Wyoming WY

Wyoming pre-2024 fiscal-agent URL wyequalitycare.acs-inc.com is fully dead — DNS does not resolve, no successor at the same host. All rule pins to this host are stale and have been re-pointed to the current state Medicaid provider portal during the WY verification sweep 2026-05-21.

Wyoming Medicaid previously contracted ACS-Inc (later Conduent/Xerox) as its fiscal agent at the URL wyequalitycare.acs-inc.com. The host has been decommissioned and DNS no longer resolves. 14 WY pa_rules were pointing to this dead host before the 2026-05-22 SME re-pin pass. Pattern recurs across states with Xerox/ACS/Conduent fiscal-agent succession.

Current + prior fiscal agents. Tracks ACS-Inc → Conduent/Gainwell transitions so we know when *.acs-inc / *.conduent / *.xerox subdomains die.

Wyoming Medicaid is PURE FFS (no comprehensive risk MCO). PA criteria do NOT live on the DOH site (health.wyo.gov is a thin program hub linking one combined Provider Manual PDF). The OPERATIONAL PA layer lives on the fiscal-agent provider portal www.wymedicaid.org (Gainwell FFS-medicaid CDN; cutover from Conduent->Gainwell completed ~April 15 2026 per newsletters). PA is overwhelmingly PHARMACY-shaped: a Preferred Drug List (PDL), an Additional Therapeutic Criteria (ATCC) doc carrying clinical PA logic, a dosage-limitation chart, and ~10 drug-class PA Forms (Sublocade, Hep C, ADHD, JCode, narcotics, buprenorphine, brand-name, miscellaneous). Medical/service PA is carried in CMS-style Provider Manual chapters. UM/care-mgmt is Acentra (WYhealth.net, formerly Kepro; old wymedicaid.acentra.com host is dead). DEAD PINS: state_meta pa_index/pharmacy/provider_manual all=wyequalitycare.acs-inc.com (DNS dead, ACS-Inc legacy); wymedicaid.acentra.com dead. LIVE replacements: www.wymedicaid.org (portal/manuals/PA), health.wyo.gov/healthcarefin/medicaid/.

Last award: 2020-03-01. Next due: 2031-03. Contracts extended through: 2031-03 (nominal 11-year end of CNSI/Acentra BMS contract; not independently re-verified).

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## 1. How WY requires PA Wyoming Medicaid requires prior authorization (PA) for specific services and medications to ensure medical necessity and compliance with state guidelines. The criteria for these PAs are detailed in various documents such as the Provider Manual and specific PA criteria documents. For instance, drugs like AFREZZA, AGAMREE, AKYNZEO, ALYFTREK, ATTRUBY, AUSTEDO, BAXDELA, BERINERT, betamethasone valerate foam, BIJUVA, BOTOX, and SUBLOCADE all have specific eligibility criteria that must be met. For example, AFREZZA requires clients over 18 years using long-acting insulin concurrently, while AGAMREE is for clients with Duchenne muscular dystrophy diagnosis. Additionally, certain antihypertensive medications require PA if they exceed labeled dosing, and BAXDELA necessitates a trial of other antibiotics before approval. ## 2. How WY publishes and reports PA Wyoming Medicaid publishes its PA criteria and guidelines through the Wyoming Department of Health (DOH) website and the fiscal agent's portal. The Provider Manual, which includes details on covered services and limitations, is available at https://health.wyo.gov/healthcarefin/medicaid/provider-manual-revision-10-23-23-1/. This manual serves as a comprehensive guide for providers, detailing step therapy requirements, documentation needs, and other relevant information. The fiscal agent portal, www.wymedicaid.org, managed by Gainwell, provides operational PA criteria and manuals such as the Pharmacy Services Covered Services & Limitations Module. ## 3. WY's CMS-0057-F and PA-reform compliance posture Wyoming Medicaid's posture relative to CMS-0057-F is observed through its centralized portal and detailed documentation on its website, though no explicit CMS-0057-F compliance commitment appears in the source documents. The state uses a centralized PA aggregator pattern where the state-run portal routes PAs across all Managed Care Organizations (MCOs) in Wyoming, giving providers consistent PA criteria and processes regardless of their MCO affiliation. **WISeR is not applicable to WY** — the CMS "Wasteful and Inappropriate Service Reduction" Medicare PA model applies only to AZ, NJ, OH, OK, TX, and WA. ## 4. How WY runs its own program Wyoming Medicaid operates under a Fee-for-Service (FFS) model without a comprehensive risk Managed Care Organization (MCO). The state has a carve-out for pharmacy services, which are managed by a Pharmacy Benefit Manager (PBM), and a partial carve-out for behavioral health services, directed to the Provider of Alcohol and Health Programs (PAHP). The fiscal agent for Wyoming Medicaid is Gainwell, which manages the provider portal www.wymedicaid.org. This portal serves as the primary operational PA layer, carrying the Preferred Drug List (PDL), Access to Therapeutic Choices Criteria (ATCC), and pharmacy manual. ## 5. Patterns, what's notable, and what's missing/uncertain ### Notable Patterns: - **Centralized Portal**: Wyoming Medicaid uses a centralized portal for PAs, which is distinct from per-MCO PA grids. - **FFS Model**: The state operates under an FFS model without comprehensive risk MCOs. - **Pharmacy Carve-Out**: Pharmacy services are managed by a PBM, indicating specialized management for these services. ### What's Missing/Uncertain: - **CMS-0057-F Compliance Details**: No explicit CMS-0057-F commitment in source documents; specific compliance metrics or reports are not provided. - **Effective/Revised Dates**: Many documents do not specify effective or revised dates, making it challenging to track changes over time. - **CPT/HCPCS Codes**: The PA criteria and provider manual do not provide CPT/HCPCS codes for services requiring prior authorization, which could be crucial for providers to understand the specific requirements. These gaps highlight areas where additional documentation or clarification would enhance transparency and usability for providers.