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    v1.0.28
    OpenPayerPolicy UpdatesAdministrative/Operational PolicyWyoming HCBS Virtual Support Policy Update | OpenP…
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    CurrentWyoming Department of HealthPolicy TOOL56

    HCBS Virtual Support Requirements

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    Governs the use of telephonic or video conferencing technology to deliver face-to-face HCBS services under the Comprehensive and Supports Waiver, including Community Living Services and Adult Day Services Basic Level tiers.

    Policy Summary
    PayerWyoming Department of Health
    PolicyHCBS Virtual Support Requirements
    Policy CodePolicy TOOL56
    Change TypeNo material change
    Effective DateN/A
    Next Review DateN/A
    Key ActionDocument the participant's informed choice between in-person and virtual support in the individualized plan of care, obtain signed informed consent, and retain it in EMWS and the participant's individual file.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    18+Participant age threshold
    30 daysTransition period
    6 yearsInformation retention
    12 monthsEmergency drill interval
    Annual

    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.

    Informed consent renewal
    Semi-annualAppropriateness assessment

    Virtual Support Eligibility and Limitations

    Eligibility and participant planning

    Virtual support may be used when the participant is eligible for the applicable waiver service and the required participant choice, consent, education, and individualized plan of care elements are completed.

    ALL of the following

    • Participant is served under the Comprehensive or Supports Waiver.
    • Participant is age 18 or older or the request is made by the participant's legally authorized representative.
    • Virtual support is used as a component of Community Living Services or Adult Day Services Basic Level tiers.
    • Participant has an informed choice between in-person and virtual support documented in the individualized plan of care (IPC).
    • Risks, health and safety concerns, benefits, operating parameters, and service limitations are discussed with the full plan of care team, and the participant and legally authorized representative, when applicable, are educated about virtual support.
    • Required informed consent is signed, retained in the Electronic Medicaid Waiver System (EMWS) and the participant's individual file, and updated annually.Annually
    • The IPC documents how virtual support will be implemented, including the participant's choice of where and how services are received, community integration, employment and social supports, technology, training, supervision needs, and ongoing appropriateness assessment.Semi-annually

    Safety and service delivery limitations

    Virtual support may not replace necessary in-person assistance or be used in a manner that compromises participant safety, choice, community access, or identified outcomes.

    ALL of the following

    • Participant has full control of the virtual support equipment, including a visual indicator that the system is operating and a mechanism to disengage the system if the participant chooses.
    • Appropriate onsite staff or other support is available if the participant disengages the system, and an established process is in place for onsite support during system failure, including power or internet outages.
    • Staffing is adequate to respond to emergencies as identified in the participant's IPC, including the required response methods and onsite support when applicable.
    • Participant does not require in-person assistance during the service; if in-person assistance is required, the participant must receive services in person and virtual support may not be provided.

    Provider standards

    Providers must be authorized by the Division and satisfy specified technology, privacy, training, emergency, documentation, and contingency standards.

    ALL of the following

    • Provider meets applicable federal and state regulations and has written authorization from the Division to provide virtual support.
    • Provider develops and complies with Division-approved written policies and procedures, reviews them annually, and updates them as needed.
    • Provider uses a Division-approved HIPAA-compliant telehealth service delivery platform and attests during certification renewal that the platform is HIPAA-compliant and that required HIPAA Privacy and Security policies and procedures have been adopted and enforced.
    • Provider maintains written policies addressing participant privacy; participant and staff training; emergency drills; equipment and system disengagement; system failure; participant and organizational costs; immediate health or safety transition; emergency notifications; and weather-related and medical emergencies.

    Reimbursement and equipment

    Virtual support is reimbursed as part of the applicable waiver service, while provider business expenses and participant-specific equipment are subject to separate limitations.

    ALL of the following

    • Virtual support is covered through the service rate identified in the current Supports and Comprehensive Waiver Fee Schedule.
    • Provider does not receive reimbursement for internet, communications, monthly subscriptions, or other expenses considered a cost of doing business, and does not pass those expenses on to the participant.
    • Participant-specific equipment may be purchased through specialized equipment when it is within the scope and limitations of the service and current funding guidelines in the Comprehensive and Supports Waiver Service Index.
    • Equipment purchased under specialized equipment is owned by the participant.

    Operational Timeframes and Retention

    Informed consent renewal
    Renewal intervalAnnually
    Consent requirementAn informed consent statement must be signed by the participant and legally authorized representative, when applicable.
    Record locationsThe consent form must be maintained in the Electronic Medicaid Waiver System and the participant’s individual file.
    Continued appropriateness assessment
    Assessment intervalSemi-annually
    Assessment purposeAssess whether virtual support continues to be an appropriate option for the participant.
    Documentation location

    Implementation and Compliance Responsibilities

    Documentation Required

    Assessment, Informed Choice, and Consent

    Before virtual support begins, document the participant’s informed choice between in-person and virtual services, discuss the model’s benefits, risks, operating parameters, limitations, and health and safety concerns with the participant, legally authorized representative (if applicable), and full plan of care team. Obtain required signed consent and retain it in EMWS and the participant’s individual file.

    • Obtain and annually update an informed consent statement signed by the participant and legally authorized representative, if applicable. The statement must confirm the participant had a choice between in-person and virtual support, acknowledge inherent risks, and confirm adequate education about operating parameters and limitations.
    • Identify other participants in the setting who may be affected by virtual support and obtain their informed consent. Document that consent and any resulting rights restrictions in each affected participant’s IPC.
    Documentation Required

    Individualized Plan of Care Requirements

    Develop an individualized plan of care (IPC) that explains how virtual support will be delivered and confirms that the service remains appropriate for the participant. Document the participant’s choice of service location and modality while preserving community integration, employment support, and social interaction opportunities.

    Virtual Support Terminology

    Virtual support
    TechnologyTelephonic or video conferencing technology
    Service modelUsed to deliver face-to-face services to participants on the Comprehensive and Supports Waiver.
    PurposeProvides necessary participant monitoring, engagement, and socialization when a participant chooses or is unable to receive services outside the home.
    Applicable service components
    Community Living ServicesEligible service component for virtual support
    Adult Day Services Basic LevelEligible service component for virtual support
    Request eligibility
    Policy Summary
    PayerWyoming Department of Health
    PolicyHCBS Virtual Support Requirements
    Policy CodePolicy TOOL56
    Change TypeNo material change
    Effective DateN/A
    Next Review DateN/A
    Key ActionDocument the participant's informed choice between in-person and virtual support in the individualized plan of care, obtain signed informed consent, and retain it in EMWS and the participant's individual file.
    SourceLink
    On This Page
    Virtual Support Eligibility and LimitationsOperational Timeframes and RetentionImplementation and Compliance ResponsibilitiesVirtual Support Terminology
    Use does not block, prohibit, or discourage in-person services or access to the community, and the participant continues to be encouraged to participate in services and engage with the community and friends.
  1. Use supports outcomes identified in the participant's IPC and is not for provider convenience.
  2. If the participant or legally authorized representative chooses to discontinue virtual support, the provider and plan of care team transition the participant to traditional services within 30 calendar days, unless an immediate health or safety transition is required.Within 30 calendar days after the discontinuation choice
    3. Provider trains staff on participant-specific needs, virtual support technology, equipment, emergency drills, disengagement, system failure, HIPAA compliance, and other required topics.
  3. Provider maintains system backup procedures, documentation of HIPAA privacy and security compliance, and an updated contingency plan that includes virtual support services.
  4. Provider conducts emergency response drills, including an onsite response drill at least once every 12 months.At least once every 12 months
  5. Provider complies with changed standards within 30 calendar days after receiving notification from the Division.Within 30 calendar days of notification
    6. The assessment must be included in the participant’s individualized plan of care.
    Transition to traditional services
    Transition deadlineWithin 30 calendar days after the participant or legally authorized representative chooses to discontinue virtual support services.
    Transition destinationTraditional services
    Immediate transitionAn immediate transition is required when a health or safety need overrides the 30-calendar-day transition timeline.
    Provider compliance with changed standards
    Compliance deadlineWithin 30 calendar days of notification
    Applicable changesProviders must adhere to changes to the Division’s virtual support standards.
    Notification sourceProviders shall receive notification of changes to standards.
    Onsite emergency response drill
    Drill intervalAt least once every 12 months
    Drill typeOnsite emergency response drill
    Provider requirementProviders must conduct emergency response drills.
    Information retention
    Retention periodAt least 6 years after the end of the applicable fiscal year
    Information coveredVirtual support information
    Related documentationStaff interventions during the virtual support period must be documented as internal incidents and reviewed as part of the ongoing plan of care team assessment.
    • Identify the specific technologies to be used, how they will be used, and the participant’s initial and ongoing training needs.
    • Document supervision needs and how technology will address them.
    • Complete a semi-annual assessment of whether virtual support remains appropriate.
    • When applicable, document virtual-support-specific de-escalation techniques and potential elopement locations.
    Note

    Operating and Safety Requirements

    Identify each technology used and its operation, and ensure the participant has full control of the virtual support equipment. Equipment must show when the system is operating and provide a mechanism for participant disengagement; providers must maintain onsite and emergency safeguards when the system is disengaged or fails.

    • Treat disengagement without consultation or prior agreement during service as an internal incident, and maintain a written response process. If the participant chooses to disengage, ensure appropriate onsite staff or other support is available.
    • Maintain an established onsite-support process for power, internet, or other system failures.
    • Provide staffing adequate for IPC-identified emergencies and Chapter 45, Section 6 requirements; the IPC must specify responses such as calls, text messages, webcam applications, or onsite visits.
    • If an outside technology entity interacts with the participant—in person, by phone, Skype, FaceTime, or another method—that entity is providing the waiver service and must meet Chapter 45 requirements as a Wyoming provider, employee, or subcontractor. A technology-only entity without participant interaction is not required to be a Wyoming provider or to follow Chapter 45.
    Note

    Participant-Centered Use and Transition

    Use virtual support only to help the participant achieve identified outcomes in the IPC—not for provider convenience—and never to block, prohibit, or discourage in-person services or community access. If the participant requires in-person assistance, provide the service in person rather than through virtual support.

    • Encourage participation in in-person services, community activities, and relationships with friends when the participant chooses or when illness, transportation problems, a pandemic, or another personal reason would otherwise prevent participation.
    • If the participant or legally authorized representative chooses to discontinue virtual support, transition the participant to traditional services within 30 calendar days.
    • Complete the plan of care team’s assessment of virtual support appropriateness when in-person assistance may be required. An immediate transition overrides the 30-day timeline when a health or safety need is identified.
    Prior Authorization

    Provider Certification and Compliance

    Meet all federal and state requirements, obtain written Division authorization before providing virtual support, and implement changes to applicable standards within 30 calendar days of notification. Use a Division-approved, HIPAA-compliant telehealth platform and attest to platform compliance and adoption and enforcement of required HIPAA Privacy and Security policies during certification renewal.

    • Ensure staff receive training on participant-specific needs and the support required for participants to learn and use virtual support technology.
    • Maintain system backup procedures, conduct emergency response drills including an onsite drill at least every 12 months, document HIPAA privacy and security compliance, and keep an updated contingency plan covering virtual support.
    • Understand that the Division may review compliance at any time and may prohibit or restrict virtual support when the platform or required policies and procedures are not used, adopted, or enforced.
    Documentation Required

    Required Provider Policies and Procedures

    Develop, obtain Division approval for, and comply with written policies and procedures before certification; review every policy annually and update it as needed. Policies must protect participant rights, support safe operation, and address privacy, training, costs, emergency response, disengagement, and transition safeguards.

    • Maintain a participant privacy policy.
    • Maintain participant training procedures covering initial and ongoing training, emergency drills, equipment use, disengagement, and system failure; maintain staff training procedures covering participant-specific needs, emergency drills, equipment, HIPAA compliance, Chapter 45 training, and virtual-support procedures.
    • Maintain a cost disclosure policy identifying participant and organizational costs for equipment and services, including internet and phone lines.
    • Maintain a policy for immediate transition from virtual support when a health or safety need overrides the 30-calendar-day transition timeline.
    • Maintain written procedures for participant disengagement, notification of emergency response personnel such as law enforcement, fire, and paramedics, and weather-related and medical emergencies.
    • Adopt and enforce all necessary HIPAA Privacy and Security policies, and retain documentation that demonstrates compliance.
    Documentation Required

    Incident Reporting and Records Retention

    Submit critical incident reports through the Division’s incident reporting system as required by Chapter 45, Section 20, and document staff interventions occurring during virtual support as internal incidents. Retain virtual support information for at least six years after the end of the fiscal year in which services were provided.

    • Review staff interventions through ongoing plan of care team assessment; reconvene the team when interventions become excessive. If virtual support remains appropriate, the team may create a tracking system for specific staff interventions instead of completing an incident report.
    • Maintain required virtual support records for the full retention period.
    Participants who are 18 years or older, or the participant’s legally authorized representative, may request virtual support as a component of these services.