1. Program Definition and Services
Case Management Services (federally monitored as Targeted Case Management - TCM) establish the mandatory administrative hub for Wyoming's Home and Community-Based Services (HCBS) waiver systems. Case managers guide participants through clinical eligibility, ensure waiver compliance, and lead person-centered care plan coordination.
- Assessment & Plan of Care Coordination: Administering functional eligibility evaluations (such as the LT104 assessment) and authoring the mandatory annual Individualized Plan of Care (IPC)
- Service Monitoring & Linkage: Facilitating independent provider selection, connecting participants with community resources, and conducting mandatory periodic health and safety check-ins
2. Regulations
The delivery of Case Management services is governed under:
- Wyoming Medicaid Rules (HCBS Provider Standards, Certification, and Sanctions)
- Wyoming Administrative Rules, Health Department (Waiver Eligibility Criteria)
- Federal HCBS Final Settings Rule
3. Licensing or Certification
An agency cannot deliver case management services without obtaining formal HCBS Waiver Case Management Agency Certification from the Wyoming Department of Health. Individual case managers must hold approved educational degrees in an eligible human services field and undergo initial state pre-screening validation.
4. Responsible State Agency
The Wyoming Department of Health (WDH), via the Division of Healthcare Financing and the Developmental Disabilities Section (DDS), acts as the primary administrative and oversight authority. System operations are handled inside the Wyoming Health Provider (WHP) portal and the Electronic Medicaid Waiver System (EMWS). Corporate entity setup is managed by the Wyoming Secretary of State.
5. Application Process
The application process is conducted through the Wyoming Secretary of State. Providers must submit a completed application along with required documentation.
6. Required Documentation
- Wyoming Secretary of State formation filings, Federal EIN letter, and active Type 2 NPI
- Official university transcripts proving a Master's degree, a Bachelor's degree + 1 year of experience, or an Associate's degree + 4 years of experience in an approved human services field
- Case Management Policy & Procedure Manual (covering crisis response, strict conflict-of-interest firewalls, mandatory case management backup systems, and participant grievance workflows)
- Signed state credentialing documents, including the Statement of Confidentiality
- Current certificates of commercial general and professional liability insurance
7. Timeline for Approval
The combined processing pipeline spanning initial educational pre-screening, background checks, WHP agency policy review, and subsequent Medicaid billing deployment typically averages 2 to 3 months.
8. Pre-Application Process
Before initiating the application, prospective providers must register their business with the Secretary of State, obtain an EIN, and secure an NPI number. Crucially, candidate transcripts must clear the state's educational pre-screening check before the system will allow an agency application to be launched.
9. Pre-Application Training
All newly onboarded case managers must complete the mandatory state training modules within one month of hire and generate signed Form EX24 summaries covering.
10. Additional Notes
- To satisfy federal and state compliance, a case management agency and its managing employees cannot own, operate, or have any financial interest in any other entity providing direct waiver services to that same participant
- Case managers must compile and submit the participant's finalized annual individualized plan of care (IPC) at least thirty calendar days before the intended plan start date
- Agencies must designate a state-certified backup case manager for each caseload.
The primary case manager must meet with their backup quarterly to review all cases and document the session directly in the participant's case notes - Working case managers must obtain and document at least eight hours of continuing education directly related to case management delivery during each year of certification
Why Choose Waiver Consulting Group?
Starting or expanding your Medicaid waiver-funded agency can feel overwhelming, but it doesn't have to be. At Waiver Consulting Group, we simplify the process by guiding you through licensing, compliance, provider enrollment, policies & procedures, and regulatory approvals
With proven expertise, a structured process, and ongoing support, we take the guesswork out of launc
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