Essential Living Support, LLC provides Wyoming DD Waiver Community Living Services (CLS) in Cheyenne, Wyoming for adults with intellectual and developmental disabilities. For case managers, discharge planners, and care providers coordinating placements, CLS at Essential Living Support, LLC delivers daily living skill development, community inclusion, and 24/7 support eligibility through one husband and wife, family owned provider relationship.
Richard Brown Jr., MBA-HCM, has authored relevant articles in Healthcare Business Today and Healthcare Guys. Both speak directly to community based care transitions, discharge planning, and the trust signals families and referrers look for. Wyoming DHCF also authorizes CLS to be provided in an acute care hospital setting under specific IPC conditions, which can support continuity for participants moving in or out of inpatient care.
Refer a participant: call (307) 369-1030 or use the referral form below.
For case managers (primary). When you are matching a participant to a Community Living Services provider, this page maps the regulatory definition, the 5 tier service system, scope and limitations, Host Home eligibility, and what makes Essential Living Support different at the day to day delivery level.
For discharge planners. When a participant is preparing to leave inpatient care and needs CLS placement, this page covers eligibility, the acute care hospital provision, and how to start a referral conversation.
For VA officers. Essential Living Support is also a VA approved medical foster home provider serving the Cheyenne VA service area. CLS is the Wyoming DD Waiver service we deliver alongside that VA designation when a Veteran’s needs and waiver eligibility align.
For care providers and referral sources. If you provide a different waiver service or a Veteran facing service and need a CLS partner for a coordinated placement, this page tells you what we deliver and how to coordinate.
For family caregivers. If you are exploring CLS for an adult family member with intellectual or developmental disabilities, this page explains what the service includes, who is eligible, and how to refer.
Capsule: Community Living Services (CLS) is the Wyoming DD Waiver service that supports adults with intellectual and developmental disabilities to live in the community as independently as possible. CLS includes daily living skill development, personal care, community inclusion, transportation, and 24/7 support eligibility, and is delivered in the participant’s primary residence or other community settings.
Source: Wyoming DHCF / Wyoming Medicaid HCBS Handbook (verbatim regulatory text follows).
Community Living Services (CLS) provide acquisition, retention, or improvement of skills related to living in the community. These supports include adaptive skill development, assistance with activities of daily living including medication assistance, light housekeeping, community inclusion, transportation, adult educational supports, and social and leisure skill development that assist the participant to reside in the most integrated setting appropriate for their needs. CLS includes personal care, protective oversight, and supervision as indicated in the IPC.
• CLS is reimbursed based on the participant’s Level of Service (LOS) score, and includes some level of ongoing 24-hour support (e.g., 24-hour on-call support) by a provider, as defined in the level of service and outlined in the participant’s IPC.
• A participant who lives in a setting that is owned or leased by a provider, the participant, or the participant’s family may receive the level of CLS that aligns with their level of service score and can be supported by their IBA. A participant who is living with their family is only eligible to receive CLS-Basic to the extent that the service can be supported by their IBA.
• A participant who receives CLS must have one primary residence. CLS may be provided in the participant’s primary residence or in other community settings the participant chooses.
• Provider owned or leased settings where CLS is furnished must be fully accessible to the participants living in that setting.
• With the exception of host homes, CLS may be delivered through participant-direction.
• Transportation between the participant’s residence, other service sites, or places in the community is included in the rate.
• CLS is a habilitation service. This means 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.
• Participants are encouraged to take vacations and travel. If a participant takes a trip outside of CLS, the provider may be reimbursed on the days the participant leaves for and returns from that trip if they provide services to the participant on those days. If a participant takes a vacation while receiving CLS, the provider must adhere to all supervision and support requirements identified in the service definition and the participant’s IPC. If service definitions and supervision levels cannot be met, case managers must work with the plan of care team to identify an alternative waiver or non-waiver service.
• Health related services may be provided after staff are trained by the appropriate trainer or medical professional, and documentation of training is evident.
• Respite cannot be used to relieve a paid caregiver, including an independent CLS provider.
• Independent CLS providers must be able to demonstrate how they can provide the 24-hour support, which is outlined in the CLS definition, in the event they have competing priorities such as daytime employment.
Capsule: CLS is available to adults with intellectual or developmental disabilities enrolled in the Wyoming DD Waiver with an Individualized Plan of Care (IPC) that authorizes the service. The tier is set by the participant’s Level of Service (LOS) score and supported by their Individual Budget Amount (IBA). Eligibility is confirmed through the participant’s case manager and the Wyoming Department of Health, Division of Healthcare Financing.
For case managers and referral sources: a participant living with a family member is only eligible for CLS-Basic to the extent the service is supported by their IBA. Participants living in a setting owned or leased by a provider, the participant, or the participant’s family may receive the CLS tier that aligns with their LOS score and IBA.
Capsule: Wyoming DD Waiver CLS is delivered in five tiers: Basic Level, Level 3, Level 4, Level 5, and Level 6. The tier is set in the participant’s IPC based on their LOS score. Each tier defines staff availability, supervision, personal care intensity, behavioral and medical support, and overnight coverage required.
Source: Wyoming DHCF / Wyoming Medicaid HCBS Handbook, Tiered Levels (verbatim regulatory text follows).
A participant receives a tiered service approved in the IPC based upon need, according to the following tier descriptions. Tier levels for this service align with the participant’s assessed LOS, and the expectations of the service as specified in the definition. All supervision and support must align with the participant’s IPC, and meet the needs of each participant present as appropriate.
Capsule: Basic Level CLS supports participants with high to moderately high independence and few significant behavioral or medical needs. Staff availability is periodic during awake hours. Personal care is capped at 20 percent of provided service. On-call 24-hour support is not required, but the IPC must outline a contingency plan for emergencies.
Verbatim:
Basic Level: Due to the participant’s high to moderately high level of independence and functioning, and few significant behavioral or medical issues that require minimal staff support, monitoring, or personal care, this tier requires periodic face-to-face staff availability during awake hours on each day billed to provide general supervision, support, monitoring, and training. On-call 24-hour support is not required for this tier level, but a contingency plan for emergency situations must be outlined in the IPC. Personal care cannot exceed 20% of the provided service.
This service may be provided through virtual supports. The participant and legally authorized representative must have a choice in where and how the service will be received, and it 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. If virtual support does not facilitate the wishes and desires of a participant, it is not an option.
Capsule: Level 3 CLS supports participants with moderate functional limitations in activities of daily living and possible behavioral support needs. Staff availability is regular and within hearing distance during awake hours. Overnight staff support is required and must be stipulated in the IPC.
Verbatim:
Level 3: Due to the participant’s moderate functional limitations in activities of daily living, and possible behavioral support needs, this tier requires regular staff availability within hearing distance of the participant, and meeting periodically with the participant on each day billed for general supervision, support, personal care, positive behavior support, monitoring, and training. Behavioral and medical supports are not intense and may be provided in a shared staffing setting. Staff support must be available through the night, and overnight expectations must be stipulated in the IPC.
Capsule: Level 4 CLS supports participants with significant functional limitations and medical or behavioral support needs. Full time staff are available throughout the day for training, personal care, reinforcement, and community activities. Overnight staff support is required and stipulated in the IPC.
Verbatim:
Level 4: Due to the participant’s significant functional limitations and medical or behavioral support needs, this tier requires full time staff to be available when the participant is in this service, with regular personal attention given throughout the day for training, personal care, reinforcement, positive behavior support, and community or social activities. Behavioral and medical supports are not generally intense and may be provided in a shared staffing setting. There must be staff support through the night as indicated in the IPC, and overnight expectations must be stipulated in the IPC.
Capsule: Level 5 CLS supports participants with significant and somewhat intensive functional, medical, or behavioral support needs. One or more full time staff are in close proximity during most awake hours. In person overnight staff support is required. Participants at this tier are not eligible for remote monitoring.
Verbatim:
Level 5: Due to the participant’s significant and somewhat intensive functional limitations and medical or behavioral support needs, this tier requires one or more full time staff support to be in close proximity during most awake hours when the participant is in this service, with frequent personal attention given throughout the day for training, personal care, reinforcement, and community or social activities. Behavioral and medical supports and personal care may be somewhat intense, but service may be provided in a shared staffing setting. There must be in-person staff support throughout the night, as indicated in the IPC. Participants who receive this service tier are not eligible for remote monitoring.
Capsule: Level 6 CLS supports participants with high medical, behavioral, or personal care needs. Full time staff are within immediate proximity during most awake hours, with at least one staff person providing personal attention unless the IPC and DHCF authorize otherwise. Occasional 2:1 support is included in the rate. Overnight in person staff support is required. Remote monitoring is not eligible at this tier.
Verbatim:
Level 6: Due to the participant’s high medical, behavioral, or personal care needs, this tier requires frequent personal support and supervision with full time staff within immediate proximity during most awake hours. The expectation is that the participant will receive the personal attention of at least one staff person unless otherwise outlined in the IPC and approved by DHCF. Occasional 2:1 support is included in this rate, and must be specified in the IPC. There must be in-person staff support available to the participant through the night, as indicated in the IPC. Participants who receive this service tier are not eligible for remote monitoring.
Capsule: Remote monitoring is an optional supervision support for participants receiving CLS at the Basic Daily Level, Level 3, or Level 4 tier. It is governed by the HCBS Waiver Remote Monitoring Requirements document and requires an individual risk assessment, IPC documentation, and Division review before implementation. Levels 5 and 6 participants are not eligible for remote monitoring (referenced in the tier descriptions above).
Source: Wyoming DHCF Comprehensive and Supports Waiver Service Index Effective 09/01/2025, page 19 (verbatim regulatory text follows).
Remote monitoring, as specifically defined in the HCBS Waiver Remote Monitoring Requirements, may be utilized for supervision for individuals at the Basic Daily Level, Level 3, or Level 4 tier. Remote monitoring will be based on an individual risk assessment and protocol, and as outlined in the IPC. Remote monitoring shall be reviewed by the Division prior to implementation. Providers and plan of care teams must follow all requirements and standards established in the HCBS Waiver Remote Monitoring Requirements document, which is located on the Services & Regulations page of the HCBS Section website.
In order to consider remote monitoring as a support for the participant:
The participant must have an informed choice between in person and remote support services.
The participant must choose service delivery through remote monitoring, and that choice must be documented in the participant’s IPC, and demonstrated through a signed consent form.
Remote monitoring must fit within the scope and definition of the community living service being received.
Remote monitoring must not be used for the provider’s convenience. The option must be used to support a participant to reach identified outcomes in the participant’s IPC.
The use of the remote monitoring option must not block, prohibit or discourage the use of in person services or access to the community. Participants must be encouraged to engage with friends and family and actively participate in their community.
If remote monitoring does not facilitate the wishes and desires of a participant, it is not an option.
Capsule: Host Home is a subcomponent of CLS delivered as one sponsor working with one participant in the sponsor’s home. New Host Home placements require Wyoming Extraordinary Care Committee (ECC) approval for an out of home placement. Essential Living Support is set up to provide Host Home Services and works with case managers and the plan of care team through the ECC review when a participant’s needs warrant the placement.
What case managers should know about Host Home: a sponsor must be an independent certified provider, can only provide CLS to one participant, cannot employ staff, and cannot be a subcontractor. The sponsor assumes 24-hour care of the participant. Relative providers (defined as biological, step, or adoptive parents) cannot provide Host Home Services. Host Home cannot be participant-directed. The ECC review process is the gating step for any new participant.
Source: Wyoming DHCF / Wyoming Medicaid HCBS Handbook (verbatim regulatory text follows).
Host Home: Host home services consist of participant specific, individually designed and coordinated services within a family (other than biological, step or adoptive parents) host home environment. Host homes differ from other community living settings by featuring one sponsor working with one participant living together in the sponsor’s home. A sponsor must be an independent certified provider, and can only provide CLS services to one participant. The sponsor cannot employ staff, and cannot be a subcontractor. The sponsor assumes 24-hour care of the participant. Relative providers (defined as biological, step, or adoptive parents) cannot provide this service. Host home services cannot be participant-directed. This service is not open to new participants without going through the Extraordinary Care Committee (ECC) approval process for an out of home placement.
Capsule: Wyoming DHCF places specific scope and limitations on CLS to keep the service consistent across providers. The most operationally relevant items for case managers and discharge planners are summarized below, with the verbatim regulatory text retained for compliance reference.
Source: Wyoming DHCF Comprehensive and Supports Waiver Service Index Effective 09/01/2025, pages 19-20 (verbatim regulatory text follows).
Age requirement and service exclusivity:
Participants must be at least 18 years old to receive CLS. Services must not duplicate or replace services covered under IDEA or through Department of Family Services programs.
24-hour service requirement and daily payment minimums:
Community living is a 24 hour service. The following requirement must be met in order for payment to be allowed:
Basic daily rate: a minimum of 4 hours of documented service per calendar day. Providers are required to provide overnight and crisis support as indicated in the participant’s IPC.
Levels 3-6 daily rate: a minimum of 8 hours of documented provider support in a 24 hour period (from 12:00am-11:59pm) unless the participant is leaving for or returning from a vacation outside of waiver services. Providers are required to provide overnight support as defined in the tier definition for the level they are receiving as indicated in the participant’s IPC.
CLS basic billing units and daily rate exclusivity:
CLS basic services may be billed as a 15 minute unit for a maximum of 5,475 units per plan year for individual services, or for a maximum of 5,475 per plan year for group services. The 15 minute unit and daily rate cannot be billed for a participant on the same day.
Non-residential service hours cap (Comprehensive Waiver):
Participants who are receiving CLS Levels 3-6 cannot receive non-residential services that exceed an average of 35 hours per week (7280 units).
This is a Wyoming Comprehensive Waiver constraint that affects how CLS interacts with Adult Day Services, Companion Services, and other non-residential services on the same IPC.
Remote monitoring risk assessment requirement:
Participants who choose remote monitoring as a supervision option must complete a risk assessment prior to utilization. Additional standards apply to providers that implement remote monitoring practices.
Emergency 24-hour CLS provision:
Participants who are not receiving CLS Levels 3-6, and who are at significant risk due to extraordinary needs that cannot be met in their current living arrangement, may request 24-hr CLS if the participant meets the definition of an emergency, as outlined in Chapter 46, Section 14 of Wyoming Medicaid Rules.
Personal Care Services exclusivity and room and board exclusion:
Support with personal care needs is a component of CLS, so service times for CLS and personal care services cannot overlap. Payment will not be made for the cost of room and board, including the cost of building maintenance, upkeep, and improvement. The method by which the costs of room and board are excluded from payment for CLS is specified in Appendix I-5 of this Application.
Personal Care Services cross-rule (PCS-side framing):
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.
Relative provider rule:
A relative provider (defined as the biological, adoptive, or step parent of a participant) may provide all components of this service as defined, but must form a Limited Liability Company (LLC) or a corporation, be a certified provider or an employee of a certified provider, and must not reside in the same primary residence as the participant.
Acute care hospital provision: Wyoming DHCF authorizes CLS to be provided in an acute care hospital under specific conditions. This is operationally important for discharge planners and case managers coordinating transitions between inpatient and community settings.
As authorized in 42 U.S.C 1396a(h), CLS 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.
Capsule: Wyoming runs two DD Waivers under the umbrella term Wyoming DD Waiver: the Comprehensive Waiver and the Supports Waiver. CLS is delivered under both waivers. CLS-Basic is the entry point and the only CLS tier supported on the Supports Waiver and on family residence settings limited by IBA. CLS Levels 3 through 6 are delivered under the Comprehensive Waiver and trigger the 35 hour non-residential service cap noted above.
For case managers planning IPCs across multiple services: CLS often pairs with Respite, Adult Day Services, Companion Services, and Personal Care Services depending on the participant’s LOS, IBA, and goals. The PCS exclusivity rule and the 35 hour Comprehensive Waiver cap are the two most common scheduling constraints we see when coordinating with case managers.
Internal references on this site:
Capsule: To start a CLS referral, call (307) 369-1030 or use the referral form embedded above this footer. Tell us the participant’s case manager (or that you are the case manager), the CLS tier indicated by their LOS, whether the placement is a standard CLS tier or a Host Home placement, and any time sensitive context (e.g., a discharge date).
For case managers, VA officers, discharge planners, and family caregivers.
Yes. Essential Living Support, LLC is a Wyoming DHCF certified DD Waiver provider in Cheyenne, Wyoming, currently delivering Community Living Services along with Adult Day Services, Community Support Services, Companion Services, Homemaker Services, Personal Care Services, and 24/7 Respite Care. Essential Living Support is also a VA approved medical foster home provider serving the Cheyenne VA service area.
Essential Living Support, LLC delivers Community Living Services across all five Wyoming DD Waiver tiers: Basic Level, Level 3, Level 4, Level 5, and Level 6. The tier a participant receives is set by their Level of Service (LOS) score and authorized in their Individualized Plan of Care (IPC).
Yes, under specific conditions. Wyoming DHCF authorizes CLS to be provided in an acute care hospital when the service is identified in the participant’s IPC, addresses needs not met by acute care, does not substitute for hospital obligations, and supports a smooth transition back to the home and community setting. Case managers and providers must coordinate with hospital staff and the plan of care team.
New Host Home placements require ECC approval before services begin. We work with the participant’s case manager and the plan of care team through the ECC submission and review. Standard CLS tiers (Basic through Level 6) do not require ECC approval and follow the routine IPC authorization process.
Personal Care Services (PCS) is included within CLS and cannot be billed during the same time frame as CLS. PCS also cannot be provided on the same IPC as Host Home Services. Case managers should plan PCS hours around CLS service times when both are needed for different parts of the day, or coordinate with the plan of care team to choose the right service mix.
Respite cannot be used to relieve a paid CLS provider. If a participant needs short term relief support that complements CLS rather than replaces it, the case manager and plan of care team should review whether a different waiver service (Companion, ADS, or another option) better fits the participant’s IPC.
Wyoming Comprehensive Waiver limits non-residential services to an average of 35 hours per week (7,280 units) for participants receiving CLS Levels 3 through 6. Non-residential services include Adult Day Services, Companion Services, and similar services delivered outside the residential CLS context. Case managers planning IPCs that combine CLS with non-residential services should design the schedule to stay within this cap.
Yes. CLS-Basic is the CLS tier delivered under the Wyoming Supports Waiver, and Essential Living Support, LLC supports participants on either the Comprehensive Waiver or the Supports Waiver depending on their assessed needs and Individual Budget Amount.
Cheyenne, Wyoming is the primary service area. We also support participants in Laramie County and Wyoming statewide where the IPC, IBA, and travel logistics allow. The service is delivered in the participant’s primary residence or in other community settings the participant chooses, consistent with the Wyoming DHCF definition.
Call (307) 369-1030 or use the referral form on this page. Tell us the participant’s case manager (or that you are the case manager), the CLS tier indicated by their LOS, whether the placement is a standard CLS tier or a Host Home placement, and any time sensitive context such as a discharge date.
Phone: (307) 369-1030
Email: rbrown@essentiallivingsupport.com
Online referral form: this page (form embedded above this footer)
Service area: Cheyenne (primary), Laramie County (secondary), Wyoming statewide (tertiary).
Authored by Richard Brown Jr., MBA-HCM, BS-HCA, Doctor of Healthcare Administration Candidate at Capella University. Veteran owned. Wyoming DD Waiver provider. Member of VFW Warren F. E. Post 1881 in Cheyenne.
Dignity. Respect. Independence. Always.