Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.28
    OpenPayerPolicy UpdatesAdministrative/Operational PolicyWyoming Medicaid HCBS Pilot Policy Update | OpenPa…
    Ask Trek AI about this page
    CurrentWyoming Department of HealthPolicy 048.0037.53.12032025

    Home and Community-Based Services Pilot Program

    Customize your policy alerts

    Sign up for Wyoming Department of Health Policy 048.0037.53.12032025 alerts

    Get alerted when Policy 048.0037.53.12032025 changes without checking for updates manually.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    Establishes Wyoming's pilot program for incentivized specialized transitional Home and Community-Based Services for clients moving from the Wyoming State Hospital or another state health institution to home or community living, including participation, qualifications, claims, milestone documentation, payments, appeals, and removal.

    Policy Summary
    PayerWyoming Department of Health
    PolicyHome and Community-Based Services Pilot Program
    Policy CodePolicy 048.0037.53.12032025
    Change TypeNo material change
    Effective DateDec 3, 2025
    Next Review DateN/A
    Key ActionProviders and case managers must complete and document transition-period milestones each month to receive incentive payments.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    120 daysMaximum emergency rule duration
    MonthlyMilestone documentation frequency
    10 daysPayment denial appeal deadline
    30 daysRemoval notice period

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    Funding-dependentPayment availability

    Pilot Participation and Payment Eligibility

    Transitional Services Pilot Participation and Payment Criteria

    Participation in the Transitional Services pilot and eligibility for incentive payments require satisfaction of all applicable conditions below. The Program tests incentivized delivery of specialized Home and Community-Based Services to a specific high-risk population transitioning to home or community-based living.

    ALL participation and payment conditions

    • Eligible service and program scope

      • The service must be specialized Home and Community-Based Services provided to a client transitioning from the Wyoming State Hospital to home or community-based living.
      • The Director may expand Transitional Services to specialized Home and Community-Based Services for clients transitioning from another state health institution; clients in that population are included only if the Director authorizes the expansion.
      • Transitional Services are provided under a pilot program designed to test an incentivized delivery model for a specific high-risk population.

    • Authorized participant requirements

      • The provider or case manager must be authorized to participate within the number of providers and case managers established by the Department and published in a Department bulletin and on its website.
      • The provider or case manager must meet and maintain all applicable qualifications stated in Chapter 45 of the Wyoming Department of Health Medicaid Rules.
      • The provider or case manager must comply with all applicable standards and requirements stated in Chapter 45 of the Rules.

    • Operational and claims requirements

      • Claims must be submitted in accordance with Chapter 3 of the Rules and applicable Program manuals and bulletins.

        If a Chapter 3 requirement conflicts with a manual or bulletin requirement, the manual or bulletin governs.

      • The Department may issue manuals and bulletins interpreting this Chapter; manuals and bulletins remain subordinate to the provisions of this Chapter.
      • Chapter 4 of the Rules does not apply to the Program.
      • The Department will issue a fee schedule for Transitional Services.

    • Incentive payment eligibility

      • Incentive payments are available only subject to the availability of funds and may be adjusted or discontinued by the Department at any time.
      • During each month of the transition period, the provider or case manager must complete and document the milestones achieved in accordance with applicable Program manuals and bulletins.
      • Incentive payments cease upon completion of the transition period.

    • Program limitations and post-denial rights

      • Participation in the Program does not create an entitlement to Transitional Services for any period before or after the expiration of Program funding.
      • A provider, case manager, or client may appeal a denied payment to the Director by submitting a written appeal within 10 days after the denial.
      • The Department may remove any participant, provider, or case manager without cause upon 30 days' prior written notice.
      • The Department may immediately remove any participant, provider, or case manager for cause by providing written notice and a statement of cause.

    Operational Timeframes and Payment Rules

    Emergency Rule Duration
    Maximum durationEmergency rules remain in effect no longer than 120 days after filing with the Registrar of Rules.
    Milestone Documentation Frequency
    Required frequencyTransition-period milestones must be completed and documented each month to receive Program incentive payments.
    Payment Denial Appeal
    Appeal deadlineA payment-denial appeal must be submitted in writing within ten days of the denial.
    Removal Without Cause

    Provider, Case Manager, and Participant Responsibilities

    Prior Authorization

    Maintain Chapter 45 qualifications

    To provide Transitional Services, providers and case managers must meet and maintain the applicable qualifications stated in Chapter 45 of the Wyoming Department of Health Medicaid Rules.

    Documentation Required

    Comply with service standards

    When providing Transitional Services, providers and case managers must comply with all applicable standards and requirements stated in Chapter 45 of the Wyoming Department of Health Medicaid Rules.

    Program Terms

    Definitions
    ProgramThe pilot program described above.
    Definitions
    RulesThe Wyoming Department of Health, Medicaid Rules.
    Definitions
    Transitional ServicesSpecialized Home and Community-Based Services provided to a client who is transitioning from the Wyoming State Hospital to home or community-based living.
    Definitions
    Expanded Transitional Services
    Policy Summary
    PayerWyoming Department of Health
    PolicyHome and Community-Based Services Pilot Program
    Policy CodePolicy 048.0037.53.12032025
    Change TypeNo material change
    Effective DateDec 3, 2025
    Next Review DateN/A
    Key ActionProviders and case managers must complete and document transition-period milestones each month to receive incentive payments.
    SourceLink
    On This Page
    Pilot Participation and Payment EligibilityOperational Timeframes and Payment RulesProvider, Case Manager, and Participant ResponsibilitiesProgram Terms
    Notice periodThe Department may remove a participant, provider, or case manager without cause by providing 30 days prior written notice.
    Billing Rule

    Submit claims under governing billing instructions

    Submit claims in accordance with Chapter 3 of the Wyoming Department of Health Medicaid Rules and applicable program manuals and bulletins. If Chapter 3 conflicts with a manual or bulletin requirement, the manual or bulletin governs.

    Documentation Required

    Document monthly transition milestones

    To receive Program incentive payments, providers and case managers must complete and document milestones achieved during the transition period each month in accordance with the Program manuals and bulletins.

    Denial Risk

    Payment eligibility may end or be reduced

    Incentive payments are subject to the availability of funds and may be adjusted or discontinued by the Department at any time. Payments cease upon completion of the transition period.

    Denial Risk

    Program removal authority

    The Department may remove any participant, provider, or case manager from the Program without cause with 30 days’ prior written notice. It may remove them immediately for cause with written notice and a statement of cause.

    The Director may authorize specialized Home and Community-Based Services for clients transitioning from another state health institution to home or community-based living; those clients are then included in the meaning of Transitional Services.