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Wyoming Medicaid

Wyoming Medicaid is a joint federal and state government program that pays for medical care for some low-income and medically needy individuals and families.

Contact Info:

122 W 25th St., 4th Floor West
Cheyenne, WY 82001
(307) 777-7531
Fax: (307) 777-6964

School-Based Services

What is School-Based Services?

Since the 1970s, the federal government has required schools to provide all children with disabilities appropriate services under the Individuals with Disabilities Education Act (IDEA). This includes health-related services such as occupational therapy, physical therapy, speech therapy, nursing services, counseling services, and audiology services. The IDEA requires students with disabilities to receive educational and related health services that will enable them to reach their educational goals as documented in their Individualized Education Program (IEP) or Individualized Family Service Plan (IFSP).

The School-Based Services (SBS) Program allows State Medicaid Agencies to reimburse local education agencies (LEAs) for providing these health related services to Medicaid eligible students in a school-based setting. By billing Medicaid for appropriate school-based services, LEAs can draw down federal Medicaid dollars for IDEA-required services provided to Medicaid eligible students. For LEAs to receive Medicaid payments for school-based services, schools must document the service in a student’s IEP or IFSP and meet the following criteria:

  • 1. The service is authorized in Section 1905(a) of the Social Security Act, and the service is medically necessary.
    3. The state has included the service in the Medicaid State Plan, or the service is available under the federal Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefits.

Health care-related services included in the child’s IEP or IFSP are limited to: audiology services, mental health services, nursing/health services, occupational therapy services, physical therapy services, and speech-language therapy services. As of July 2022, the Centers for Medicare & Medicaid Services (CMS) has approved Wyoming’s State Plan Amendment (SPA), authorizing the SBS Program to go live. The Wyoming Department of Health, in collaboration with the Wyoming Department of Education, is working closely with pilot districts to implement the SBS Program and ensure proper support is in place as LEAs begin enrolling with Wyoming Medicaid and billing for services.

The number of Wyoming students who qualified to participate in SBS during the 2021-2022 school year

Parental Consent

In order for school districts to bill Medicaid for school-based services, schools are required to obtain written consent from parents prior to the reimbursement occurring. Parents only need to sign the parental consent form once and then it follows the student through their school years and can move with the student if they transfer school districts (within the state of Wyoming). Parental consent is voluntary, and a parent may refuse or revoke their parental consent at any time. If a parent does not give consent or revokes consent, the school district must still provide all services included in the child’s IEP or IFSP service plan at no cost to the parent.

Parental Consent Resources

National Provider Identifier

The National Provider Identifier (NPI) is a 10-digit identification number that is assigned by the Centers for Medicare and Medicaid Services (CMS) to providers who are covered by the provision of HIPAA. Health plans, clearinghouses, and covered health care providers that submit claims or other information electronically are required to apply for and use an NPI. Providers apply for a single NPI that they will keep for the rest of their careers.

  • Every Wyoming Medicaid provider that meets the definition of a healthcare provider (as defined by CMS) is required to obtain an NPI, regardless of whether they bill their claims electronically or on paper.
  • Wyoming Medicaid requires its providers to use taxonomy codes in conjunction with their NPIs when billing claims electronically or on paper.
  • The website to start the NPI process can be found here.
  • Provider NPIs can be looked up here by using the search engine.

NPI Resources

Medicaid Provider Enrollment

To participate in the Wyoming SBS Program and bill Medicaid, LEAs and individual practitioners must be enrolled as a Wyoming Medicaid provider. The WDH is contracted with HTG Technology Group (HTG) to operate the provider enrollment system.

Steps to Enroll as an SBS Program Provider:

 

  1. Navigate to https://wyoming.dyp.cloud/ to register on the Discover Your Provider (DyP) provider enrollment portal for Wyoming Medicaid, hosted by HTG Technology Group.
  1. Navigate to “Newly-Enrolled Pay-to Providers – Web registration”
  1. The secure Provider Portal is specifically for Wyoming Medicaid Providers and is tailored to secure provider transactions and needs. For more information regarding the secure Provider Portal, please click Provider Portal Quick Start Guide.
  1. After confirming registration via email, login to your provider enrollment account and follow the steps outlined in the DyP User Guide for an Individual Enrollment.
  1. Upon final submission of the provider enrollment application, a provider specialist will process your application and you will be notified via email of the final application determination.
  1. You can login into your provider portal account at any time to review your provider information and make updates. Click the Change of Circumstance (CoC) tab at the top of the screen to create a CoC request with your necessary data updates.
  1. If you have questions regarding your provider enrollment, contact the Provider Enrollment Customer Service Call Center 1-877-399-0121 or email WYEnrollmentSvcs@HHSTechGroup.com.
Billing and Documentation

The Wyoming Medicaid Fee Schedule can be found here. Viewers are able to look up codes by description, find the current reimbursement rate by code, and download the entire fee schedule. The fee schedule is updated on an as-needed basis.

Billing and Documentation Resources

Resources produced by CMS regarding documentation can be found here.

If you have questions regarding billing Wyoming Medicaid for services rendered, you can utilize the Wyoming Medicaid website located at: https://wyomingmedicaid.com/ or contact Provider Services at 1 (888) WYO-MCAD or 1-888-996-6223.

Wyoming Medicaid Children's Programs and Eligibility

Wyoming Medicaid children’s programs provide health coverage for eligible children from birth through age 18.

Programs include:

  • Child MAGI
  • Foster care children in DFS custody
  • Former Foster Youth up to the age of 26 who were in DFS custody and on a federally funded Medicaid program at the age of 18
  • Children receiving an adoption subsidy
  • Newborns born to Medicaid-eligible mothers are automatically eligible for the first year

To qualify a child must be:

  • A Wyoming resident
  • U.S. citizens or lawful permanent residents who have lived in the U.S. for at least five years
  • A child ages 0-18
  • Income eligible for Child MAGI
  • Children ages 0-5 whose family income is at or below 154% of the Federal Poverty Level (FPL)
  • Children ages 6-18 whose family income is at or below 133% of the FPL

Medicaid Eligibility Process: Medicaid Eligibility

 

You may qualify for one or more of the assistance programs available under Medicaid or Kid Care CHIP.

Apply now and we will help you find the programs for which you are eligible.
APPLY HERE

Newsletters and Trainings

SBS Newsletters

SBS Trainings

WDE MEMOs, Rules, and Links

The Wyoming School-Based Services Medicaid Program is a collaboration between the Wyoming Department of Education (WDE) and Wyoming Department of Health (WDH). You can access the WDE’s website here

WDE Rules

  • Chapter 7- Services for Children with Disabilities: WDE Chapter 7
  • Chapter 44- SpEd within the Education Resource Block Grant Model: WDE Chapter 44

WDE MEMOs

WDE Links

SPA, Admin Rules, Legislation, Reports, and CMS Guidelines

As of July 2022, the Centers for Medicare & Medicaid Services (CMS) has approved Wyoming’s State Plan Amendment (SPA), authorizing the SBS Program to go live.

Joint WDH and WDE Legislative Reports

General SBS Reports

Guidelines and Bulletins Published by CMS

Provider Cheat Sheets

SBS stakeholders are encouraged to always refer to the School-Based Services Program Manual when needing guidance. However, the following cheat sheets have been created to be used as quick reference guides.

Provider References

Quick Links

Contact Us

For more information about School-Based Services:
Program Manager: Justin Browning
Phone: 307-777-7491
Email: wdh-schoolbasedservices@wyo.gov or justin.browning1@wyo.gov

Address:
122 W 25th St., 4th Floor West
Cheyenne, WY 82001

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SBS Help Desk

 

Page last updated 06/16/2023