Wyoming home health agency license: the two-service test, provisional license and survey

Does your business fall under the home health license?

Wyoming’s statute defines a home health agency as one “primarily engaged in arranging and directly providing nursing or other health care services to persons at their residence”.⁠¹ The HLS licensure rule narrows this. You are a home health agency if you arrange for and directly provide two or more health care services in clients’ homes.⁠³ The rule lists these as health care services: nursing, physical therapy, speech therapy, occupational therapy, respiratory therapy, medical social work, home health aide and dietary services.⁠³ A license is required before you serve your first client.⁠²

How common business models fit the definition:

• Nursing plus aide care, or any two therapies. You need this license.⁠³
• Housekeeping, shopping, laundry, errands and basic meals only. The program rule defines a homemaker as someone who “provide[s] no personal care”.⁠⁴ Wyoming’s health facility list has no separate license for homemaker or companion agencies.⁠¹ See the non-medical home care overview.
• Personal care (bathing, grooming, feeding, ambulating, skin care) delivered by aides. Chapter 9 makes personal care the job of the home health aide, who must be a certified nursing assistant (CNA).⁠⁴ An agency offering aide care alone provides one listed service, not two. The statute’s definition says only “nursing or other health care services,” while the rule says “two or more,” and HLS has published no guidance on an agency whose only service is CNA-level personal care. Ask HLS in writing, at (307) 777-7123 or [email protected], whether that model needs a home health license, and keep the answer before you open.
• Hospice. Hospice has its own HLS rule chapter and is not covered here.⁠¹⁰
• Residential care. If clients will live on your premises, look at the assisted living facility or adult foster care home license. For a daytime program, see the adult day care facility license.

Wyoming has no certificate of need step. The health facilities article simply says nobody may establish a health care facility without a license.⁠¹

Two rule chapters from 2001

HLS lists two rule chapters for home health agencies. Chapter 10 covers licensure and took effect November 1, 2001. Chapter 9 covers program administration and took effect October 15, 2001.⁠¹⁰ Chapter 9 was written by the Aging Division under the Senior Citizens Act. Where the two conflict, the licensure rules win.⁠³⁠⁴

Both chapters predate several agency moves, so some details in them are out of date. The rules name an “Office of Health Quality” at 2020 Carey Avenue.⁠³⁠⁴ HLS’s March 16, 2026 checklist gives this address: Hathaway Building, Suite 510, 2300 Capitol Avenue, Cheyenne, WY 82002, (307) 777-7123, [email protected].⁠⁵ The fee rules also differ. Chapter 10 tells you to pay the Treasurer, State of Wyoming.⁠³ HLS’s 2021 application instructions say to make checks payable to the Wyoming Department of Health.⁠⁶ Follow the instructions, or confirm the payee with HLS when you file.

The two people HLS checks first

Before your application can move, HLS reviews the qualifications of two key people. Their résumés and supporting documents are checklist items 5 and 6.⁠⁵

Administrator. Your governing body must appoint an administrator in writing. That person must be “responsible and available for all aspects of agency operation”.⁠⁴ To qualify, the administrator must be one of the following:⁠⁴

• a licensed physician, a registered nurse, or a college graduate with a bachelor’s degree, in each case with at least three years of health care management experience; or
• someone without a degree who can document the equivalent of six years of supervisory experience in health care management.

The administrator must also name, in writing, a qualified person who acts for them when they are unavailable.⁠⁴

Supervisory nurse. This must be an RN with at least one year of home health experience who is available during normal business hours.⁠⁴ If your RN lacks that year, a written consultation agreement can fill the gap. All parties must sign it. It must give your RN immediate access, 24 hours a day and 7 days a week, to an RN who has at least one year of home health experience. It stays in force until your RN reaches one year, and each consultation must be documented and kept where your RN works.⁠⁴ If the agreement applies to you, it goes in the packet as checklist item 7.⁠⁵

One dually qualified person may serve as both administrator and supervisory nurse.⁠⁴

Aides, homemakers and supervision intervals

Chapter 9 defines a home health aide as a CNA certified by the Wyoming Board of Nursing who has completed 16 hours of additional home health training approved by the Board.⁠⁴ Your agency must keep documentation of each aide’s competency training in their personnel file.⁠⁴ All clinical staff must be licensed or certified under Wyoming law.⁠⁴

Homemaker services are optional. You can provide them directly or contract them out to a vendor. Either way, you must file a homemaker policy. If you will not offer homemaker services, you must file a written statement saying so.⁠⁴⁠⁵

Every employee needs a check of the Department of Family Services central registry, which lists perpetrators of child abuse and of abuse or neglect of disabled adults.⁠⁴ Your packet must show the DFS screen results for the manager and every employee already on staff.⁠⁵ You must also document that each employee is free of communicable diseases that could put clients at risk.⁠⁴

The 17-item packet HLS approves before anything else

HLS’s Home Health Agency Checklist for State Licensure, dated March 16, 2026, lists everything you must mail or email to HLS:⁠⁵

1. Application and fee

   The completed license application form with the required fee.

2. Fidelity bond

   Proof of a bond of at least $2,500, increased as your number of employees grows.

3. Organizational chart

   It must show lines of authority from management down to the client-care level.

4. Geographic service area

   List the cities, towns or whole counties you will serve, and say whether they all border your parent location.

5. Administrator

   Qualifications, résumé and supporting documents.

6. Supervisory nurse

   Qualifications, résumé, supporting documents and license number.

7. Consulting nurse

   The consultation agreement, if you need one.

8. Central registry

   Your policy for checking every employee, plus screen results for the manager and existing staff.

9. Scope of services

   Your policy on the services you provide.

10. Quality management

    Your quality management program, which W.S. 35-2-910 requires of every licensee.⁠¹

11. Client rights

    Your client rights policy.

12. Grievances

    Your written grievance procedure.

13. Personnel records

    A policy naming the one person responsible for keeping personnel records confidential.

14. Employee health

    Your policy, including communicable disease information.

15. Hiring

    Your policy for screening job applicants.

16. Advance directives

    Your advance directive policy.

17. Homemakers

    Your homemaker services and training policy, or a written statement that you will not offer homemaker services.

The policies have to match what Chapter 9 requires. The client rights list has 14 rights, including the right to be told the cost of care and how payment will be handled at admission, and the right to call a home health hotline number that you provide.⁠⁴ Your grievance procedure must give clients the names, addresses and phone numbers of outside agencies they can contact. It must also commit you to reporting unresolved grievances to HLS within 10 days of filing.⁠⁴ Client complaints must be referred in writing to the State Long Term Care Ombudsman.⁠⁴

The statute requires a sworn application. If the applicant is not an individual, two officers or the managing agents must sign it. The form also asks whether you have ever had a health care license denied, suspended or revoked in any state.⁠¹

Choosing your geographic service area

Wyoming licenses home health agencies by service area. You can define the area by whole counties, by cities or towns, or by zip codes, and you must attach a map.⁠⁶ If you plan to bill Medicare, the area on your state license must match the one in your CMS-855 enrollment application.⁠⁶ HLS asks whether each requested area borders your parent location.⁠⁵

Widening the area later takes a separate application. The March 13, 2026 expansion checklist asks for a narrative explaining why each new area needs you, backed by access-to-care data such as a lack of other providers. It also asks how you will staff and supervise each area and how client records will get back to your main office.⁠⁸ Plan your first service area with this in mind.

From application to permanent license

1. Send the application, fee and checklist

   Email works, with the subject line “License Application Submission”. You still have to mail an original signature page together with the check. Do not mail a hard copy of the whole application, because HLS says that can cause delays.⁠⁶ Each facility needs its own application and its own check.⁠⁶ HLS sends all official notices, including survey results, to the single email address you list.⁠⁶

2. Receive a provisional license

   Once HLS approves your packet, it issues a provisional license, and you may begin serving clients.⁠² The statute allows a provisional license with restrictions when operating will not endanger patients.⁠¹

3. Request your survey in writing

   When you are giving two or more services to clients, you must ask HLS in writing for a health survey.⁠²

4. Unannounced survey

   State surveyors come without notice “as soon as scheduling permits”.⁠² The survey covers the rules, home visits, a review of client records and how well your quality management program works.⁠³

5. Correct any deficiencies

   HLS sends cited deficiencies within 10 working days after the survey. You have 10 working days from receipt to submit a plan of correction. HLS then has 10 working days to accept or reject it. Each correction date can be no more than 60 days after the last day of the survey.⁠³

6. Receive the permanent license

   HLS issues it once you are found in compliance.⁠² The license takes effect on the survey date if there were no deficiencies. Otherwise it takes effect on the date your acceptable plan of correction was developed.⁠³ You must display the license in a public area of your office.⁠³

HLS publishes no processing time for any of these steps.

If HLS denies, suspends or revokes your license, you have 10 days from receiving the notice to request a hearing in writing.⁠³

Fees as published

The full $150 is due even if your license starts partway through the year, and licenses renew each year when you pay the fee.⁠¹ HLS’s application instructions note that the statute changed fees on July 1, 2021, and that HLS accepts only checks.⁠⁶ The statute’s separate inspection fee applies to assisted living applicants, and HLS publishes no survey fee for home health agencies.⁠¹

Medicare certification and the 2026 federal freeze

A Wyoming license “does not enroll or certify” you in Medicare or Medicaid.⁠² HLS is also the state survey agency for Medicare. Its process runs in this order:⁠²

1. Submit a CMS-855A enrollment application to your Medicare administrative contractor.
2. Wait for the contractor to send its recommendation to HLS. HLS will not do the federal survey before then.
3. HLS surveys you against the Conditions of Participation and forwards its findings to the CMS regional office in Denver.
4. CMS sets your participation date. Medicare will not pay for any visit before that date.

New Part A providers also need a civil rights clearance from the HHS Office for Civil Rights.⁠² HLS warns that CMS ranks most initial surveys at the lowest priority, which makes accreditation-based deemed status the faster route.⁠²

What changed in 2026. CMS put a nationwide moratorium on Medicare enrollment of new home health agencies and new branches, effective May 13, 2026, for an initial six months. CMS can extend it in six-month steps and says it will publish any extension in the Federal Register.⁠¹⁴ The freeze does not reach applications the Medicare contractor had received before May 13, 2026.⁠¹⁴⁠¹⁵ During the moratorium, accreditation does not give deemed status.⁠¹⁵ A search of the Federal Register on October 12, 2026 found no extension notice, and the initial six months run to about mid-November 2026. The official sources do not say whether CMS will extend it, so ask your Medicare administrative contractor or CMS provider enrollment ([email protected]) about the status before you plan around a Medicare start date.

Under the moratorium you can still get a Wyoming license and serve private-pay clients. You must tell every prospective client before admission if your agency is not Medicare or Medicaid certified.⁠⁴ You must also give 30 days’ notice before you change your charges.⁠⁴

Medicaid and the Community Choices Waiver

To enroll in Wyoming Medicaid, a provider must meet the state’s licensing standards and, where applicable, Medicare certification standards.⁠¹¹ HLS’s page says Medicare approval is a prerequisite for the state Medicaid program.⁠²

The Community Choices Waiver (CCW) serves older adults and adults with physical disabilities in their homes. CMS approved its renewal effective July 1, 2026.⁠¹³ In the state’s renewal application, the home health aide and skilled nursing services are provided by home health agencies holding the Wyoming license, and the license is one route to providing personal support and respite services.⁠¹² An agency that is a home health agency and offers waiver homemaker or respite services must be fully licensed, enrolled in Medicaid and certified by the Division of Healthcare Financing for that service.⁠¹² The Division certifies a new agency for one year and recertifies at least every three years, and HLS checks employee qualifications during its licensure surveys.⁠¹² The state document cited here is the draft application dated November 13, 2025, so confirm the final waiver terms with the Division before you apply.

Branches, drop sites and ownership changes

Branches. A branch inside Wyoming operates under the parent agency’s license. A branch located out of state must be licensed individually in Wyoming.⁠³ Adding a branch takes HLS’s March 16, 2026 form. It asks for the branch staff and their qualifications, any high-tech services such as infusion therapy, ventilator or tracheostomy care, and how the parent agency will supervise the branch.⁠⁷

Drop sites. The drop site form asks whether staff are assigned there, whether aides get assignments there, and whether clinical records are kept there.⁠⁹

Ownership changes. The statute says licenses cannot be assigned or transferred.⁠¹ HLS processes a change of ownership the same way as a new application.⁠⁶ Chapter 10 also requires written notice to HLS at least 30 days before any transfer.⁠³

Name changes. You must tell HLS in writing before the change. HLS then needs a new application and fee.⁠³

Closing. Give HLS 30 days’ written notice before you close. Return the license on the first working day after closing. Keep personnel, financial and client records for at least six years.⁠³

Renewal, inspections and penalties

HLS sends renewal applications with a cover letter that sets the due date, and the license year starts July 1.⁠³ HLS surveys agencies for renewal.⁠³ If a nationally recognized accrediting body approved under federal rules accredits your agency, the statute grants renewal without a state inspection. HLS can still inspect any standard where the accreditor’s standards fall below the state’s.⁠¹ Chapter 9 requires you to keep client records for six years.⁠⁴

Operating without a license is a misdemeanor. It carries a fine of up to $750, up to six months in jail, or both. Each calendar week of operation counts as a separate offense.⁠¹

Sources

1. 1
   Wyoming State Legislature, Wyoming Statutes Title 35, ch. 2, art. 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, Home Health Agency: Wyoming licensure information Checked 12 Oct 2026 · Back to text ↑
3. 3
   Wyoming Department of Health, Chapter 10: Licensure of Home Health Agency (effective 11/01/2001) Checked 12 Oct 2026 · Back to text ↑
4. 4
   Wyoming Department of Health, Aging Division, Chapter 9: Program Administration of Home Health Agencies (effective 10/15/2001) Checked 12 Oct 2026 · Back to text ↑
5. 5
   Wyoming Department of Health, Healthcare Licensing and Surveys, Home Health Agency Checklist for State Licensure (03/16/2026) 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, Home Health Agency Addition of Branch Location (03/16/2026) Checked 12 Oct 2026 · Back to text ↑
8. 8
   Wyoming Department of Health, Healthcare Licensing and Surveys, Home Health Agency Geographic Service Area(s) Expansion (03/13/2026) Checked 12 Oct 2026 · Back to text ↑
9. 9
   Wyoming Department of Health, Healthcare Licensing and Surveys, Home Health Agency Addition of Drop Site Location (08/14/2025) Checked 12 Oct 2026 · Back to text ↑
10. 10
    Wyoming Department of Health, Healthcare Licensing and Surveys, HLS Rules and Regulations Checked 12 Oct 2026 · Back to text ↑
11. 11
    Wyoming Department of Health, Wyoming Medicaid Rules, Chapter 3: Provider Participation Checked 12 Oct 2026 · Back to text ↑
12. 12
    Wyoming Department of Health, Application for 1915(c) HCBS Waiver WY.002.07.00 (Community Choices Waiver), effective July 1, 2026 Checked 12 Oct 2026 · Back to text ↑
13. 13
    Centers for Medicare & Medicaid Services, CMS approval letter, Community Choices Waiver renewal WY.0236.R07.00 Checked 12 Oct 2026 · Back to text ↑
14. 14
    Federal Register, Announcement of Nationwide Temporary Moratoria on Enrollment of New Hospices and Home Health Agencies (2026-09717) Checked 12 Oct 2026 · Back to text ↑
15. 15
    Centers for Medicare & Medicaid Services, QSO-26-11-HHA/Hospice: enrollment moratoria and survey impact Checked 12 Oct 2026 · Back to text ↑

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