Wyoming - Respite Care Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Wyoming Department of Health (WDH) Division of Healthcare Financing and the Behavioral Health Division certify Respite Care Services providers to deliver temporary caregiver relief through the Community Choices, Comprehensive, and Supports Waivers.

Approval requires passing a state-level provider certification review specific to the target waiver before submitting a Medicaid enrollment application through the HHS Tech Group provider portal. Wyoming does not issue a standalone facility license for in-home respite care; instead, agencies operate under waiver-specific certification standards or existing Home Health Agency licenses if delivering skilled nursing tasks.

1. Service Definition and Scope

Respite care in Wyoming provides short-term relief to unpaid primary caregivers of waiver participants. It ensures the participant continues to receive necessary supervision and support while the caregiver is temporarily unavailable.

The service can be delivered in the participant's home, the provider's home, or an approved community setting, depending on the specific waiver's service definition.

• Service Modalities: In-home, community-based, and facility-based overnight care.
• Target Populations: Adults 65+ or with physical disabilities (Community Choices Waiver), and individuals with intellectual/developmental disabilities (Comprehensive and Supports Waivers).
• Excluded Activities: Cannot be used for routine childcare, while the caregiver is at work, or to replace nursing care unless skilled respite is specifically authorized.
• Unit Types: Billed in 15-minute increments for short durations or per diem for 24-hour overnight relief.

2. Regulatory and Oversight Agencies

Oversight of Respite Care Services is split based on the waiver program. The Division of Healthcare Financing manages the Community Choices Waiver, while the Behavioral Health Division oversees the developmental disability waivers.

Medicaid enrollment and claims processing are handled by the state's fiscal agent through a dedicated provider portal.

• Agency: Wyoming Department of Health (WDH) (https://health.wyo.gov/)
• Division: WDH Division of Healthcare Financing (https://health.wyo.gov/healthcarefin/medicaid/)
• Division: WDH Behavioral Health Division (https://health.wyo.gov/behavioralhealth/)
• Portal: Wyoming Medicaid Provider Portal (https://wyoming.dyp.cloud/)

3. Gatekeeping Prerequisites: Who Can Even Apply

Wyoming does not impose a Certificate of Need (CON), closed network moratorium, or county sponsorship requirement for Respite Care Services. The market operates under open enrollment for any entity that meets waiver certification standards.

Applicants must secure waiver-specific certification from the appropriate WDH division before their Medicaid enrollment application will be processed.

• Certificate of Need: None exists for HCBS respite care in Wyoming.
• Network Status: Open enrollment; no RFP or managed care contracting required.
• Prior Approval: Providers must obtain waiver-specific certification from the respective WDH division before Medicaid enrollment is accepted.
• Business Registration: Must be registered and in good standing with the Wyoming Secretary of State.

4. Licensure and Certification Requirements

Wyoming does not issue a distinct "Respite Care License." In-home providers are certified directly under the waiver rules by the operating division.

If respite is provided in a congregate or facility setting, the physical location must hold the appropriate state license for that facility type.

• In-Home Respite: Requires WDH waiver certification rather than a state facility license.
• Facility-Based Respite: Must hold an active Wyoming Assisted Living Facility or Adult Day Care license if providing services in a congregate setting.
• Skilled Respite: Requires an active Wyoming Home Health Agency license if delegating nursing tasks.
• Certification Renewal: Waiver certification is typically reviewed every 1 to 3 years depending on the division.

5. Medicaid Provider Enrollment

After obtaining waiver certification, providers submit an enrollment application through the Wyoming Medicaid Provider Portal operated by HHS Tech Group.

Providers must sign the Wyoming Medicaid Provider Agreement and meet all federal screening requirements.

• System: Wyoming Medicaid Provider Portal (https://wyoming.dyp.cloud/).
• NPI Requirement: Must obtain a Type 2 NPI for the agency.
• Application Fee: Subject to the federal Medicaid application fee unless waived by Medicare enrollment.
• Agreement: Must sign the Wyoming Medicaid Provider Agreement.

6. Staffing, Training and Background Checks

Direct support professionals delivering respite must meet baseline age, background, and training standards before providing care.

Agencies are responsible for maintaining personnel files that prove compliance with these standards.

• Age Requirement: Staff must be at least 18 years old.
• Background Checks: Must clear the Wyoming Division of Criminal Investigation (DCI) fingerprint check and Department of Family Services (DFS) Central Registry.
• Certifications: Current CPR and First Aid certification required prior to independent client contact.
• Training: Must complete training on abuse/neglect reporting, participant rights, and specific needs outlined in the Individualized Service Plan (ISP).

7. Documentation, Policies and Records

Providers must maintain comprehensive policy manuals and daily service records to justify Medicaid billing.

Documentation must clearly link the service provided to the goals and authorizations in the participant's care plan.

• Service Records: Must document start/stop times, date, location, and activities provided during the respite shift.
• Caregiver Verification: Requires signature or electronic verification from the primary caregiver or participant.
• Incident Reporting: Policies must dictate reporting of critical incidents to WDH within 24 hours.
• Record Retention: All clinical and billing records must be retained for a minimum of six years.

8. Billing, Rates and Claims

Respite claims are submitted through the MMIS portal based on prior authorizations generated by the participant's case manager.

Services cannot be billed concurrently with other direct care waiver services.

• Prior Authorization: All respite hours must be authorized in the participant's approved ISP before delivery.
• Procedure Codes: Commonly billed using S5150 (15-minute units) or S5151 (per diem).
• Claim Format: Submitted via the 837P electronic format or CMS-1500 form.
• Rate Setting: Rates are established by the WDH Division of Healthcare Financing and published in the waiver fee schedules.

9. Approval Sequence and Timeline

The process moves from business formation to division certification, followed by Medicaid enrollment.

Delays in background checks or incomplete policy submissions are the most common causes of extended timelines.

• Step 1: Register business entity with the Wyoming Secretary of State (1-2 weeks).
• Step 2: Submit waiver certification application to the appropriate WDH division (30-60 days).
• Step 3: Complete background checks and staff training (concurrent with certification).
• Step 4: Submit Medicaid enrollment application via the Provider Portal (30-45 days).

10. Common Denials and Survey Findings

Applications and post-enrollment audits frequently fail due to incomplete documentation or failure to adhere to authorized service limits.

Surveyors heavily scrutinize service logs to ensure respite is not being used as a substitute for routine childcare or employment support.

• Application Denial: Missing or incomplete DFS Central Registry background checks for owners or staff.
• Audit Finding: Billing for respite while the primary caregiver is at work (which is prohibited under waiver rules).
• Audit Finding: Missing start and stop times on daily service logs.
• Audit Finding: Delivering services before the ISP prior authorization is officially approved.

11. Key Contacts and Resources

Primary resources for prospective providers include the WDH divisions and the Medicaid fiscal agent.

Providers should regularly check the WDH website for provider bulletins and manual updates.

• Wyoming Department of Health: https://health.wyo.gov/
• Division of Healthcare Financing: https://health.wyo.gov/healthcarefin/medicaid/
• Behavioral Health Division: https://health.wyo.gov/behavioralhealth/
• Wyoming Medicaid Provider Portal: https://wyoming.dyp.cloud/

See all Wyoming services · Wyoming Medicaid consulting · book a consultation.