Wyoming assisted living facility license: Level 1, Level 2 and the HLS process

Which license fits your project

Wyoming defines an assisted living facility (ALF) as “a dwelling operated by any person, firm or corporation engaged in providing limited nursing care, personal care and boarding home care, but not habilitative care, for persons not related to the owner of the facility.”⁠¹ The definition expressly covers facilities with secured units and facilities dedicated to people with Alzheimer’s disease or other dementia.⁠¹ No resident minimum appears anywhere in the statute or rules, and the fee schedule starts at one bed, so a single-family house with two residents and a 60-bed building fall under the same license.⁠¹ The ALF rules define “limited nursing care” as care at the level a certified nursing assistant provides.⁠⁴

The state’s health facilities act says no one may establish any health care facility without a license, and HLS states that a valid license is required before you provide care to anyone.⁠¹⁠² Running an unlicensed facility is a misdemeanor punishable by a fine of up to $750, up to six months in jail, or both, and each calendar week counts as a separate offense.⁠¹

Wyoming licenses several neighboring facility types under the same act, and choosing wrongly means a second application later:⁠¹

• Boarding home. Rooms, meals and personal daily living care, with no nursing and no habilitative care. It has its own rules (Chapters 7 and 8)⁠¹³ and a fee set by the department between $500 and $750.⁠¹ If you will help with medications under RN oversight or give any CNA-level care, you are describing an ALF, not a boarding home.
• Adult foster care home. Care in a home-like setting for up to five unrelated adults who need long-term care, with a $250 fee. See the Wyoming adult foster care home guide.
• Alternative eldercare home. A separate facility type defined in the Wyoming Long Term Care Choices Act, which controls over the health facilities act if the two conflict.⁠¹
• Adult day care facility. Activities-of-daily-living support and supervision on a social model for four or more adults with physical or mental disabilities, with a $250 fee.⁠¹

A boarding home that was operating before the ALF rules took effect and converts to an ALF must give HLS written verification from a certified electrician that all wiring meets code.⁠³

Level 1 or Level 2: decide before you design

Chapter 12 of the HLS rules creates two license levels. A Level 1 license is for facilities without a secure unit. A Level 2 license is for facilities with a secure unit, and those facilities must meet every Level 1 requirement plus the Level 2 rules.⁠⁴ The application form asks for the number of Level 1 beds and Level 2 beds and whether the Level 2 beds are in a secure unit.⁠⁷

This choice drives your manager hire, your nurse schedule and your building layout, so settle it before an architect draws anything. The Level 2 add-ons, all from Chapter 12, Section 10:⁠⁴

Level 2 residents must be discharged when intermittent nursing care becomes ongoing or when they need more than limited help to evacuate the building.⁠⁴ The 2025 licensure checklist lists seven extra submissions for Level 2 applicants, from the manager’s added qualifications to Level 2 admission and discharge policies.⁠⁵

Who you can admit, and what Level 1 staff cannot do

Wyoming draws the care ceiling with an explicit list. Chapter 12, Section 8 bars Level 1 facility staff from providing:⁠⁴

• continuous help with transfers and mobility
• care of residents who cannot feed themselves or whose diet must be monitored
• total help with bathing and dressing
• invasive catheter or ostomy care
• care of residents on continuous oxygen that needs continuous monitoring or is titrated by saturation
• care of residents whose wandering endangers them
• incontinence care by facility staff
• sterile dressing changes, and stage II skin care and beyond
• care of residents with frequent aggressive, abusive or disruptive behavior, or with chemical abuse that puts anyone at risk
• monitoring of acute medical conditions

What you do provide is defined as core services: meals, housekeeping and laundry; help arranging local transportation and medical, dental and eye care; recreation; a personal fund account if the resident asks; partial help with bathing and limited help with dressing; minor non-sterile dressing changes; stage I skin care; infrequent mobility help; RN assessments; an RN medication review every two months (62 days) or whenever medications change; and 24-hour monitoring of each resident.⁠⁴

Care beyond that comes from outside providers under a written contract among the resident, the facility and the provider. Chapter 12 names Community Choices Waiver services, hospice, Medicare/Medicaid-certified home health and private duty care as services delivered outside the ALF’s authority, and every such contract must spell out each party’s duties for evacuation and fire safety.⁠⁴ If you plan to partner with a home health agency, see the Wyoming home health agency guide.

Admission paperwork the rules require

Before admission, an RN completes the state’s ALF 102 screening tool, valid only if done within 45 days before admission with no change in condition. It may be taken by phone but must be verified in person by an RN, and it is redone at least yearly.⁠⁴ The resident must also arrive with a history and physical done by a physician or physician extender within 90 days before admission, and admission orders must cover TB screening and influenza and pneumococcal immunization status.⁠⁴ The RN’s own assessment happens no earlier than one week before admission, again on any significant change, and at least every 12 months.⁠⁴

The building

Room and bathroom standards

Chapter 4, Section 6 sets the physical plant numbers HLS engineers check:⁠³

Square footage excludes toilets, closets, wardrobes, alcoves and vestibules.⁠³ Bedrooms cannot be in an attic, basement, stairwell or hall, and no resident may have to walk through another resident’s bedroom to reach their own room or a bathroom.⁠³ Chapter 12 adds that free-standing closets are deducted from bedroom square footage, shared rooms need 3 feet between beds, and at least one primary grade-level entrance must be wheelchair accessible.⁠⁴

The half-private rule is the one that most often changes a business plan: in a 10-bed house at least five beds must be in private rooms, which caps how many residents a given floor plan can hold.⁠³

Site and construction limits

The building must sit in a lawfully constituted fire district, on an all-weather road kept open year-round, within 30 minutes’ drive of a physician or ambulance service.⁠³ Mobile homes cannot be used as ALFs or additions to them.⁠³ Any building more than one story needs an automatic elevator, and multi-story wood-frame buildings must be sprinklered.⁠³

HLS’s construction rule (Chapter 3, effective April 3, 2008) adopts the 2006 editions of the NFPA 101 Life Safety Code and the International Building, Fire, Mechanical, Plumbing and Fuel Gas codes.⁠⁹ ALFs are exempt from the FGI design guidelines that apply to hospitals and nursing homes, but an ALF with sleeping rooms for more than 16 residents must have an NFPA 13 sprinkler system.⁠⁹ Chapter 12 also sets an evacuation standard: groups of eight or fewer residents must rate “prompt” (evacuating in three minutes or less) and groups of nine or more must rate prompt or slow (three to 13 minutes), measured by timed fire drills; the rule makes an exception for a facility whose construction meets the impractical rating.⁠⁴ Your resident mix, and how fast they can get out, therefore limits which construction type you can use.

A building conversion needs occupancy approval from HLS before a license issues, and every item of noncompliance must be fixed first.⁠³ If a building’s license lapsed, Chapter 3 exempts it from the current code requirements only when the lapse is no more than ten years and the building was continuously maintained to the standard in effect at its last licensure (for NFPA 101, the 2000 edition); any construction, remodel or expansion during the lapse must meet the new-construction rules.⁠⁹

Plan review

By statute, anyone planning construction, alteration or an addition must submit plans and specifications to HLS for approval before construction starts.⁠¹ HLS applies this to converting an existing structure into a health care facility as well.⁠⁸ The HLS ALF page tells applicants to call an HLS engineer at (307) 777-7123 after reading the rules to discuss building requirements and the construction review process.⁠²

Under Chapter 3, preliminary plans are reviewed first. Their approval expires after 12 months if final plans are not approved, and a plan approval lapses if construction does not begin within 180 days.⁠⁹ You may use HLS engineers or a registered third-party reviewer at your own expense for the final plan review and interim inspections. Some municipalities have taken over final building-code review (the third-party option does not apply there), but HLS keeps preliminary review and all final licensure and Life Safety Code inspections.⁠⁸ Private water systems must test safe and potable before licensure.⁠⁴

The manager and the staff

Manager qualifications

If the ALF has a governing body, it designates a manager; if not, the owner appoints one.⁠⁴ Under Chapter 12, Section 6, the manager must:⁠⁴

• be at least 21 and able to read, write and speak English
• have a telephone listed in the directory under the facility’s name
• pass an open-book test on the ALF licensure and program rules with a score of 85% or higher (HLS posts the “ALF-101 Manager Test” on its ALF page⁠²)
• have either 48 semester hours (72 quarter hours) of post-secondary study in health care, elderly care, case management, facility management or a related field, or two years of paid or volunteer experience working with elderly or disabled people
• never act as guardian or conservator for a resident, or hold a resident’s power of attorney

The manager is also the person who must deliver an acceptable plan of correction within 10 days after receiving a statement of deficiencies.⁠⁴

Staffing rules

Chapter 12 sets no numeric staff-to-resident ratio. Staffing must be enough to meet residents’ needs, with at least one RN, LPN or CNA on duty every shift and at least one person awake on duty at all times.⁠⁴ Any nurse aide you employ must be certified by the Wyoming State Board of Nursing, and the manager must verify it.⁠⁴ If you do not employ an RN, you must contract with one for initial assessments, periodic reviews, assistance plans and medication management.⁠⁴ The RN supervises all medication administration; unlicensed staff may only assist with oral medications (reminding, opening containers, observing and documenting).⁠⁴

Every staff member must clear a Wyoming Division of Criminal Investigation fingerprint check and a Department of Family Services Central Registry screening before any direct resident contact.⁠⁴ New employees receive orientation on resident rights, evacuation and emergency procedures, and emergency-procedure training within their first week, repeated at least every 12 months.⁠⁴

If you will admit residents who need therapeutic or mechanically altered diets, you must employ or contract with a registered dietitian, and the person running daily food service needs experience equal to a Certified Dietary Manager.⁠⁴ The 2025 checklist asks every applicant for the dietary manager’s qualifications and a copy of the dietitian contract.⁠⁵

What goes in the application packet

HLS asks for the application, fee and the checklist items by mail or email to Healthcare Licensing and Surveys, 2300 Capitol Avenue, Suite 510, Cheyenne, WY 82002, [email protected].⁠²⁠⁵ The checklist dated August 14, 2025 lists:⁠⁵

1. Application and fee

   The completed ALF Initial/CHOW application with the license fee.

2. Background checks

   Evidence of DCI fingerprint checks and Central Registry screenings on all employees.

3. RN

   Name and nursing license number of a qualified registered nurse.

4. Manager

   Qualifications and proof of passing the HLS examination.

5. Dietary

   The dietary manager’s qualifications and the registered dietitian contract.

6. Core policies

   Quality improvement; employee health, including TB testing; and reporting incidents to HLS.

7. The 18 operating policies

   Resident rights; abuse discipline; admission, transfer, bed-hold and discharge; medication management; emergency care (missing resident, blizzard, water outage); fire/disaster plan; departure and return; smoking; visiting hours; activities; resident trust accounts; personnel; grievances; per diem rates and what they include; incident reports; notice of rate changes; outside contractual responsibilities; and change-of-condition notification.

8. Level 1 admission and discharge criteria

9. Level 2 items 12-18,

   if you are applying for Level 2 care.

The application instructions add a readable floor plan showing resident room numbers and the dining, activity, bathing and toilet areas.⁠⁶ The owner named on the form is the entity with legal control of the operation, not the owner of the building.⁠⁶

The statute requires a sworn application that discloses whether the applicant has ever had a health facility license denied, suspended, revoked or terminated for cause in any state, plus evidence that the applicant can comply with the rules.⁠¹ An organization’s application must be signed by two officers or by its managing agents.⁠¹ The form requires original signatures of two officers listed in the ownership section; HLS says a CEO, CFO, administrator or director signature will usually not be accepted, and managing agents must attach company documents proving their authority.⁠⁷

Payment is by check only, payable to the Wyoming Department of Health, per the 2021 instructions.⁠⁶ (The 2001 Chapter 4 rule still names the State Treasurer as payee.⁠³) If you email the packet, use the subject line “License Application Submission” and still mail the original signature page together with the check.⁠⁶

From application to full license

1. Read the rules and call HLS engineering

   HLS asks applicants to review the regulations and then talk with an engineer about building requirements and construction review.⁠²

2. Get plan and occupancy approval

   New construction, additions and conversions go through preliminary and final plan review before work starts; converted buildings need occupancy approval before a license issues.⁠¹⁠³⁠⁹

3. Submit the application, fee and checklist packet

   HLS reviews the paperwork against the checklist.⁠²⁠⁵

4. Receive a provisional license

   Once HLS approves the building and paperwork, it issues a provisional license and you may begin serving residents.⁠² A provisional license lasts no more than 60 days and may be renewed at HLS’s discretion.⁠³

5. Admit residents, then request the survey in writing

   HLS surveys only once you are actually serving residents, and the survey is unannounced, scheduled “as soon as scheduling permits.”⁠²

6. Answer deficiencies

   HLS sends cited deficiencies within 10 working days after the survey; you have 10 calendar days to return an acceptable plan of correction naming who fixes each item, how, who monitors it, and a correction date no more than 60 days after the survey.⁠³

7. Full license

   When the survey finds you in compliance, HLS issues the permanent license.⁠² By statute, the division acts on an ALF application within 30 days after receiving the inspector’s report.⁠¹ Post the license in a public area, and post survey results where the public can review them.⁠³

Fees as published

The license runs July 1 to June 30 and the full fee is due even if the license is issued partway through that year, so opening in May costs a full year’s fee that expires on June 30.⁠¹ The HLS form lists the same three tiers for new and change-of-ownership applications.⁠⁷ The statute directs the division to select an inspector for ALF applicants, set the inspector’s fee, and tell you the amount before the inspection; HLS says the survey fee invoice arrives after the inspection.⁠¹⁠² HLS does not publish the dollar amount.

Wyoming’s health facilities act contains no certificate-of-need step for an ALF.⁠¹

Running the facility: rules surveyors check first

A few Chapter 12 operating rules shape daily routines and show up on surveys:⁠⁴

• Fire drills. At least 12 a year, monthly, with at least one per shift each quarter, recorded with timed evacuation results; keep two years of drill records. Each new resident is shown the fire plan and exits on their first day.
• Emergency plans. Written plans for fire, severe weather and missing residents, kept in the building.
• Food. At least three meals in 24 hours, menus planned two weeks ahead and posted in the kitchen.
• Water and heat. Bathing and handwashing water no hotter than 120°F; the heating system inspected every year before the heating season; no portable space heaters.
• Linens. Two complete changes of clean bed linen on hand for every licensed bed.
• Discharge. Residents get 30 days’ written notice of a facility-initiated discharge except for imminent danger or care needs beyond ALF limits; the allowed reasons are limited to five, and a resident who objects may request an informal conference within 10 days.

Medicaid: the Community Choices Waiver

A license does not enroll you in Medicare or Medicaid.⁠² Wyoming Medicaid pays ALFs through the Community Choices Waiver (CCW), a 1915(c) waiver for adults 19 and older with physical disabilities and people over 65. CMS approved its renewal effective July 1, 2026, with Assisted Living Facility services included.⁠¹¹

Under the renewal application (a November 2025 draft that CMS approved on March 26, 2026), the ALF service covers personal care and supportive services, social and recreational programming and medication assistance in a setting that meets federal home and community-based settings requirements and has 24-hour on-site response.⁠¹⁰ Payment excludes room and board, comfort items and facility upkeep, and nursing and therapy are incidental, so the rate does not cover 24-hour skilled care.⁠¹⁰

To become a CCW provider you need the ALF license, enrollment as a Medicaid provider and certification by the Division of Healthcare Financing. DHCF certifies a new provider for one year, then recertifies at least every three years.⁠¹⁰ Chapter 12 requires managers to keep a list of the rooms occupied by waiver participants and give it to the program division on request.⁠⁴

Renewal, changes and closing

Licenses renew each year on payment of the fee, unless suspended or revoked; HLS sends a renewal application with a due date in its cover letter.⁠¹⁠³ Renewal applications also report admission and occupancy data.⁠⁶ Periodic surveys use the Chapter 4 and Chapter 12 rules, and where they conflict, Chapter 4 controls.⁠³

The statute says licenses are not assignable or transferable, though Chapter 4 lets HLS approve an assignment on 30 days’ written notice.⁠¹⁠³ A change of ownership is processed exactly like an initial application, and a new owner takes on the previous owner’s plan of correction.⁠³⁠⁶ A change of name or bed count needs a new application and the $250 revised-license fee.⁠¹⁠³ For a voluntary closure, notify HLS in writing at least 30 working days ahead, place every resident elsewhere, and keep personnel, financial and resident records for six years.⁠³

When conditions endanger residents, HLS may place conditions on the license, suspend admissions, install a monitor or manager at the owner’s expense, or deny, suspend or revoke the license after notice and a hearing opportunity, and it can summarily suspend a license for a substantial and immediate threat.⁠¹

What has changed and what has not

• Licensing rules unchanged since 2020. HLS still lists Chapter 4 (effective June 28, 2001) and Chapter 12 (effective August 24, 2020) as the ALF rules.⁠² Parts of Chapter 4 are dated: it names the former “Office of Health Quality” and an old Carey Avenue address, while HLS now sits at 2300 Capitol Avenue.⁠²⁠³
• New checklist, August 2025. HLS posted a revised licensure checklist dated August 14, 2025, with separate Level 2 items.⁠⁵
• CCW renewal, July 1, 2026. The renewed waiver adds a provider qualification that the ALF must be able to support the participant’s person-centered service plan, and folds participant transportation into the ALF rate.⁠¹⁰⁠¹²
• Construction statute trimmed in 2025. Laws 2025, chapter 102 repealed W.S. 35-2-906(b), (c), (f) and (g); the plan-approval requirement in subsection (a) remains.⁠¹

Wyoming has guides for the other care licenses as well: adult foster care homes, home health agencies, child care centers and family child care homes. The Wyoming state page lists them all.

Sources

1. 1
   Wyoming Legislature, Wyoming Statutes, Title 35, chapter 2, article 9 (Health Care Facilities, W.S. 35-2-901 to 35-2-914) Checked 12 Oct 2026 · Back to text ↑
2. 2
   Wyoming Department of Health, Healthcare Licensing and Surveys, Assisted Living Facility Checked 12 Oct 2026 · Back to text ↑
3. 3
   Wyoming Department of Health, Chapter 4: Licensure of Assisted Living Facilities (effective 06-28-2001) Checked 12 Oct 2026 · Back to text ↑
4. 4
   Wyoming Department of Health, Chapter 12: Program Administration of Assisted Living Facilities (effective 08-24-2020) Checked 12 Oct 2026 · Back to text ↑
5. 5
   Wyoming Department of Health, Healthcare Licensing and Surveys, Assisted Living Facility Checklist for State Licensure (08-14-2025) Checked 12 Oct 2026 · Back to text ↑
6. 6
   Wyoming Department of Health, Healthcare Licensing and Surveys, State Initial/CHOW License Application Instructions (07-2021) Checked 12 Oct 2026 · Back to text ↑
7. 7
   Wyoming Department of Health, Healthcare Licensing and Surveys, Assisted Living Facility State Initial/CHOW License Application (07-2021) Checked 12 Oct 2026 · Back to text ↑
8. 8
   Wyoming Department of Health, Healthcare Licensing and Surveys, Healthcare Facility Construction Checked 12 Oct 2026 · Back to text ↑
9. 9
   Wyoming Department of Health, Chapter 3: Construction Rules and Regulation for Healthcare Facilities (effective 04-03-2008) Checked 12 Oct 2026 · Back to text ↑
10. 10
    Wyoming Department of Health, Division of Healthcare Financing, Application for a 1915(c) HCBS Waiver: Community Choices Waiver renewal draft, effective July 1, 2026 Checked 12 Oct 2026 · Back to text ↑
11. 11
    Centers for Medicare & Medicaid Services, CMS approval letter, Community Choices Waiver renewal WY.0236.R07.00 Checked 12 Oct 2026 · Back to text ↑
12. 12
    Wyoming Department of Health, Division of Healthcare Financing, Community Choices Waiver Renewal: Summary of Proposed Changes (renewal effective July 1, 2026) Checked 12 Oct 2026 · Back to text ↑
13. 13
    Wyoming Department of Health, Healthcare Licensing and Surveys, Rules and Regulations (Healthcare Licensing and Surveys) Checked 12 Oct 2026 · Back to text ↑

Was this information accurate? Report an errorPrint or save as PDF