- CCW Case Manager Manual – 10/2024
- CCW Provider Manual – 10/2024
- CCW EMWS Document Naming Conventions
Getting Started
Person-Centered Service Planning
Planning
- Participant Profile Assessment – 4/2024 English | Español
- PCSP Team Modification Signature and Verification Form – 5/2024
- Provider Evidence of Participant-Specific Training – 5/2024
Supplementals/Protocols
- Environmental Modification Request – 4/2023
- Skilled Nursing PA Request Form – 2/2023 Instructions
Monitoring
- Quarterly Visit Verification Form – 8/2022 English Ι Español
- NEW! Instructions for Generating CareBridge EVV Visit Reports – 11/2024
- Provider Documentation Non-Compliance Report – 5/2024
Transitions
Case Manager
- Transition Checklist – 10/2022
- Change of Case Management Agency Form – 11/2022 English Ι Español
Facility
- DD EMWS File Naming Conventions – 10/2022
- DD Commonly Used Acronyms – 11/2022
- DD Commonly Used Terms – 11/2022
Getting Started
- Supports Waiver Guide and Application English | Español | PDF Application
- Case Management Selection Form – 7/2022 English | Español
- IPC Planning Workbook – 8/2022 English | Español
- Targeted Case Management Plan of Care – 7/2022 English Ι Español
- Targeted Case Management 15 Unit Tracking – 02/2022
Individualized Plan Development
Assessments
- ICAP Authorization and Information – 1/2023 English Ι Español
- Criteria for DD Psychological Evaluations – 2/2023
- Criteria for Neuropsychological Evaluations – 2/2023
Planning
- IPC Guide – 06/2024 English
- IPC Team Meeting Checklist – 10/2022 English Ι Español
- Rights Restriction Review Tool – 1/2023 English Ι Español Ι Braille
- Medication Consent Form – 4/2023 English Ι Español
- Remote Monitoring Risk Assessment – 1/2023 English Ι Español Ι Braille
- Case Management Agency Case Manager Update Form – 7/2022
Supplementals/Protocols
- Environmental Modification Request Worksheet – 12/2022
- Positive Behavior Support Plan Manual – 4/2023 English | Español | Braille
- Positive Behavior Support Plan – 4/2023 English Ι Español
- Request for Prior Authorization of Skilled Nursing Services – 3/2019 Instructions
- Specialized Equipment Request Worksheet – 11/2022
- Transition Checklist – 12/2022
- Third Party Liability Form – 1/2022
Monitoring
- Home Visit and Service Observation Signature Form – 3/2023 English Ι Español
- Provider Documentation Non-Compliance Form – 5/2024
ECC
- ECC Checklist – 5/2022
- ECC Request – 5/2021
- ECC Team Consensus Form – 5/2021 English Ι Español
- Partnership Access Line (PAL) Consultation Process – 12/2023 English Ι Español
Many Participant-Direction documents are provided through our Financial Management Service (FMS), ACES$. If you don’t find what you’re looking for below,
Please Visit the
ACES$ FMS Document Center
Case Managers
Community Choices Waiver HCBS Specific Documents:
- CCW Participant Direction FMS Change Notification Form – 10/2022 English | Braille
- CCW Participant-Direction Support Plan – 2/2023 English Ι Español Ι Braille
- CCW Participant-Direction Budget Worksheet – 5/2022
- CCW Participant-Directed Budget Calculator – 5/2022
- The ACES$ referral form, enrollment packets, and other documents can be found on the ACES$ FMS Document Center.
|
Case managers, please assist participants interested in Participant Direction by providing them with the following documents linked in the Participants/Employers of Record section below:
It is very important that case managers, participants, employers, and employees understand their roles and responsibilities before making the decision to enroll in Participant Direction. |
Participants/Employers of Record
- Participant-Direction Employer Manual – PD08 – 4/2023 English Ι Español Ι Braille
- Designation of Employer and Acknowledgement Form – PD06 – 4/2023 English Ι Español Ι Braille
- CCW Employer Agreement Form – PD09 – 11/2021 English | Braille
- Participant Direction Employee File Checklist – PD05 – 8/2022 English Ι Español Ι Braille
- Other manuals, forms, and instructions for employers are available in the ACES$ FMS Document Center
Employees
- Employee manuals, payroll forms, and other employee documents are available in the ACES$ FMS Document Center.
Wyoming Health Provider (WHP) Portal Guidance Documents
For technical assistance contact providerportal@gannettpeaktech.com
Tips, Best Practices and FAQs – 5/2022
Manuals
- Provider Portal Application Guidance – DD – 10/2024
- Provider Portal Login Guidance – 10/2024
- Provider Portal Administration Guidance – – 12/2022
- Provider Change Guidance Manual – 11/2023
- Provider Incident Submission Guidance – 12/2022
- Provider Complaint Process – 4/2022
- Provider Corrective Action Plan (CAP) Guidance Manual – 8/2022
Videos
Electronic Medicaid Waiver System (EMWS) Guidance Documents
For technical assistance contact emws-helpdesk@wyo.gov.
- CCW EMWS File Naming Conventions -10/2022
- DD EMWS File Naming Conventions – 10/2022
Tools
- D ARPA Rate Increase Calculation Tool
- DD Relative Provider Clarification Chart – 4/2023 English Ι Español Ι Braille
- HCBS Participant-ALF Lease Addendum – 11/2023
Schedule & Log Templates
- DD Participant Specific Training – 2/2022
- Medical Assistance Record (MAR) – 2/2022
- Schedule – Habilitative Services – 1/2022
- Schedule – Non-Habilitative Services – 1/2022
- Task Analysis – 11/2022
- Transportation Mileage Log – 1/2022
Community Choices Waiver (CCW)
Please rename all files before uploading using
CCW WHP File Naming Conventions
Failure to properly name documents will result in applications being rejected.
- Required documents vary by service type; Please see Appendix A in the CCW Provider Manual – 10/2024
- CCW Case Manager Manual – 10/2024
- CW Case Manager Requirements Checklist – 10/2024
- CCW Background Screening Information
- Provider Staff File Checklist – Cert16 (omit for initial certification) – 5/2024
| CERTIFICATIONS & RENEWALS |
Comprehensive & Supports Waivers (DD Waivers)
Please rename all files before uploading using
DD WHP File Naming Conventions
Failure to properly name documents will result in applications being rejected.
Getting Started
- Initial DD Certification Required Documents – 5/2024
- DD Certification Renewal Required Documents – 5/2024
- DD Background Screening Information
Administrative Forms
- Conflict Free Case Manager Confirmation- CM29 – 9/2021
- Continuing Education Tracking Record – Cert02 9/2021
- Only required for renewal certification of case managers and providers of individual habilitation training.
- DD Provider Documentation Standards – Cert03 – 6/2024
- Declination of Medication Assistance – PV05 – 9/2022
- Employee Roster (provider generated)
- Incident Reporting Demonstration of Understanding (omit for initial certification)
- DD Providers – Cert13 – 5/2024 | DD Case Managers – Cert12 – 5/2024
- No Services Provided in a Provider Operated Setting – PV03 – 11/2022
- Provider Staff File Checklist – Cert11 – 5/2024 (omit for initial certification)
- HCBS Training Summary- JEX24 – 9/2024
- Required for each initial certification training module
- Provider Vehicle Information Form – Cert05 – 9/2022
- Statement of Confidentiality Form – Cert10 – 9/2021
Example Policies & Procedures
Example templates found here do not replace required documentation and are for illustration purposes only. If you choose to utilize the template(s), please complete all blank areas.
- General Policies and Procedures – EX17 – 3/2024
- Case Management Policies and Procedures – EX22 – 11/2022
- Code of Conduct Example – EX15 – 2/2022
- Critical Incident Reporting Policy and Procedure – EX14 – 10/2021
- Internal Incident Reporting Policy and Procedure – EX23 – 10/2022
- Medication Assistance Policy and Procedures – EX19 – 04/2020
Emergency Plans & Inspections
- Home-Based Services Example Emergency Plan – EX18 – 11/2022
- Community-Based Services Example Emergency Plan – EX16 – 11/2022
- Emergency Plan Review Form – Cert06 – 3/2024
- Provider Safety Standards (annual inspection) – 10/2024 English | Spanish
- Outside Entity Inspection Report
- A written report is required from the outside entity inspector.
- Inspection Repair Report
- Provider-created document demonstrating completion of any required repairs.
Remember to rename all files before uploading using WHP Naming Conventions for CCW or DD
Failure to properly name documents will result in applications being rejected.