Prospective Provider Information
This information s designed to assist prospective provide…rs in becoming certified to provide services as a Medicaid waiver provider.
- Prospective Provider Frequently Asked Questions – FAQ’s Coming Soon
- General Provider Application
- Please contact Mark Sparks, Provider Support Specialist as (307)777-3322 or (800) 510-0280 FOR QUESTIONS OR ADDITIONAL INFORMATION
- Contact the Provider Support Unit
- Towns & Services Selection Form – PDF Revised 7/2017
- Towns & Services Selection Form – Word Doc Revised 7/2017
Provider Application Information
NEW General Provider Application – Posted 8/22/2017 (Word)
NEW General Provider Application– Posted 8/22/2017 (PDF)
NEW General Provider Application Instruction Guide (PDF)- Posted 8/22/2017
- Conflict Free Case Management Organization Application (Word Template)
- Towns & Services Selection Form – PDF Revised 7/2017
Changes to Provider Certification
Providers can make changes to their current certification at any time by submitting their request in writing to their Provider Support Specialist. An e-mail is acceptable. They do not need to wait until their recertification date.
Changing (Moving) or Adding a Service Location Site
Examples of adding or changing service location sites include: adding new group homes, opening a second day habilitation site, or moving to a new home where a provider is going to provide waiver services.
Providers shall notify the Division of the new location at least 30 calendar days prior to the location being used for any waiver services.
- Providers are required to obtain an inspection completed by an outside entity of the new location.
- Address the recommendations identified in the inspection by writing a statement identifying what was done to correct the recommendation and the date that it was completed. The Division shall review the inspection report and verify that all recommendations have been addressed.
- This must be completed before services can be provided at that location.
- The Division will complete a walk-through of the new location within a six-month period after a provider adds the location.
- Providers who are changing their mailing address must contact the Division at least 30 days prior to the change, so that the Division can assure the provider has filled out the appropriate paperwork.
- Providers may complete any address changes directly through the ACS website, but also need to contact the Provider Support Specialist for their area. Please note that ACS will suspend all payments to a provider if they do not have an accurate mailing address.
In order to complete the change of address, providers must submit to their local Provider Support Specialist the WOLFS-109b form with the updated information.
Adding a Service
Providers can add a service to their certification at any time during their certification. However, before providers can begin to provide the service, the Division must verify that they meet the requirements of the service. Depending on the type of service being added, verification may include submitting verification of education, policies and procedures, background checks, completion of any open health and safety Quality Improvement Plans (QIPs), and/or the results of an inspection completed by an outside entity.
The Division reviews the information and notifies providers in writing when they are approved to begin providing the new service. However, providers must not begin to provide the service until they have been chosen by a participant, and received a copy of the pre-approval form and the individual plan of care signed by the Division, received participant specific training on the individual they are providing waiver services to, and have received a PA# from ACS.
Deleting a Service
Providers can delete a service from their certification at any time during the year. However, before deleting a service, providers are required to give at least 30 days notice to participants they are currently serving. Providers shall follow the Division’s transition process, when required.
In order to delete a service, providers must:
- Contact their local Provider Support Specialist and submit the name of the service to be deleted from their certification with the effective date in writing or via e-mail.
- The provider will receive a revised certificate and their name will be removed from the list of available providers for that service.
Voluntary Decertification as a Provider
Providers can voluntarily decertify as a provider at any time during the year. However, providers are required to give at least 30 days notice to participants they are currently serving. Providers shall follow the Division’s transition process, when required.
In order to voluntarily decertify from services, providers must contact their local Provider Support Specialist person and submit in writing or via e-mail when services will no longer be provided.
Q: What is a test incident? Do I need to file the test incident report as if it were real?
A: A test incident allows providers to become familiar with the incident reporting process beyond formal training. Yes, just make sure that you place Suzy Test as the name of the participant that you are filing the report on. Also, do not contact the other agencies at the bottom of the report, just type it in as if you had.
Q: If I have completed the CPR/1st Aid class but I don’t have my card yet, what should I do?
A: Obtain a copy of the roster from the instructor indicating the date that you took the class and whether you passed or not.
Q: If I have employees do I need to send all the information on my employees to the Provider Support Specialist?
A: Yes, you need to include this information if you don’t provide services in facility (including your home) you own or lease. If you require a visit from your Provider Support Specialist to complete your recertification, then you do not need to include your employee’s information as it will be checked during the visit.
Q: Do I have to have a visit from a Provider Support Specialist even if I don’t do services in my home?
A: Support Brokers and Case Managers are still required to have a visit with their Provider Support Specialist. This face-to-face consultative visit is so that communication is easier and questions and/or concerns can be discussed more freely. A home visit is not required; the visit can be done anywhere as long as it provides for privacy and compliance with HIPAA.
Q: If I am a therapist or a nurse, do I need an on-site visit from the Provider Support Specialist?
A: No, you do not need an on-site visit although one can be done if you would like one. If you have employees and do not wish to have an on-site completed, then you will need to send copies of current licensure, current CPR/1st Aid, and the successful background check of any employee that is providing services to a waiver participant. All employees that work with waiver participants are also required to complete and document the Division required trainings which are available on DVD. A copy of this documentation is required as well.
Q: Who do I send my completed recertification packet to when I have completed it?
A: You will send your completed packet to the Provider Support Specialist in your area which is identified on the first page of your recertification packet. Contact information is also on the Division’s web site.
Q: Do I need to revise my current policies and procedures and emergency plans or can I use the standardized forms in the recertification packet?
A: You can do it either way as long as all of the requirements are being addressed. For the standardized policies, procedures, and emergency plans there are some areas which you will need to write in specifics to you. Always make a copy of what you are using for your records as these are what you will be held responsible for when completing the testing of emergency plans.
Q: Do I need to watch the Division required DVD trainings before each recertification?
A: No, they are only required to be completed once. You could be asked to re-watch a specific part of one of the DVD’s if your Provider Support Specialist finds that you need retraining.
Q: How do I get a two year certification?
A: A two year certification can be given if, during your recertification, no Health and Safety or Rights recommendations are found.
Q: If the Provider Support Specialist already has a copy of my current driver’s license and CPR/1st Aid cards, do I still need to send in another copy with my recertification paperwork?
A: Yes, it is required for copies to be submitted with your recertification paperwork each time.
Q: What do I do if I haven’t received a recertification packet and it is the month of my recertification?
A: If you do not receive a recertification packet from your Provider Support Specialist within 90 days of your certification expiring, it is your responsibility to contact them or another Division staff to have one sent to you.
Steps to Re-Certification
Whether you are CARF or Non-CARF Accredited, this page will help you understand the steps required to complete your recertification as a Waiver Provider. Please review the steps and if you have any questions, please contact your local Provider Support Specialist.
|Steps for CARF Providers||Steps for Non-Carf Providers|
|1. The Division notifies all CARF providers of the scheduling for the on-site survey for the next year after the schedule has been set by the Provider Support Program team.||1. The Division notifies providers in writing that their certification is expiring at least 90 calendar days prior to the certification expiration date. The provider should review this letter because it summarizes the requirements that must be met to be recertified. With the written notification there is also a recertification packet with instructions on what is needed to complete the recertification as well as the required forms. The time frames must be adhered to that are listed in the letter so there are no interruptions in certification.
All recertification forms included in the recertification packet that are submitted must be the original signed forms.If you do not receive a recertification packet at least 90 days before your certification expiration date, contact your Provider Support Specialist. It is your responsibility to follow up with the Provider Support Specialist to obtain a recertification packet if you did not receive one by the time frame stated above.
|2. Approximately 90 days prior to the on-site survey, providers receive a letter from the lead surveyor reminding them of the survey dates and requesting specific information. Organizations should make sure that this letter is reviewed carefully and that the information requested is submitted by the date requested.||2. If an on-site visit is required (Day Habilitation, Residential Habilitation, Residential Habilitation Training, Child Habilitation, Companion Services, Supported Living, Community Integrated Employment, Personal Care, Respite Care, Special Family Habilitation Home, Case Management*, and Independent Support Broker*) the letter will include which Provider Support Specialist to contact to schedule the visit. The visit must be scheduled far enough in advance that the Provider Support Specialist can make arrangements for travel and lodging if needed.|
|3. During the on-site survey for the recertification the Provider Support Specialist or team will:
|3. During the on-site visit, the Provider Support Specialist will review:
The Provider Support Specialist will also conduct a walk through of the home and a vehicle inspection in order to complete a health and safety inspection.
|4. During the exit meeting the Provider Support team will review the results of the survey, including areas of exemplary practice, commendable practices, suggestions and areas of non-compliance with recommendations that the organization is going to need to address. Provider Support Specialists are also expected to be a resource to organizations as they address any concerns.||4. If an on-site visit is not required (Homemaking only, Specialized Equipment, Home Modifications, Physical Therapy, Occupational Therapy, Speech Therapy, Skilled Nursing, Dietician, Cognitive Retraining), there is a form in the recertification packet that will give instructions for specific information and documents that are to be sent to the Provider Support Specialist to be reviewed.
Do not send the original documentation for a participant, participant specific training, Division required trainings, CPR/1st Aid cards, or logs for the testing of emergency plans.
|5. Upon completion of the survey a certificate is issued within 30 days and includes all current services the organization is certified in.||5. During the recertification, Provider Support staff will also review any updates to the waivers and do retraining if needed. This is a great time to ask questions, voice problems, concerns, or opinions, and obtain information that will make you more successful as a provider.
After a Provider Support Specialist has completed a provider’s recertification, either on-site or through the paper review, they will review the results of the recertification, including areas in compliance, suggestions, and areas of non-compliance with recommendations that will need to be addressed. It is important that a provider understands the findings of the recertification and, when applicable, the areas which need improvement. Provider Support Specialists are also expected to be a resource to providers as they address any concerns.
Provider Manual 2012
7-1-2017 Dependents of Active Military Members Bulletin – 7.1.2017
6-1-2017 ECC/CRT Merge
11-3-2016 Change to Subsequent Assessments and Goods and Services – posted 11/8/2016
4-19-2011 – Medication Assistance Standards Revisions – PDF
To view the current Medicaid Rules, please visit the Secretary of State’s website at
To navigate to the DDD Medicaid Rules on the Secretary of State’s website:
- Select “Health, Department of” in the Agency Drop-down Menu
- Select “Medicaid” in the Program Window
- Select “Current Rules and Regulations” in the Rule Type Window
- Click “Search”
The DDD Rules within Wyoming Medicaid Rules are covered in:
- Chapter 43 – Acquired Brain Injury Home and Community Based Waiver
- Chapter 44 – Environmental Modifications, Specialized Equipment, and Self-Directed Goods and Services for Medicaid Home & Community Based Waiver Services
- Chapter 45 – DD Waiver Provider Standards, Certification and Sanctions
- Chapter 46 – Medicaid Supports and Comprehensive Waivers
Chapter 1 of DDD rules for Case Management Services can be found by selecting “Health, Dept of”, then “Developmental Disabilities Division”, then “Current Rules and Regulations.”
Home Based Worker
Q: What are the criteria to be certified to contract with the state and not be classified as a Home-based Worker?
1. Hire at least one employee.
2. Certified to provide services in a home or facility you own or lease (your name must appear on the lease or mortgage).
3. Provide case management, support brokerage, skilled nursing, occupational therapy, speech therapy, and/or physical therapy.
4. You are only certified to provide homemaking services
5. If you are only providing specialized equipment and/or environmental modifications
Q: Can I be both a Home-based Worker and contract with the state?
Q: How can we keep our home-based worker?
A: You can keep your home-based worker if you choose an Agency of Choice Financial Management Service or the Fiscal/Employer Agent Financial Management Service, which is Public Partnerships, LLC. You can also choose to be the employer of record through self-direction and hire the home based worker as your employee.
Q: If we are not considered a home-based worker because our home is ok to do services in, can I ever provide the same service, Respite, in the participant’s home?
A: Yes, you can still provide services in the participant’s home.
Q: Will it affect services during transition if the provider is home-based so services aren’t interrupted?
A: The Division is allowing providers who are considered home-based workers to continue their certification through September 30, 2010 to allow for a transition. There should be no interruption in services during this transition.