Mississippi - Adult Companion Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Mississippi Division of Medicaid (DOM) does not cover or enroll providers under a distinct Adult Companion Services category; instead, non-medical supervision and socialization are delivered as Personal Care Services (PCS) or In-Home Respite under the 1915(c) Elderly and Disabled (E&D) Waiver. Providers seeking to offer these services must submit a proposal package to the DOM Office of Long-Term Care and score at least 85 on a mandatory orientation exam before an enrollment application is accepted.

Approval requires establishing an agency in Mississippi, passing the DOM orientation, and enrolling through the Mississippi Medicaid Enterprise System (MESA) portal. Applicants must maintain compliance with Title 23, Part 208 of the Mississippi Administrative Code, which mandates fingerprint-based national criminal background checks for all direct care staff and strict adherence to the beneficiary's Plan of Services and Supports (PSS).

1. Service Definition and Scope

Because Mississippi does not utilize an Adult Companion Services definition, providers must enroll to provide Personal Care Services (PCS) or In-Home Respite. These services provide non-medical assistance, supervision, and socialization to allow elderly and disabled individuals to remain safely in their communities.

PCS includes assistance with activities of daily living (ADLs) and instrumental activities of daily living (IADLs), while In-Home Respite provides temporary relief to the primary caregiver. Both are governed by the E&D Waiver under Title 23, Part 208 of the Mississippi Administrative Code.

• Service Equivalent: Personal Care Services (PCS) and In-Home Respite.
• Funding Authority: 1915(c) Elderly and Disabled (E&D) Waiver.
• Target Population: Individuals aged 65 and older, or physically disabled individuals aged 21 and older.
• Scope of PCS: Non-medical assistance with eating, bathing, dressing, personal hygiene, and socialization.
• Scope of Respite: Temporary supervision and assistance provided in the home to relieve the primary caregiver.
• Exclusions: Cannot be provided concurrently with Adult Day Care or by a home health aide performing the same duties.
• Setting: Must be delivered in the beneficiary's home or community, not in an institutional setting.
• Service Plan: All activities must be explicitly detailed in the approved Plan of Services and Supports (PSS).

2. Regulatory and Oversight Agencies

The primary oversight body for E&D Waiver services is the Mississippi Division of Medicaid (DOM), specifically its Office of Long-Term Care. They manage waiver policies, provider approvals, and compliance monitoring.

The Mississippi Department of Health (MSDH) plays a role in licensing certain facility-based or medical providers, but standard non-medical PCS agencies are primarily regulated directly by DOM through the waiver provider agreement.

• Mississippi Division of Medicaid (DOM): Administers the E&D Waiver and oversees provider compliance (https://medicaid.ms.gov).
• DOM Office of Long-Term Care: Reviews provider proposal packages and administers the mandatory orientation (https://medicaid.ms.gov/programs/long-term-care/).
• Mississippi Medicaid Enterprise System (MESA): The official portal for provider enrollment and claims submission (https://portal.ms-medicaid-mesa.com).
• Mississippi Department of Public Safety: Processes the required fingerprint-based national criminal background checks (https://www.dps.ms.gov).

3. Gatekeeping Prerequisites: Who Can Even Apply

Mississippi imposes strict structural preconditions before an agency can even apply to enroll as a PCS or In-Home Respite provider under the E&D Waiver. The state utilizes a proposal and orientation gatekeeping system rather than an open-door enrollment policy.

An applicant must be an established agency and must successfully pass a mandatory orientation exam. Failure to meet these initial steps completely blocks access to the MESA enrollment portal.

• Mandatory Orientation: Applicants must attend a DOM-mandated orientation session before applying.
• Exam Score Requirement: The applicant must score at least 85 on the orientation exam to proceed.
• Proposal Package: A completed proposal package must be submitted to and approved by the Office of Long-Term Care.
• Business Establishment: The agency must be currently established and registered with the Mississippi Secretary of State.
• Tax Identification: Must possess written confirmation from the IRS confirming the tax identification number and legal business name.
• NPI Requirement: Must obtain a National Provider Identifier (NPI) and verification from the NPPES system.
• Exclusion Status: The entity and its owners must not be under investigation by the DOM Office of Program Integrity or the Medicaid Fraud Control Unit.

4. Licensure and Certification Requirements

Mississippi does not issue a specific Department of Health license for non-medical Personal Care Services or Adult Companion agencies. Instead, the authority to operate is granted through certification and approval by the Division of Medicaid as an E&D Waiver provider.

Providers must maintain compliance with all stipulations in Title 23, Part 208 of the Mississippi Administrative Code. Any change of ownership requires a new proposal packet submission within 35 days.

• State Licensure: No distinct DOH license exists for non-medical PCS; DOM waiver approval serves as the operating authority.
• Secretary of State Registration: Must provide a copy of the business registration with the Mississippi Secretary of State.
• Waiver Certification: Must be certified by DOM to provide services under the E&D Waiver.
• Change of Ownership: Requires submission of a new proposal packet to DOM within 35 days of the change.
• Local Permits: Must maintain any required local city or county business licenses or permits.
• Continuous Compliance: Must remain in good standing without violations of the Medicaid Provider Agreement in the 18 months prior to enrollment.

5. Medicaid Provider Enrollment

Once the proposal package is approved by the Office of Long-Term Care, the agency must complete the formal Medicaid enrollment process through the Mississippi Medicaid Enterprise System (MESA) portal.

The enrollment application requires uploading the DOM approval letter, ownership disclosures, and financial documentation. Providers must revalidate their enrollment periodically as directed by DOM.

• Enrollment Portal: Applications must be submitted via the MESA Provider Portal (https://portal.ms-medicaid-mesa.com).
• Required Documentation: Must upload the DOM Office of Long-Term Care approval letter, IRS confirmation, and Secretary of State registration.
• Identity Verification: Verification of social security numbers for all provider owners using a SSN card, driver's license, or notarized statement.
• W-9 Form: The name on the identity verification document must exactly match the name on the provider owner's W-9.
• Application Fee: Subject to the ACA institutional provider application fee unless waived by Medicare enrollment.
• Site Visit: DOM or its contractor may conduct a pre-enrollment site visit to verify the agency's operational status.
• Revalidation: Providers must revalidate their Medicaid enrollment at least every five years.

6. Staffing, Training and Background Checks

Direct care workers providing PCS or In-Home Respite must meet strict background and training standards outlined in the Mississippi Administrative Code. Agencies are responsible for ensuring all staff are cleared before client contact.

The most critical requirement is the fingerprint-based national criminal background check. Agencies must also verify staff against exclusion lists and ensure completion of mandatory training.

• Background Checks: Administrative Code requires a national criminal background check with fingerprints on all employees.
• Exclusion Checks: Mandatory timely checks of the OIG List of Excluded Individuals/Entities (LEIE) and the Mississippi Nursing Exclusion list.
• Age Requirement: Direct care workers must typically be at least 18 years of age.
• Basic Training: Staff must complete training in CPR, First Aid, and basic infection control.
• Orientation: Agency must provide internal orientation covering beneficiary rights, abuse/neglect reporting, and the specific duties in the PSS.
• Supervision: The agency must have a designated supervisor to monitor direct care staff and ensure PSS compliance.
• Record Maintenance: All background check results and training certificates must be maintained in the employee's personnel file.

7. Documentation, Policies and Records

Providers must maintain comprehensive records for both beneficiaries and employees. The Division of Medicaid requires immediate access to all records for audit purposes.

Service delivery must be documented in real-time and align perfectly with the case manager's approved Plan of Services and Supports (PSS). Agencies must also have a compliant policies and procedures manual.

• Plan of Services and Supports (PSS): All services delivered must be explicitly authorized in the beneficiary's PSS.
• Service Logs: Must maintain detailed timesheets or electronic visit verification (EVV) records showing exact start and stop times.
• Policy Manual: Must maintain a policies and procedures manual compliant with all state and federal laws.
• Audit Access: Must ensure immediate access to all beneficiary and employee records as required for DOM audit purposes.
• Corrective Action Plans: Must ensure all Corrective Action Plans (CAPs) issued by DOM are implemented appropriately and timely.
• Incident Reporting: Must have documented procedures for reporting critical incidents, abuse, neglect, or exploitation to DOM and Adult Protective Services.
• Retention: Records must generally be retained for a minimum of five years or as specified in the Medicaid Provider Agreement.

8. Billing, Rates and Claims

Claims for PCS and In-Home Respite are submitted to the Division of Medicaid through the MESA portal. Providers must use the specific HCPCS codes designated for the E&D Waiver.

Rates are established by the Division of Medicaid and published in the state's fee schedules. Providers cannot bill for services that exceed the frequency or duration authorized in the PSS.

• Billing System: Claims are processed through the Mississippi Medicaid Enterprise System (MESA).
• Procedure Codes: Providers must use DOM-specified HCPCS codes (e.g., T1019 for Personal Care Services) as outlined in the waiver billing manual.
• Prior Authorization: Services must be prior-authorized based on the case manager's PSS before billing.
• Electronic Visit Verification (EVV): PCS and In-Home Respite are subject to federal EVV mandates; providers must use the state-sponsored or a compliant alternate EVV system.
• Rate Publication: Current reimbursement rates are published on the DOM website under the HCBS fee schedule.
• Billing Limits: Cannot bill for days the beneficiary is hospitalized or in an institutional setting.
• Timely Filing: Claims must be submitted within the timely filing limits specified in the Mississippi Medicaid Provider Billing Handbook.

9. Approval Sequence and Timeline

The pathway to becoming a PCS or In-Home Respite provider in Mississippi is sequential and heavily front-loaded. An agency cannot simply apply online; they must first clear the DOM Office of Long-Term Care's orientation and proposal process.

The entire process from establishing the business to receiving an active Medicaid provider number can take several months, depending on the scheduling of the mandatory orientation and the speed of the proposal review.

• Step 1: Establish the business entity and register with the Mississippi Secretary of State.
• Step 2: Obtain an NPI and IRS tax identification confirmation.
• Step 3: Attend the mandatory DOM Office of Long-Term Care orientation.
• Step 4: Score 85 or higher on the mandatory orientation exam.
• Step 5: Submit the completed proposal package to the Office of Long-Term Care.
• Step 6: Receive the formal approval letter from DOM.
• Step 7: Submit the Medicaid enrollment application via the MESA portal with all required attachments.
• Step 8: Pass any required pre-enrollment site visits and receive the active Medicaid Provider ID.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied due to incomplete proposal packages or failure to pass the orientation exam. DOM strictly enforces the 85-point minimum score.

During post-enrollment audits, the most common survey findings relate to inadequate personnel files, specifically missing fingerprint background checks or lapsed OIG exclusion verifications.

• Exam Failure: Scoring below 85 on the mandatory orientation exam results in an immediate halt to the process.
• Name Mismatches: Denials occur if the name on the IRS W-9 does not exactly match the Secretary of State registration and identity documents.
• Missing Background Checks: Surveyors frequently cite agencies for allowing staff to work before the fingerprint background check is fully cleared.
• EVV Non-Compliance: Failure to properly utilize the Electronic Visit Verification system leads to claim denials and recoupments.
• PSS Deviations: Billing for hours or tasks not explicitly authorized in the beneficiary's Plan of Services and Supports.
• Lapsed Exclusions: Failure to conduct monthly OIG LEIE and Nursing Exclusion checks on all staff.
• Incomplete Policies: Proposal packages rejected because the policies and procedures manual lacks required state-specific abuse reporting protocols.

11. Key Contacts and Resources

Prospective providers should begin by reviewing the E&D Waiver requirements on the Mississippi Division of Medicaid website. The Office of Long-Term Care is the primary contact for the mandatory orientation and proposal package.

For technical assistance with the enrollment application itself, providers must utilize the MESA portal resources and contact the provider enrollment helpdesk.

• Mississippi Division of Medicaid (DOM): https://medicaid.ms.gov
• DOM Office of Long-Term Care: Oversees waiver policy and provider proposals (https://medicaid.ms.gov/programs/long-term-care/).
• MESA Provider Portal: For Medicaid enrollment and claims (https://portal.ms-medicaid-mesa.com).
• Mississippi Administrative Code: Title 23, Part 208 contains the specific rules for HCBS Long Term Care (https://www.sos.ms.gov).
• Mississippi Secretary of State: For business registration verification (https://www.sos.ms.gov).
• Mississippi Department of Public Safety: For fingerprint background check procedures (https://www.dps.ms.gov).

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