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

Last reviewed: 2026-09-09

In Delaware, Skilled Respite Services are funded primarily through the Division of Developmental Disabilities Services (DDDS) Lifespan Waiver and the Diamond State Health Plan Plus (DSHP+) managed care program. The service provides temporary relief to primary unpaid caregivers by supplying licensed nursing professionals (RNs or LPNs) to care for individuals whose medical or behavioral needs exceed what an unskilled caregiver can safely manage.

To become an approved provider, an agency must first obtain a Home Health Agency license from the Office of Health Facilities Licensing and Certification (OHFLC), as skilled nursing tasks cannot be performed by unlicensed personal assistance agencies. Following licensure, providers seeking to serve the DDDS population must pass the DDDS Provider Authorization Committee review and respond to an open Request for Proposals (RFP) through the Division of Management Services (DMS) before enrolling in Delaware Medicaid via the Gainwell portal.

1. Service Definition and Scope

Skilled Respite is defined in Delaware as temporary, short-term relief provided to a primary unpaid caregiver, parent, court-appointed guardian, or foster parent of an individual with complex care needs. It is delivered in the individual's place of residence or the home of a friend or family member.

Unlike unskilled respite, which involves supervision and assistance with Activities of Daily Living (ADLs), skilled respite requires a qualified licensed or certified provider, such as a Registered Nurse (RN) or Licensed Practical Nurse (LPN). It is authorized for individuals with ongoing skilled medical needs (e.g., suctioning, G-tube feeding) or severe behavioral health needs requiring clinical supervision.

2. Regulatory and Oversight Agencies

Multiple divisions within the Delaware Department of Health and Social Services (DHSS) oversee the provision of skilled respite. The Office of Health Facilities Licensing and Certification (OHFLC) handles the facility/agency licensure required to deploy nurses.

The Division of Developmental Disabilities Services (DDDS) manages the Lifespan Waiver and authorizes providers for that population, while the Division of Medicaid and Medical Assistance (DMMA) oversees the DSHP+ managed care program and final Medicaid enrollment.

3. Gatekeeping Prerequisites: Who Can Even Apply

Delaware imposes strict structural prerequisites for agencies wishing to bill Medicaid for skilled respite. Because the service requires licensed nurses performing skilled tasks, an applicant cannot operate merely as a Personal Assistance Services Agency; they must hold a Delaware Home Health Agency License.

For providers targeting the DDDS Lifespan Waiver, enrollment is not a simple open application. Providers must first submit an application to the DDDS Provider Authorization Committee. Once authorized, they must respond to the continuous Request for Proposals (RFP) titled "Home and Community Based Services for Individuals with Intellectual and Developmental Disabilities" through the DMS Bonfire hub. Only after passing the RFP process can they enroll in Medicaid.

4. Licensure and Certification Requirements

To provide skilled respite, an agency must be licensed as a Home Health Agency in Delaware. The licensure process begins by submitting a written statement of intent to OHFLC describing the services to be offered and requesting an application.

The agency must demonstrate compliance with all state regulations regarding nursing supervision, clinical record keeping, and patient rights. A Personal Assistance Services Agency license is insufficient for skilled respite, as it only covers unskilled ADL support.

5. Medicaid Provider Enrollment

Once licensed and (if applicable) authorized by DDDS and DMS, the provider must enroll in Delaware Medicaid. The state uses a web-based MMIS system operated by Gainwell Technologies.

Providers must have their National Provider Identifier (NPI), Home Health Agency license, and the Qualified Provider Authorization Letter issued by DDDS ready before beginning the Gainwell enrollment process.

6. Staffing, Training and Background Checks

Because this is a skilled service, the direct care workers must be licensed professionals (RNs or LPNs) operating under the scope of their Delaware nursing licenses. Paraprofessionals may only be used for behavioral health needs if they are specifically trained and supervised by a licensed clinician.

All staff must undergo criminal background investigations in accordance with state requirements and complete Department-required training, including training on the participant's specific service plan and unique medical or behavioral needs.

7. Documentation, Policies and Records

Providers must maintain meticulous clinical and administrative records to justify Medicaid billing and demonstrate compliance during OHFLC surveys. This includes maintaining an Essential Elements to a Medicaid Compliance Plan.

For DDDS services, providers must utilize the state's Electronic Client Data Management System and Electronic Health Record systems as mandated during the provider orientation.

8. Billing, Rates and Claims

Skilled respite is billed to Delaware Medicaid (via Gainwell for fee-for-service or the respective MCO for DSHP+). Respite is authorized through the member's care plan, and hours are not granted automatically; they must be written into the plan by the care coordinator.

For state-funded (non-Medicaid) DDDS respite, parents may pay expenses up front and request reimbursement, or the agency may bill directly if approved. Providers must ensure they do not duplicate billing across different programs.

9. Approval Sequence and Timeline

The approval process is multi-phased and lengthy. Phase 1 involves information gathering and reviewing mandatory DDDS orientation sessions. Phase 2 requires submitting a complete application to the DDDS Provider Authorization Committee, which includes a budget review and an interview.

Phase 3 involves responding to the DMS RFP (reviewed quarterly) and enrolling in Medicaid via Gainwell. Phase 4 consists of final contracting and approval. The entire process can take several months due to the quarterly RFP review cycle.

10. Common Denials and Survey Findings

Applications to DDDS are frequently denied at the initial review stage if they are incomplete or not formatted exactly as required (e.g., failing to use the Word format Requirements Summary Checklist or separate PDFs for each question).

During OHFLC surveys, Home Health Agencies often face citations for failing to maintain proper nursing supervision documentation, inadequate staff training records, or failing to follow the specific medical interventions outlined in the participant's care plan.

11. Key Contacts and Resources

Providers should rely on the official Delaware DHSS websites for the most current manuals, RFP postings, and licensure regulations. The DDDS Provider Authorization Committee is the primary point of contact for waiver enrollment questions.

For DSHP+ managed care contracting, providers must contact the individual MCOs operating in Delaware.

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