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

Last reviewed: 2026-09-10

In Oklahoma, Skilled Respite Services are funded through the state's Home and Community-Based Services (HCBS) waivers, administered by the Oklahoma Department of Human Services (DHS) Developmental Disabilities Services (DDS) and the Oklahoma Health Care Authority (OHCA). The service is designed to provide temporary relief to primary caregivers of individuals whose medical needs require the intervention of licensed nursing staff.

To become an approved provider, agencies must first apply directly to the DHS DDS State Office and demonstrate financial solvency, including maintaining a minimum of $100,000 in liquid assets or lines of credit. Only after receiving approval from DHS can a provider proceed to enroll with OHCA through the SoonerCare provider portal.

1. Service Definition and Scope

Skilled Respite Service in Oklahoma provides temporary, short-term relief to unpaid primary caregivers of individuals with developmental disabilities or related conditions. This specific tier of respite is delivered by licensed nursing personnel (LPNs or RNs) because the care recipient's medical needs exceed the scope of practice for unlicensed direct support professionals.

The service is primarily utilized under the state's HCBS waivers, such as the Community Waiver and the In-Home Supports Waivers, to prevent institutionalization and support family preservation.

• Service Name: Skilled Respite
• Delivery Setting: Typically the individual's home or a community setting
• Target Population: Individuals with developmental disabilities requiring nursing-level care
• Staffing Requirement: Must be delivered by a Licensed Practical Nurse (LPN) or Registered Nurse (RN)
• Purpose: Temporary relief for the primary unpaid caregiver

2. Regulatory and Oversight Agencies

The oversight of Skilled Respite Services is a collaborative effort between the Oklahoma Department of Human Services (DHS) and the Oklahoma Health Care Authority (OHCA). DHS Developmental Disabilities Services (DDS) is responsible for the programmatic approval, quality assurance, and policy enforcement.

OHCA serves as the state Medicaid agency, handling the final provider enrollment, contracting, and claims processing through the SoonerCare system.

• Programmatic Oversight: Oklahoma Department of Human Services (DHS) Developmental Disabilities Services (DDS) (https://oklahoma.gov/okdhs/services/dds.html)
• Medicaid Agency: Oklahoma Health Care Authority (OHCA) (https://oklahoma.gov/ohca.html)
• Provider Enrollment Portal: OHCA Provider Portal (https://www.ohcaprovider.com/)
• Background Checks: Oklahoma State Bureau of Investigation (OSBI) (https://osbi.oklahoma.gov/)

3. Gatekeeping Prerequisites: Who Can Even Apply

Oklahoma imposes strict financial and operational prerequisites before an agency can even apply to provide HCBS waiver services, including Skilled Respite. The most significant structural barrier is the financial solvency requirement mandated by OAC 340:100-3-16.

Applicants must prove substantial liquid assets and submit a comprehensive operational plan to the DHS DDS State Office before they are eligible to enroll with OHCA.

• Financial Solvency Gate: Must demonstrate liquid assets or lines of credit of at least $100,000 or three times the average monthly budgeted expenses, whichever is greater
• Application Routing: Initial application must be submitted to and approved by the DHS DDS State Office, not directly to OHCA
• Operational Plan: Must submit a detailed organizational summary, line-item budget, and quality assurance program
• Insurance Minimums: Must secure $250,000 professional liability, $100,000 general liability, $100,000 commercial auto, and $25,000 employee dishonesty coverage

4. Licensure and Certification Requirements

Oklahoma does not issue a distinct "Skilled Respite Agency" license. Instead, providers must be approved as an HCBS provider through DHS DDS and ensure that the staff delivering the service hold the appropriate nursing licenses.

Agencies must comply with the Oklahoma Administrative Code (OAC) Title 340, Chapter 100, which governs Developmental Disabilities Services providers.

• Agency Certification: Approved as an HCBS provider by DHS DDS per OAC 340:100-3-16
• Staff Licensure: Nurses delivering the service must hold an active, unencumbered LPN or RN license from the Oklahoma Board of Nursing
• Corporate Status: Must provide a State of Oklahoma certificate of incorporation
• Tax Identification: Must provide a federal tax identification number

5. Medicaid Provider Enrollment

Once approved by DHS DDS, the provider must enroll with the Oklahoma Health Care Authority (OHCA) to become a SoonerCare provider. This process is completed online through the OHCA Provider Portal.

Providers must sign a provider agreement and may be subject to on-site screening visits by OHCA representatives to ensure program integrity.

• Enrollment System: OHCA Provider Portal
• Required Agreement: Must sign a SoonerCare provider agreement
• Screening Requirement: Subject to on-site screening visits per 42 CFR Part 455
• Disclosure: Must complete ownership and control disclosures per 42 C.F.R. § 455.104
• Application Fee: Subject to federal Medicaid application fee unless waived or paid to another state/Medicare

6. Staffing, Training and Background Checks

Agencies must ensure that all personnel meet strict background and qualification standards. The executive director or program director must have a Bachelor's degree and at least two years of supervisory experience.

All staff, including the licensed nurses providing the respite, must undergo comprehensive background checks and complete DHS-mandated training.

• Director Qualifications: Bachelor's degree and minimum two years supervisory/management experience
• Background Checks: Oklahoma State Bureau of Investigation (OSBI) background search required
• Registry Checks: Community Services Worker Registry search required
• Training: Must attest to meeting DHS training requirements per OAC 340:100-3-38 through 340:100-3-38.13
• Direct Care Staff: Must be licensed LPNs or RNs for Skilled Respite

7. Documentation, Policies and Records

Providers must maintain comprehensive policies and records as part of their operational plan and ongoing compliance. This includes a grievance process approved by the Office of Client Advocacy.

Agencies must also have clear policies for suspected maltreatment reporting, personnel management, and health and wellness maintenance.

• Grievance Policy: Must be reviewed and approved by the Office of Client Advocacy per OAC 340:2-3-2
• Maltreatment Reporting: Policies must align with Section 1025.1 of Title 56 of the Oklahoma Statutes
• Conflict of Interest: Must have a written policy addressing board membership, contracted services, and client-staff relationships
• Records Maintenance: Must comply with OAC 340:100-3-40
• Medication Administration: Policies must align with OAC 340:100-5-32 and 340:100-5-33

8. Billing, Rates and Claims

Billing for Skilled Respite Services is processed through the OHCA SoonerCare MMIS system. Providers must complete OHCA provider-billing training before submitting claims.

Rates are established by OHCA and DHS based on the waiver fee schedule. Providers must ensure that services are prior-authorized in the individual's plan of care.

• Billing System: OHCA SoonerCare MMIS
• Training Requirement: Must complete OHCA provider-billing training
• Prior Authorization: Services must be included in the approved plan of care
• Rate Setting: Determined by OHCA and DHS waiver fee schedules
• Financial Audits: Must maintain documentation to successfully complete annual financial audits

9. Approval Sequence and Timeline

The approval process is sequential, starting with the DHS DDS State Office and concluding with OHCA enrollment. The timeline can vary based on the completeness of the application and the speed of background checks.

Providers should expect the process to take several months from the initial submission of the operational plan to the final execution of the SoonerCare contract.

• Step 1: Submit application and operational plan to DHS DDS State Office
• Step 2: Secure required insurance and demonstrate financial solvency
• Step 3: Complete OSBI and registry background checks for key personnel
• Step 4: Receive programmatic approval from DHS DDS
• Step 5: Complete OHCA SoonerCare enrollment and sign provider agreement
• Step 6: Complete required provider orientation and billing training

10. Common Denials and Survey Findings

Applications are frequently delayed or denied due to failure to meet the strict financial solvency requirements or incomplete operational plans. OHCA may also terminate or deny agreements based on background check findings.

During on-site screenings or audits, common findings include inadequate documentation of staff training, lapsed insurance coverage, or failure to maintain required liquid assets.

• Financial Denial: Failure to prove $100,000 liquid assets or lines of credit
• Background Denial: Convictions of certain crimes by owners or managing employees per 42 C.F.R. § 455.106
• Insurance Lapses: Failure to maintain the required liability and employee dishonesty coverages
• Training Deficiencies: Incomplete documentation of DHS-mandated staff training
• Policy Deficiencies: Unapproved grievance processes or inadequate conflict of interest policies

11. Key Contacts and Resources

Prospective providers should utilize the official state portals and contact numbers to navigate the dual requirements of DHS and OHCA. The DHS DDS State Office is the primary point of contact for the initial application.

For questions regarding the Medicaid contract and billing, providers should contact the OHCA Provider Enrollment division.

• DHS Developmental Disabilities Services: https://oklahoma.gov/okdhs/services/dds.html
• OHCA Provider Enrollment Portal: https://www.ohcaprovider.com/
• OHCA Provider Contracts Phone: (800) 522-0114, option 5
• OHCA Provider Enrollment Email: [email protected]
• Oklahoma Administrative Code (OAC) Title 340: https://oklahoma.gov/okdhs/library/policy.html

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