaid/providers/

Wyoming Board of Nursing

Website: https://wsbn.wyo.gov

Community Choices Waiver Info

Website: https://health.wyo.gov/healthcarefin/ltc/home-and-community-based-waiver/

Developmental Disabilities Division (DDD)

Website: https://health.wyo.gov/behavioralhealth/dd/

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WYOMING SKILLED NURSING PROVIDER

WCG supports nurses, home health agencies, and private healthcare companies in launching fully compliant, high-quality skilled nursing services across Wyoming.

Scope of Work:

• Medicaid and waiver program enrollment

• Skilled Nursing P&P Manual development

• Charting templates, Plan of Care documentation, and visit logs

• RN supervision forms and LPN delegation workflows

• HIPAA, infection control, and safety protocols

• Staff credentialing logs and continuing education trackers

• Audit preparation and billing documentation tools

Continue To Our Client Portal To Get Started

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