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Connecticut - Skilled Respite Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

The Connecticut Department of Public Health (DPH) requires agencies delivering skilled nursing respite under the Connecticut Home Care Program for Elders (CHCPE) or Department of Developmental Services (DDS) waivers to hold an active Home Health Care Agency (HHCA) license. Skilled respite utilizes registered nurses (RNs) or licensed practical nurses (LPNs) to temporarily relieve primary caregivers of participants with complex medical needs that exceed the scope of unlicensed homemaker-companion agencies.

Before enrolling in the Connecticut Medical Assistance Program (CMAP) via Gainwell Technologies, prospective providers must secure this DPH license and, for CHCPE participation, secure a subcontracting agreement with one of the state's designated Access Agencies, such as Southwestern CT Agency on Aging (SWCAA) or Connecticut Community Care (CCC). DDS waiver providers must submit a Letter of Intent and attend a mandatory Provider Information Session before applying for DDS certification.

1. Service Definition and Scope

Connecticut does not issue a distinct license solely for "Skilled Respite." Instead, this service is authorized as a skilled nursing service delivered by a licensed Home Health Care Agency (HHCA) under the CHCPE or DDS waivers. It provides short-term, intermittent nursing care to participants unable to care for themselves, offering relief to the primary unpaid caregiver.

The service must be explicitly written into the participant's individualized plan of care by the Access Agency care manager or DDS case manager. It is strictly limited to tasks requiring a licensed nurse, such as medication administration, wound care, or ventilator management, which cannot be delegated to an unlicensed homemaker or companion.

2. Regulatory and Oversight Agencies

The Department of Public Health (DPH) Facility Licensing and Investigations Section (FLIS) is the primary regulatory body responsible for licensing Home Health Care Agencies in Connecticut. They conduct initial and ongoing surveys to ensure compliance with the Public Health Code.

The Department of Social Services (DSS) administers the Medicaid program and the CHCPE waiver, while the Department of Developmental Services (DDS) oversees waivers for individuals with intellectual disabilities. Gainwell Technologies operates the CMAP provider enrollment portal.

3. Gatekeeping Prerequisites: Who Can Even Apply

To bill Medicaid for skilled respite in Connecticut, an entity must first obtain a Home Health Care Agency license from DPH. There is no Certificate of Need (CON) required for a new HHCA in Connecticut, but the DPH licensure process is a strict prerequisite before any Medicaid enrollment can begin.

For the CHCPE waiver, providers cannot enroll as independent standalone entities; they must secure a subcontracting agreement with a state-contracted Access Agency. For DDS waivers, agencies must submit a Letter of Intent to DDS and attend a mandatory Provider Information Session before their certification application is accepted.

4. Licensure and Certification Requirements

Prospective HHCAs must submit a licensure application to the DPH Facility Licensing and Investigations Section (FLIS). The application requires detailed policies and procedures, an organizational chart, and the designation of a qualified agency administrator and clinical supervisor.

DPH will review the application and conduct an initial on-site survey to verify compliance with the Connecticut Public Health Code (Sections 19-13-D66 to 19-13-D79). The agency must demonstrate readiness to provide skilled nursing services safely and effectively.

5. Medicaid Provider Enrollment

Once licensed by DPH, the agency must enroll in the Connecticut Medical Assistance Program (CMAP) using the Provider Enrollment/Re-enrollment Wizard managed by Gainwell Technologies. The wizard requires the provider to select the appropriate taxonomy and provider type for a Home Health Agency.

Providers placed in the high-risk category during enrollment are subject to fingerprint-based background checks as defined in 42 CFR 455.434. The wizard does not allow incomplete applications to be saved; all required data and follow-on documents must be submitted in one session or mailed promptly.

6. Staffing, Training and Background Checks

Skilled respite must be delivered by a Registered Nurse (RN) or a Licensed Practical Nurse (LPN) holding an active, unencumbered license from the Connecticut DPH. The HHCA is responsible for verifying the credentials and competency of all nursing staff prior to deployment.

Agencies must conduct comprehensive background checks on all direct care staff, including state and national criminal history checks and registry verifications. Staff must also receive agency-specific orientation and ongoing in-service training as mandated by DPH regulations.

7. Documentation, Policies and Records

Providers must maintain a comprehensive clinical record for each participant receiving skilled respite. This record must include the individualized plan of care authorized by the Access Agency or DDS, nursing assessments, and detailed progress notes for every shift worked.

All services must be documented with precise start and end times, the specific skilled tasks performed, and the signature of the nurse providing the care. Electronic Visit Verification (EVV) is mandated by DSS for certain home-based services to capture time and attendance.

8. Billing, Rates and Claims

Claims for skilled respite are submitted to the CMAP MMIS system operated by Gainwell Technologies. Services must be prior-authorized by the participant's Access Agency or DDS case manager, and the billed units must match the authorized plan of care.

Rates for home health services, including skilled nursing respite, are established by DSS and published on the CMAP website under the provider fee schedules. Providers cannot charge the department or the client a rate higher than the DSS-approved rate.

9. Approval Sequence and Timeline

The approval process begins with the DPH Home Health Care Agency licensure application, which can take several months depending on FLIS survey volume and the agency's readiness. Once licensed, the agency must secure a contract with an Access Agency or DDS.

After securing the necessary network contracts, the provider submits the CMAP enrollment application through Gainwell Technologies. The Medicaid enrollment process typically takes 30 to 60 days if all follow-on documents are accurate and complete.

10. Common Denials and Survey Findings

Licensure applications are frequently delayed or denied due to incomplete policy manuals or failure to employ an administrator and clinical supervisor who meet the strict DPH experience requirements. During initial surveys, DPH often cites agencies for inadequate infection control policies or missing personnel file documentation.

Medicaid enrollment applications are commonly rejected if the provider selects the wrong taxonomy code, fails to mail the required follow-on documents to Gainwell within the allotted timeframe, or attempts to enroll without first securing the mandatory Access Agency or DDS approvals.

11. Key Contacts and Resources

Providers should utilize the official state portals for the most current regulations, fee schedules, and application forms. The DPH Facility Licensing and Investigations Section handles all HHCA licensure inquiries.

For Medicaid billing and enrollment questions, Gainwell Technologies provides a dedicated Provider Enrollment Unit. Agencies seeking to serve waiver participants must also coordinate directly with the regional Access Agencies or DDS regional offices.

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