Wyoming - I/DD Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Wyoming Department of Health (WDH) Home and Community-Based Services (HCBS) Section certifies providers to deliver services under the Comprehensive and Supports Waivers, governed by Chapter 45 of the state's Medicaid Rules. These waivers fund habilitation, supported living, and community integration for individuals with intellectual and developmental disabilities (I/DD) or acquired brain injuries (ABI).

Prospective providers must complete a multi-step DD Background Screening and submit all documentation through the Wyoming Health Provider Portal (WHP) within 90 days of initiation, while case management applicants face an explicit pre-screening of official college transcripts before authorization to apply is even granted.

1. Service Definition and Scope

Wyoming operates two primary HCBS waivers for the I/DD population: the Supports Waiver and the Comprehensive Waiver. Both aim to help eligible persons actively participate in the community, be competitively employed, and live safely.

Services range from traditional provider-driven models to participant-directed options where the participant manages their own budget and hires their own employees.

• Supports Waiver: Provides supportive services to eligible individuals of all ages with an I/DD or ABI to prevent institutionalization.
• Comprehensive Waiver: Provides comprehensive services to individuals who meet additional emergency criteria for immediate, extensive support.
• Participant-Direction: An approach where participants manage their budget, hire, train, and negotiate wages for their employees.
• Traditional Services: A provider-driven process where the certified agency determines hiring, scheduling, and service delivery methods.
• Case Management: A service to identify, select, obtain, coordinate, and use both paid services and natural supports.

2. Regulatory and Oversight Agencies

The Wyoming Department of Health (WDH) is the single state agency responsible for Medicaid. Within WDH, the Home and Community-Based Services (HCBS) Section handles provider certification and waiver operations.

Medicaid enrollment and claims processing are managed through the state's Provider Enrollment, Screening, and Monitoring (PRESM) system.

• Wyoming Department of Health (WDH): The overarching state agency for health services (https://health.wyo.gov).
• WDH HCBS Section: Certifies DD waiver providers and manages waiver policy (https://health.wyo.gov/healthcarefin/hcbs/).
• Wyoming Medicaid: Oversees the financial and enrollment aspects of the waiver programs (https://health.wyo.gov/healthcarefin/medicaid/).
• Wyoming Health Provider Portal (WHP): The system used for initial HCBS certification applications (https://www.wyoproviderportal.com/).
• PRESM Portal: The Wyoming Medicaid enrollment and billing system (https://wyoming.dyp.cloud/).

3. Gatekeeping Prerequisites: Who Can Even Apply

Wyoming does not currently utilize a Certificate of Need (CON) process or closed RFP procurement for general DD waiver services. However, there are specific structural preconditions that block certain applications from proceeding.

The state enforces strict pre-screening for specific provider types and automatically purges incomplete applications from its portal.

• Case Manager Pre-Screening: Case manager applicants must submit official college transcripts and a current resume by listing themselves as Staff on the Demographics page of the WHP portal before they are authorized to apply.
• 90-Day Application Purge: Any application initiated in the WHP portal that is not fully submitted within 90 days is automatically canceled by the state.
• Participant Emergency Criteria: While not a provider gate, providers of the Comprehensive Waiver must understand that participants can only access this waiver if they meet state-defined emergency criteria.
• Background Screening Prerequisite: Applicants must successfully pass each portion of the multi-step DD Background Screenings before certification is granted.

4. Licensure and Certification Requirements

Providers must be certified by the WDH HCBS Section under the standards set forth in Chapter 45: DD Waiver Provider Standards, Certification, and Sanctions. Wyoming does not issue a traditional facility license for most HCBS waiver services; instead, it issues a DD Certification.

The certification process is entirely digital and requires strict adherence to state-mandated file naming conventions.

• Governing Rule: Chapter 45 of the Department of Health's Medicaid Rules dictates all provider standards and sanctions.
• Application Portal: All initial certification applications must be submitted through the Wyoming Health Provider Portal (WHP).
• File Naming Conventions: Applicants must rename ALL uploaded files according to the DD WHP File Naming Conventions guidelines (TOOL57) or the application will be rejected.
• Child Supervision Verification: Providers serving children under 12 may be required to provide written verification of their ability to provide support, which may include licensure by the Department of Family Services.

5. Medicaid Provider Enrollment

After receiving HCBS certification, providers must separately enroll in Wyoming Medicaid to bill for services. This is done through the Provider Enrollment, Screening, and Monitoring (PRESM) system.

Medicaid enrollment is a distinct legal agreement from the HCBS certification and carries its own renewal timeline.

• Enrollment System: Providers must complete enrollment via the PRESM cloud portal.
• Provider Agreement: A signed Wyoming Medicaid Provider Agreement is required once the state notifies the applicant to proceed.
• Provider Type Selection: Applicants must select the exact PRESM Provider Type corresponding to their approved DD services during enrollment.
• Renewal Cycle: Wyoming Medicaid Enrollment and the Provider Agreement must be renewed every 5 years.

6. Staffing, Training and Background Checks

Wyoming mandates specific background checks and training protocols for all DD waiver providers and their staff. These requirements are designed to ensure participant safety and proper care delivery.

Medication administration requires specific state-approved training.

• Background Screenings: All staff must complete and successfully pass the state's multi-step DD Background Screenings.
• Medication Assistance Training (MAT): Staff assisting participants with medications must maintain a current certificate of completion for the Division's MAT program.
• Case Manager Qualifications: Must meet educational standards verified via official college transcripts during the pre-screening phase.
• Conflict of Interest: Providers must identify potential conflicts among employees, relatives, or legally authorized representatives and document how they will be mitigated.

7. Documentation, Policies and Records

Chapter 45 outlines stringent recordkeeping and data collection standards for DD waiver providers. Providers must maintain comprehensive policies that align with state definitions and participant rights.

Routine medical evaluations and individualized plans of care (IPC) form the core of participant documentation.

• Conflict Mitigation Policy: A written policy identifying and mitigating conflicts of interest among employees and participants.
• Medical Evaluations: Community living service providers must ensure each participant receives a medical evaluation every 12 months, unless otherwise directed by a licensed medical professional.
• Individualized Plan of Care (IPC): Providers must participate in and document services according to the IPC developed by the plan of care team.
• Record Retention: Providers must maintain records in accordance with Chapter 45, Section 7 (Provider Recordkeeping and Data Collection).

8. Billing, Rates and Claims

Reimbursement for DD waiver services is governed by Chapter 45, Section 11 (Rate Reimbursement Requirements). Providers submit claims through the Wyoming Medicaid PRESM system.

Rates are established by the WDH and are subject to periodic rate studies and legislative appropriations.

• Billing System: Claims are submitted through the Wyoming Medicaid PRESM portal.
• Rate Authority: Reimbursement requirements are detailed in Chapter 45, Section 11 of the Medicaid Rules.
• Service Index: Providers must bill according to the codes and limits specified in the Comprehensive and Supports Waiver Service Index.
• Scam Warning: Wyoming Medicaid never charges a fee to enroll or re-enroll; providers should report any such requests to the Attorney General.

9. Approval Sequence and Timeline

Becoming a DD waiver provider in Wyoming is a sequential process that begins with HCBS certification and ends with Medicaid enrollment. The state enforces strict timelines for application completion.

Failure to follow the sequence or meet deadlines results in application cancellation.

• Step 1: Complete the multi-step DD Background Screenings.
• Step 2: Submit the initial certification application via the WHP portal within 90 days of starting.
• Step 3: Receive HCBS certification approval from the WDH Credentialing Team.
• Step 4: Complete Wyoming Medicaid Enrollment in PRESM and sign the Provider Agreement.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied due to administrative errors rather than a lack of qualifications. The state's digital systems require precise adherence to instructions.

Providers must pay close attention to file naming and deadlines.

• File Naming Errors: Uploading documents to the WHP portal without using the mandatory DD WHP File Naming Conventions.
• Application Expiration: Failing to submit the WHP application within the 90-day window, resulting in automatic cancellation.
• Pre-Screening Failures: Case managers failing to upload official transcripts to the Demographics page.
• Incorrect Provider Type: Selecting the wrong PRESM Provider Type during the Medicaid enrollment phase.

11. Key Contacts and Resources

The WDH HCBS Section provides dedicated support for prospective providers through its credentialing team and online resources.

Providers should utilize the official portals and contact emails for technical assistance.

• HCBS Credentialing Team: [email protected]
• Wyoming Health Provider Portal (WHP): https://www.wyoproviderportal.com/
• Wyoming Medicaid PRESM Portal: https://wyoming.dyp.cloud/
• WDH HCBS Provider Page: https://health.wyo.gov/healthcarefin/hcbs/becomeaprovider/dd-cert
• Wyoming 2-1-1: Health and human services referral system (https://211wyoming.communityos.org/cms/)

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