Companion Services is a core, ongoing service at Essential Living Support, LLC. It pairs a Wyoming DD Waiver participant with a consistent companion in a home and community based setting, with the goal of supporting daily routines, reducing isolation, and maintaining independence over time.
Companion Services at Essential Living Support provide non-medical companionship and supervision for adults age 18 and up under the Wyoming DD Waiver. The service supports emotional well-being, reduces isolation, and maintains daily routines through conversation, supervised community access, and accompaniment to appointments. Eligibility follows the participant’s Individualized Plan of Care.
Companion Services include supervision, socialization, and assistance for a participant to maintain safety in the home and community, and to enhance independence. Companions may assist or supervise the participant with tasks such as meal preparation, laundry, and shopping, but do not perform these activities as discrete services. Companions may also perform light housekeeping tasks that are incidental to the care and supervision of the participant. The provision of Companion Services does not entail hands on nursing care, but does include personal care, such as medication assistance, and assistance with activities of daily living, as needed, during the provision of services. Routine transportation is included in the reimbursement rate.
As authorized in 42 U.S.C 1396a(h), Companion Services may be provided in an acute care hospital if the services are:
A. Identified in the participant’s IPC;
B. Provided to meet needs of the participant that are not met through the provision of acute care hospital services;
C. Not a substitute for services that the acute care hospital is obligated to provide through its conditions of participation or under Federal or State law, or under another applicable requirement; and
D. Designed to ensure smooth transitions between the acute care setting and the home and community based settings, and to preserve the individual’s functional abilities.
Case managers and providers must coordinate with hospital staff and plan of care team members in order to ensure that the participant’s transition from a temporary hospital stay to their home is seamless.
This service is available to participants ages 18 and up. It is reimbursed at a 15 minute unit and is available as a 1:1 service or as a group service for 2 or 3 people. Service can be provided for no more than nine (9) hours a day except for special events or out of town trips. This service cannot be used to provide monitoring while a participant sleeps.
Companion Services provided to participants ages 18 through 21 must not duplicate or replace services that are covered under IDEA. Providers cannot serve children and adults at the same time unless authorized in advance by DHCF. Services cannot be provided during the same time period as other waiver services, which is subject to audit by the Program Integrity Unit.
A participant’s IPC may include two or more types of non-residential services as long as service times do not overlap. Non-residential services must not exceed an average weekly amount of 35 hours (7,280 units) if the participant receives Community Living Services levels 3-6.
Relative providers (defined as biological, adoptive, or step parents) cannot provide this service. This service is subject to electronic visit verification.
Refer a participant for Companion Services: call (307) 369-1030 or use the referral form at the end of this page.
Adult Day Services (ADS) is a core, ongoing service at Essential Living Support, LLC. It provides structured daytime support for Wyoming DD Waiver participants in a community connected setting, with the goal of building skills, sustaining engagement, and creating consistent daily routines.
Adult Day Services at Essential Living Support provide structured daytime support for adults age 18 and up with intellectual and developmental disabilities under the Wyoming DD Waiver. Programming covers skill-building, social engagement, community participation, and supervised activities, delivered through Basic, Intermediate, or High tiers based on the participant’s Level of Service score.
Adult Day Services (ADS) consist of meaningful daytime activities that maximize or maintain a participant’s skills and abilities; keep participants engaged in their environment and community through optimal care and support; actively stimulate, encourage, develop, and maintain personal skills; introduce new leisure pursuits; establish new relationships; improve or maintain flexibility, mobility, and strength; or build on previously learned skills. ADS provides active, person centered supports that foster independence as identified in the participant’s IPC.
ADS includes personal care, protective oversight, and health maintenance activities such as medication assistance and routine activities that may be provided by unlicensed, DHCF certified direct support professionals. Personal care must not exceed 20% of the provided service.
ADS may be provided in the participant’s home if the participant or legally authorized representative and the plan of care team decides the home is a more appropriate place to receive the service and the IPC supports the medical, behavioral, or other reason for the service to be provided in the participant’s home. The participant and legally authorized representative must have a choice in where and how the service will be received, and this choice must be documented in the participant’s IPC. Documentation must demonstrate that opportunities for community integration, support for employment, and social interactions are still incorporated in the participant’s life. Transportation is a component of adult day services and is included in the rate to providers.
As authorized in 42 U.S.C 1396a(h), this service may be provided in an acute care hospital if the services are:
Case managers and providers must coordinate with hospital staff and plan of care team members in order to ensure that the participant’s transition from a temporary hospital stay to their home is seamless.
A participant receives a tiered service approved in the IPC based upon need.
A participant with a Level 1 or 2 Level of Service (LOS) score will generally be in this tier. This service tier requires limited staff supports for, and personal attention to, a participant due to a moderately high level of independence and functioning. Behavioral needs, if any, can be met with medication or informal direction by staff. The participant may have periods of time with indirect staff supervision where staff are onsite and available within hearing distance. This service may be provided through virtual supports.
A participant with a Level 3 or 4 LOS will generally be in this tier. Service tier requires full time heightened supervision with staff available as indicated in the IPC due to significant functional limitations, medical or behavioral needs. Behavioral and medical supports are not generally intense and can be provided in a shared staffing environment. Regular personal attention is given throughout the day for personal care, reinforcement, community, or social activities. This service may be provided through virtual supports.
A participant with a Level 5 or 6 LOS will generally be in this tier. Service tier requires full time supervision with staff available within close proximity and as indicated in the IPC. Frequent staff interaction and personal attention for significant functional limitations and medical or behavioral needs is provided. Support and supervision needs are moderately intense, but can still generally be provided in a shared staffing environment unless otherwise specified in the IPC. Frequent personal attention is given throughout the day for reinforcement, positive behavior support, personal care, community, or social activities.
ADS is available to individuals who are 18 years of age or older. ADS must not duplicate or replace services covered under IDEA. Evidence demonstrating that school district services have been exhausted must be submitted for participants under the age of 21. ADS is not a habilitation service.
Approved units will be based on the participant’s needed level of support and must fit within the assigned budget. ADS is billed as a 15 minute unit.
A relative provider (defined as a biological, adoptive, or step parent) may provide ADS subject to compliance with Chapter 45, Section 31 of Wyoming Medicaid Rules. ADS must not be provided during the same time period as other waiver services, which is subject to audit by the Program Integrity Unit within the State Medicaid Agency.
Support with personal care needs, including medication assistance, is a component of the service, but cannot comprise the entirety of the service. Personal care services must not be billed at the same time as this service. Participants who receive ADS cannot be paid for work activities performed during this service.
A participant shall not receive a service tier that is higher than the tier level associated with their level of service score. A participant’s IPC may include two or more types of non-residential services as long as service times do not overlap. (Comp) Non-residential services must not exceed an average weekly amount of 35 hours (7,280 units) if the participant receives Community Living Services levels 3-6.
Refer a participant for Adult Day Services: call (307) 369-1030 or use the referral form at the end of this page.
Community Support Services (CSS) offer assistance with acquisition, retention, or improvement in self help, socialization and adaptive skills. Services include activities designed to keep participants engaged in their environment, develop and maintain relationships, and build on previously learned skills. Services must be furnished in accordance with the participant’s IPC and include full access to the community to the same degree as community members who do not receive HCBS. Supporting the participant in adult educational pursuits is an approved activity of this service.
CSS must be scheduled in settings separate from the participant’s residence. Services must be furnished in a variety of settings in the community and cannot be limited to only fixed site or congregate settings. Activities and environments must foster the acquisition of skills, appropriate behavior, greater independence, community networking, and personal choice. Transportation is a component of community support services and is included in the rate to providers.
CSS should focus on enabling the participant to attain or maintain their maximum functional level and should serve to reinforce skills or lessons taught in other settings, including skills learned during therapy services.
CSS is a habilitation service. Training on objectives is expected as part of the provision of services, and the participant’s progress must be documented and made available to the participant, legally authorized representative, and case manager each month.
A participant receives a tiered service approved in the IPC based upon need.
A participant with a Level 1 or 2 Level of Service (LOS) score will generally be in this tier. This service tier requires limited staff supports for, and personal attention to, a participant due to a moderately high level of independence and functioning. Behavioral needs, if any, can be met with medication or informal direction by staff. The participant may have periods of time with indirect staff supervision where staff are available within hearing distance.
A participant with a Level 3 or 4 LOS will generally be in this tier. Service tier requires full time heightened supervision with staff available as indicated in the IPC due to significant functional limitations, medical and/or behavioral needs. Behavioral and medical supports are not generally intense and can be provided in a shared staffing setting. Regular personal attention is given throughout the day for personal care, reinforcement, community, or social activities.
A participant with a Level 5 or 6 LOS will generally be in this tier. Service tier requires full time supervision with staff available within close proximity and as indicated in the IPC. Frequent staff interaction and personal attention for significant functional limitations and medical or behavioral needs is provided. Support and supervision needs are moderately intense, but can still generally be provided in a shared setting unless otherwise specified in the IPC. Frequent personal attention is given throughout the day for reinforcement, positive behavior support, personal care, community, or social activities.
CSS is available for participants ages 18 and older. Services must not duplicate or replace services covered under IDEA. Evidence demonstrating that school district services have been exhausted must be submitted for participants under the age of 21.
Approved units must be based on the participant’s needed level of support and must fit within the participant’s assigned budget. CSS is reimbursed at a 15 minute unit.
The CSS high level of care tier is available to participants who want help building meaningful relationships and social connections in the community with a more individualized approach from the provider. A participant with any LOS score may add the high level of care tier for this service to their IPC for individual services with up to one other waiver participant where the entire time is spent solely in the community and not in a provider setting.
A relative provider (defined as a biological, adoptive, or step parent) may provide this service subject to compliance with Chapter 45, Section 31 of Wyoming Medicaid Rules. CSS must not be provided during the same time period as other waiver services, which is subject to audit by the Program Integrity Unit within the State Medicaid Agency.
Support with personal care needs, including medication assistance, is a component of the service, but cannot comprise more than 20% of the service. Personal care services must not be billed at the same time as this service. Participants cannot be paid for work activities performed during this service.
A participant’s IPC may include two or more types of non-residential services as long as service times do not overlap. Non-residential services must not exceed an average weekly amount of 35 hours (7,280 units) if the participant receives Community Living Services levels 3-6.
Phone: (307) 369-1030
Or use the referral form at the end of this page.
Homemaker services consist of chore type activities such as meal preparation and routine household care. Services are available when the individual who is regularly responsible for these activities is temporarily unavailable or unable to manage the home and care for him or herself or others in the home.
Examples of covered tasks include but are not limited to regular home maintenance and more involved cleaning tasks such as cleaning appliances and washing windows. All tasks must be completed for the benefit of the participant.
Homemaker is not a direct care service.
A maximum of three (3) hours per week per household (624 units per year) is allowed. Relative providers (defined as biological, adoptive, and step parents) cannot provide this service.
This service is not available to participants who receive Host Home Services or CLS level 3-6.
A provider of homemaker services shall not bill for two participants during the same time frame.
Phone: (307) 369-1030
Or use the referral form at the end of this page.
Personal Care Services (PCS) consist of a range of assistance to enable participants to accomplish tasks that they would normally do for themselves if they did not have a disability. Assistance may include hands on assistance or prompting the participant to perform a task. PCS may be provided on an episodic or on a continuing basis. Health related services that may be provided include care relating to medical or health protocols, medication assistance or administration, and range of motion exercises. Health related services may be provided after staff are trained by the appropriate trainer or medical professional, and documentation of training is evident.
PCS may include assistance in performing activities of daily living (ADLs) (e.g., bathing, dressing, personal hygiene, bathroom assistance, transferring, maintaining continence) and more complex instrumental activities of daily living (IADLs) on the participant’s property (e.g., light housework, laundry, meal preparation exclusive of the cost of the meal, medication and money management).
The participant must be physically present during this service. PCS must be provided in the participant’s home or on their property. PCS must be essential to the health and welfare of the participant rather than that participant’s family.
As authorized in 42 U.S.C 1396a(h), PCS may be provided in an acute care hospital if the services are:
A. Identified in the participant’s IPC;
B. Provided to meet needs of the participant that are not met through the provision of acute care hospital services;
C. Not a substitute for services that the acute care hospital is obligated to provide through its conditions of participation or under Federal or State law, or under another applicable requirement; and
D. Designed to ensure smooth transitions between the acute care setting and the home and community based settings, and to preserve the individual’s functional abilities.
Case managers and providers must coordinate with hospital staff and plan of care team members in order to ensure that the participant’s transition from a temporary hospital stay to their home is seamless.
PCS is available to all ages and is a 1:1 service. The number of units authorized by DHCF are based on the participant’s extraordinary care needs as specified in their IPC and other assessments, and shall not exceed 7,280 units for the Comprehensive Waiver. The Supports Waiver does not have a unit cap.
PCS is included in ADS, Companion, Child Habilitation, CSS, Supported Employment, and CLS, and cannot be billed during the same time frame as these services, which is subject to audit by the Program Integrity Unit within the Single State Medicaid Agency. PCS cannot be provided on the same IPC as Host Home services.
PCS offered through the Medicaid State Plan can only be provided through a home health agency. Being a rural state, many Wyoming communities do not have home health providers to serve their community. Those that do often do not have enough employees to meet the extensive needs of some waiver participants. Participants who need PCS must utilize providers that can provide the type, amount, and flexible hours of services deemed most appropriate for them. This waiver service allows the plan of care team to find and utilize providers that can best meet the participant’s needs.
A relative provider (defined as a biological, adoptive, or step parent) may provide PCS with certain restrictions:
Extraordinary care cases must meet the following criteria:
1. The participant’s Adaptive Behavior Quotient is 0.35 or lower on the Inventory for Client and Agency Planning (ICAP) assessment; and
2. The participant needs assistance with ADLs or IADLs exceeding the range of expected activities that a legally responsible individual would ordinarily perform on behalf of a person without a disability or chronic illness of the same age, that are necessary to assure the health and welfare of the participant, and that will avoid institutionalization. (Example: a 12 year old needing assistance with dressing and bathing, whereas the average 12 year old does not.); or
3. The participant requires care from a person with specialized medical skills relating to the participant’s diagnosis or medical condition as determined appropriate by the participant’s medical professional and DHCF.
A legally authorized representative of a participant under the age of 18 may provide PCS to their ward if they meet the restrictions noted above. A legally authorized representative will not be authorized to provide PCS to a participant who is 18 years of age or older.
If a legally authorized representative is providing PCS to their minor ward, the IPC must be developed and monitored by a case manager without a conflict of interest to ensure the services are in the best interest of the participant.
Relative providers and legally authorized representatives cannot provide this service through participant-direction.
The IPC must state that services do not duplicate similar services, natural supports, or services otherwise available to the participant.
Transportation costs are not included as part of this service.
This service is subject to electronic visit verification.
Phone: (307) 369-1030
Or use the referral form at the end of this page.