Wyoming - Residential Care Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Wyoming Department of Health (WDH) HCBS Section certifies 24-hour residential support under the Comprehensive Waiver as Community Living Services. Providers must navigate a strict capacity limit, as Wyoming Administrative Code Chapter 45-13(d) prohibits the certification of any new provider-owned or operated community living setting that serves five or more participants.

Approval requires a sequential process starting with HCBS DD Certification through the Wyoming Health Provider (WHP) portal, followed by Medicaid enrollment in the PRESM system. Facilities operating as Assisted Living Facilities must also secure a license from WDH Healthcare Licensing and Surveys (HLS) prior to waiver certification.

1. Service Definition and Scope

In Wyoming, 24-hour residential care for individuals with intellectual and developmental disabilities is delivered as Community Living Services under the Comprehensive Waiver. These services provide habilitation, supervision, and personal care in a provider-owned or controlled setting.

Certified waiver providers must ensure services are home and community-based in nature, integrating participants into the broader community and avoiding institutional characteristics.

• Service Name: Community Living Services
• Funding Authority: Wyoming Comprehensive Waiver
• Target Population: Individuals with intellectual disabilities or acquired brain injuries meeting emergency criteria
• Setting Limits: Maximum of four participants per new provider-owned setting
• Included Supports: Personal care, habilitation, and supervision

2. Regulatory and Oversight Agencies

Multiple divisions within the Wyoming Department of Health (WDH) oversee residential providers, dividing responsibilities between waiver certification, facility licensure, and Medicaid billing.

Providers must interact with different portals for certification and enrollment.

• HCBS Section: Certifies DD waiver providers (https://health.wyo.gov/healthcarefin/hcbs/)
• Healthcare Licensing and Surveys (HLS): Licenses Assisted Living Facilities (https://health.wyo.gov/aging/hls/)
• Wyoming Medicaid: Manages provider enrollment via PRESM (https://wyoming.dyp.cloud/landing)
• Wyoming Health Provider (WHP) Portal: Manages the initial certification application (https://www.wyoproviderportal.com/)

3. Gatekeeping Prerequisites: Who Can Even Apply

Wyoming imposes a strict capacity moratorium on new residential settings for waiver services. While there is no Certificate of Need process for HCBS group homes, the bed limit acts as a definitive structural barrier.

Applicants must also secure portal access and complete all background checks before an application is even accepted.

• Capacity Moratorium: New provider-owned community living settings serving 5 or more participants cannot be certified per Chapter 45-13(d)
• Pre-Application Access: Applicants must request and be approved for WHP portal access before applying
• Application Window: Applications not submitted within 90 days of initiation are permanently canceled
• Certificate of Need: None exists for HCBS group homes in Wyoming

4. Licensure and Certification Requirements

Providers must obtain DD Certification from the HCBS Section to bill the Comprehensive Waiver. If the setting operates as a formal Assisted Living Facility, Chapter 4 licensure from HLS is also required.

Settings must pass physical inspections and comply with the HCBS Settings Final Rule.

• DD Certification: Required for all Comprehensive Waiver Community Living providers
• ALF Licensure: Required under Chapter 4 rules if operating a formal assisted living facility
• Inspection Requirement: Service settings must be inspected by an outside entity at least once every 24 months
• File Naming: All uploaded documents must strictly follow the DD WHP File Naming Conventions

5. Medicaid Provider Enrollment

After HCBS certification is granted, providers must enroll as a Wyoming Medicaid Provider. This is a distinct step handled through a separate system.

Enrollment requires signing a provider agreement that must be maintained and renewed on a set cycle.

• System: Provider Registration and Enrollment System for Medicaid (PRESM) (https://wyoming.dyp.cloud/landing)
• Provider Type: Must select the correct PRESM Provider Type matching Community Living Services
• Agreement Renewal: Wyoming Medicaid Provider Agreement must be renewed every 5 years
• Prerequisite: HCBS certification must be completed before PRESM enrollment is permitted

6. Staffing, Training and Background Checks

Wyoming requires multi-step background screenings and specific training to be completed before an application is submitted to the state.

Staff assisting with medications must hold specific state-recognized credentials.

• Background Screening: Multi-step DD Background Screenings required for all staff
• Medication Training: Medication Assistance Training (MAT) certificate required if assisting with medications
• Timing: All training and background checks should be completed before requesting a WHP application
• CPR and First Aid: Required for all direct care staff prior to service delivery

7. Documentation, Policies and Records

Providers must maintain emergency plans and participant rights documentation in accordance with Chapter 45 rules.

Policies must explicitly align with the HCBS Settings Rule, ensuring participant autonomy.

• Emergency Plans: Must include contingency plans for essential services and address children under 12 if present
• Drill Records: Documentation of annual review and at least one fire drill with evacuation
• Settings Rule Compliance: Policies must ensure participants have access to food at any time and visitors of their choosing
• Rights Restrictions: Any restriction must be time-limited and documented in the individualized plan of care

8. Billing, Rates and Claims

Billing is conducted through the Wyoming Medicaid MMIS. Rates are established by the WDH Division of Healthcare Financing based on participant acuity.

Providers must ensure claims match the authorized services in the participant's plan of care.

• System: Wyoming Medicaid MMIS
• Waiver Funding: Billed exclusively under the Comprehensive Waiver for this service
• Rate Methodology: Tiered daily rates based on the participant's assessed level of need (LT101/ICAP)
• Claim Format: Standard CMS-1500 or 837P electronic transactions

9. Approval Sequence and Timeline

The approval process is strictly sequential, starting with portal access and ending with the Medicaid Provider Agreement.

Failure to move through the steps within the allotted timeframes results in application cancellation.

• Step 1: Request WHP portal access (allow up to 48 hours for approval)
• Step 2: Complete training and multi-step background screenings
• Step 3: Submit DD Certification application within the 90-day window
• Step 4: Complete PRESM Medicaid enrollment and sign the Provider Agreement

10. Common Denials and Survey Findings

Applications are frequently delayed or denied due to administrative errors or failure to meet setting requirements.

Surveyors strictly enforce the capacity limits and file naming conventions during the initial review.

• Timeout Denials: Applications canceled automatically if not submitted within 90 days
• Capacity Violations: Rejection for proposing a setting with 5 or more participants
• File Naming Errors: Applications rejected for not using the mandatory DD WHP File Naming Conventions
• Settings Rule: Failure to demonstrate community integration or unrestricted access to food and visitors

11. Key Contacts and Resources

The Wyoming Department of Health provides dedicated email support for credentialing questions and maintains specific portals for each step of the process.

Providers should rely on the official WDH HCBS website for the most current rule chapters and checklists.

• HCBS Credentialing Team: [email protected]
• WHP Portal Login: https://wyohcbs.us.auth0.com
• Medicaid Enrollment (PRESM): https://wyoming.dyp.cloud/landing
• HCBS Provider Page: https://health.wyo.gov/healthcarefin/hcbs/becomeaprovider/

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