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

Last reviewed: 2026-09-09

Delaware funds Respite Care Services primarily through the Diamond State Health Plan-Plus (DSHP-Plus) 1115 demonstration waiver and the Division of Developmental Disabilities Services (DDDS) Lifespan Waiver.

To bill for these services, an agency must first hold a valid license from the Division of Health Care Quality (DHCQ) as a Home Health Agency, Personal Assistance Services Agency, or Family Care Home, and then secure network contracts with Delaware's Medicaid Managed Care Organizations.

1. Service Definition and Scope

In Delaware, Respite Care Services provide short-term relief to unpaid primary caregivers, ensuring the waiver participant continues to receive necessary supervision and support.

The service can be delivered in the individual's home, a licensed Family Care Home, or a facility setting, depending on the specific waiver authorization.

• Scope: Includes assistance with activities of daily living, supervision, and basic health and safety monitoring.
• Limitations: Cannot be billed simultaneously with other direct care services like personal care or day habilitation.
• Settings: Authorized for in-home delivery or out-of-home in licensed facilities.
• Waiver Authority: Covered under DSHP-Plus and the DDDS Lifespan Waiver.

2. Regulatory and Oversight Agencies

Multiple divisions within the Delaware Department of Health and Social Services (DHSS) oversee respite providers.

Licensure is handled by DHCQ, while Medicaid enrollment and waiver operations are managed by DMMA and DDDS.

• Division of Health Care Quality (DHCQ): Licenses the underlying agency types (https://dhss.delaware.gov/dhss/dhcq).
• Division of Medicaid and Medical Assistance (DMMA): Oversees the Medicaid state plan and 1115 waiver (https://dhss.delaware.gov/dhss/dmma).
• Division of Developmental Disabilities Services (DDDS): Operates the Lifespan Waiver for individuals with intellectual disabilities (https://dhss.delaware.gov/dhss/ddds).
• Delaware Medical Assistance Portal (DMAP): The Gainwell-operated MMIS portal for provider enrollment (https://medicaid.dhss.delaware.gov/provider).

3. Gatekeeping Prerequisites: Who Can Even Apply

Delaware does not license a standalone 'Respite Agency.' Applicants must first establish a licensed healthcare or personal care business.

For DSHP-Plus, providers must secure contracts with the state's Managed Care Organizations (MCOs) to receive referrals and reimbursement.

• Licensure Prerequisite: Must hold an active DHCQ license as a Home Health Agency (HHA), Personal Assistance Services Agency (PASA), or Family Care Home (FCH) before applying for Medicaid enrollment.
• MCO Contracting: DSHP-Plus respite providers must successfully credential and contract with Highmark Health Options, AmeriHealth Caritas Delaware, or Delaware First Health.
• DDDS Authorization: Providers targeting the Lifespan Waiver must apply through the DDDS Provider Authorized Provider network process.
• Physical Location: Agencies must maintain a physical office or licensed home within Delaware or the immediate border area as defined by DMMA.

4. Licensure and Certification Requirements

Providers must comply with the Delaware Administrative Code Title 16 requirements for their specific agency type.

For out-of-home respite in a residential setting, a Family Care Home license or similar facility license is mandatory.

• PASA License: Requires submission of policies, procedures, and an administrator qualified by DHCQ.
• Family Care Home (FCH) License: Requires a physical inspection by DHCQ and a maximum capacity limit as defined in 16 DE Admin. Code 3310.
• Application Fee: Varies by license type, typically submitted to DHCQ with the initial application packet.
• Inspections: Initial license is often provisional for six months, followed by an on-site survey to grant full licensure.

5. Medicaid Provider Enrollment

Once licensed, providers must enroll through the Delaware Medical Assistance Portal (DMAP).

Enrollment requires passing federal screening criteria based on the provider's risk level.

• Portal: Applications are submitted online via DMAP (https://medicaid.dhss.delaware.gov/provider).
• Application Fee: Subject to the federal Medicaid application fee unless waived by Medicare enrollment.
• Screening Level: Typically categorized as moderate or high risk, requiring fingerprint-based background checks for owners with 5% or more interest.
• MCO Credentialing: After DMAP approval, providers must complete separate credentialing applications with each Delaware Medicaid MCO.

6. Staffing, Training and Background Checks

Direct support professionals providing respite must meet state-mandated training and background check requirements.

Agencies are responsible for maintaining these records in the employee's personnel file.

• Background Checks: Mandatory fingerprint-based state and federal criminal history checks through the Delaware State Bureau of Identification (SBI).
• Registry Checks: Must clear the Delaware Adult Abuse Registry and Child Protection Registry.
• CPR/First Aid: All direct care staff must hold current certification in CPR and basic First Aid.
• Dementia Training: FCH providers serving individuals with Alzheimer's must complete annual dementia-specific training per 16 DE Admin. Code.

7. Documentation, Policies and Records

Providers must maintain comprehensive records for both the agency's operations and the individual participants.

DHCQ and the MCOs conduct routine audits to ensure compliance with documentation standards.

• Service Plan: Respite must be delivered according to the participant's authorized person-centered service plan.
• Timesheets: Must include exact start and stop times, date of service, and signatures of the staff and the participant or caregiver.
• Level of Care: FCH providers must maintain a copy of the resident's level of care determination.
• Policy Manual: Must include emergency procedures, grievance processes, and abuse reporting protocols.

8. Billing, Rates and Claims

Reimbursement for respite is handled primarily through the MCOs for DSHP-Plus or through the MMIS for fee-for-service DDDS participants.

Rates are established by DMMA and DDDS, though MCOs may negotiate specific contract rates.

• Procedure Codes: Typically billed using HCPCS codes such as S5150 (unskilled respite, 15 minutes) or S5151 (per diem), depending on the authorization.
• Prior Authorization: All respite services require prior authorization from the participant's MCO or DDDS case manager.
• Claim Submission: Claims are submitted electronically via the DMAP portal or the respective MCO's clearinghouse.
• EVV Requirement: In-home respite services are subject to Electronic Visit Verification (EVV) mandates in Delaware.

9. Approval Sequence and Timeline

The process to become a fully billing respite provider in Delaware is sequential and can take several months.

Licensure must be fully secured before Medicaid enrollment can begin.

• Step 1: Submit licensure application and policies to DHCQ (3-6 months).
• Step 2: Pass DHCQ initial inspection and receive provisional license (1 month).
• Step 3: Submit Medicaid enrollment application via DMAP (1-3 months).
• Step 4: Complete credentialing and contracting with Delaware MCOs (2-4 months).

10. Common Denials and Survey Findings

Applications and surveys frequently face delays due to incomplete documentation or failure to meet physical plant requirements.

Understanding these common pitfalls can expedite the approval process.

• Incomplete Policies: DHCQ often rejects applications that lack Delaware-specific abuse reporting or emergency policies.
• Background Check Gaps: Failure to complete the Adult Abuse Registry check before a staff member's first day of contact.
• Physical Plant: For FCHs, failing to provide a separate bedroom for the resident away from the provider's family members.
• MCO Network Adequacy: MCOs may deny contracts if they determine their current network of respite providers is adequate.

11. Key Contacts and Resources

Prospective providers should utilize the official state portals and division websites for the most current forms and manuals.

Contacting the specific division early in the process is highly recommended.

• DMAP Provider Services: 1-800-999-3371 for enrollment portal assistance (https://medicaid.dhss.delaware.gov/provider).
• DHCQ Licensing: Oversees PASA and FCH licensure (https://dhss.delaware.gov/dhss/dhcq).
• DDDS Provider Network: For Lifespan Waiver inquiries (https://dhss.delaware.gov/dhss/ddds).
• Highmark Health Options: MCO provider contracting (https://www.highmarkhealthoptions.com).

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