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

Last reviewed: 2026-09-10

Mississippi Division of Medicaid (DOM) funds In-Home Respite (IHR) and Institutional Respite Care Services primarily through the Elderly and Disabled (E&D) and Intellectual Disabilities/Developmental Disabilities (ID/DD) waivers. The service provides short-term relief to unpaid primary caregivers, ensuring the beneficiary receives continuous companionship, support, or assistance with feeding and personal care needs.

Approval for Institutional Respite requires the applicant to already operate as a Mississippi Medicaid-enrolled Title XIX hospital, nursing facility, or licensed swing bed facility. In-Home Respite providers must secure a Home Health Agency license or distinct HCBS certification from the Mississippi State Department of Health (MSDH) before submitting a proposal packet to DOM within thirty-five days of licensure.

1. Service Definition and Scope

Respite Care Services in Mississippi are categorized into In-Home Respite (IHR) and Institutional Respite. These services offer temporary, short-term relief to an unpaid primary caregiver.

IHR staff provide direct care activities including companionship, general supervision, and assistance with feeding and personal care needs, while Institutional Respite is delivered in a facility setting.

• In-Home Respite (IHR): Delivered in the beneficiary's private residence to relieve the primary caregiver.
• Institutional Respite: Delivered overnight in a licensed Title XIX facility.
• Primary Activities: Companionship, support, general supervision, and personal care.
• Exclusions: Cannot be provided simultaneously with other direct care waiver services.
• Waiver Authority: Governed under Miss. Admin. Code Part 208 for HCBS Waivers.

2. Regulatory and Oversight Agencies

The Mississippi Division of Medicaid (DOM) manages the HCBS waivers and handles provider enrollment. The Mississippi State Department of Health (MSDH) oversees facility licensure and home health certification.

Providers must interact with both agencies, securing licensure from MSDH before applying for Medicaid enrollment through the MESA portal.

• Mississippi Division of Medicaid (DOM): https://medicaid.ms.gov
• MSDH Division of Health Facilities Licensure and Certification (DHFLC): https://msdh.ms.gov/page/30.html
• Mississippi Medicaid Enterprise System Assistance (MESA) Portal: https://portal.ms-medicaid-mesa.com
• Centers for Medicare and Medicaid Services (CMS): https://www.cms.gov

3. Gatekeeping Prerequisites: Who Can Even Apply

Mississippi imposes strict structural preconditions for respite providers. Institutional Respite is restricted entirely to existing licensed facilities.

In-Home Respite providers must hold specific state licenses or certifications before DOM will accept a Medicaid enrollment application.

• Institutional Respite Prerequisite: Must be a Mississippi Medicaid-enrolled Title XIX hospital, nursing facility, or licensed swing bed facility.
• In-Home Respite Prerequisite: Must hold a current State license certification as a Home Health Agency or specific HCBS certification.
• Certificate of Need (CON): Must provide DOM with a copy of an approved CON, if applicable to the facility type.
• Operating History: Certain HCBS providers must be established and in business for a minimum of one year prior to enrollment.

4. Licensure and Certification Requirements

Licensure is handled by the MSDH Division of Health Facilities Licensure and Certification. Providers must meet all state and federal laws applicable to their specific facility or agency type.

A change of ownership requires submitting a proposal packet to DOM for review and approval within thirty-five days of the change.

• Agency Licensure: Must furnish DOM with a copy of the current State license certification and/or recertification.
• Medicare Certification: Home Health Agencies providing respite must be certified under Title XVIII of the Social Security Act.
• HCBS Settings Rule: Must comply with CMS regulations for home and community-based services.
• Change of Ownership: Requires compliance with Miss. Admin. Code, Part 200, Rule 4.3.

5. Medicaid Provider Enrollment

Enrollment is processed through the MESA portal. Providers must execute a provider agreement with the Division of Medicaid.

Providers must obtain a separate provider number specifically for the respite service type they intend to offer.

• Enrollment Portal: Applications are submitted via the MESA system.
• Provider Agreement: Must execute a formal participation agreement with DOM.
• Separate Provider Number: Required specifically for Institutional Respite or In-Home Respite services.
• Retroactive Enrollment: The effective date of enrollment can be retroactive to the date of licensure.

6. Staffing, Training and Background Checks

Direct care staff must meet stringent qualifications and training requirements defined by DOM. Agencies must ensure all direct care providers have current and active licenses or certifications.

HCBS waiver providers are required by Administrative Code to ensure all staff complete mandated training modules.

• Staff Qualifications: Direct care providers must have a current and active license and/or certification.
• Training Requirements: Must meet training standards defined by the Division of Medicaid for HCBS Waiver Providers.
• Supervision: IHR staff must operate under the supervision of a registered nurse (RN) if employed by a home health agency.
• Background Checks: Required for all direct care staff in accordance with state law.

7. Documentation, Policies and Records

Providers must maintain a comprehensive policies and procedures manual compliant with all state and federal laws, including DOM regulations.

Strict documentation of service delivery times and activities is required to support claims.

• Policy Manual: Must have a policies and procedures manual compliant with DOM regulations.
• Service Documentation: Must accurately record service begin and end times.
• OTP Devices: One-time password devices for electronic visit verification cannot be removed from the home except by the Case Management Agency.
• Direct Care Records: Must document companionship, support, or personal care activities provided during the shift.

8. Billing, Rates and Claims

Claims are submitted through the MESA portal for fee-for-service reimbursement. Providers must not submit service begin and end times on behalf of the personal care provider improperly.

Rates are established by DOM and published in the state fee schedules.

• Billing System: Claims are processed through the MESA portal.
• Reimbursement Model: Paid on a fee-for-service basis according to the DOM fee schedule.
• EVV Compliance: In-Home Respite requires compliance with Electronic Visit Verification mandates.
• Claim Restrictions: Cannot bill for respite concurrently with other direct care waiver services.

9. Approval Sequence and Timeline

The approval sequence begins with securing the appropriate facility or agency license from MSDH. Once licensed, the provider submits an enrollment application to DOM.

The timeline depends heavily on the MSDH survey schedule and the completeness of the MESA portal application.

• Step 1: Obtain Certificate of Need (CON) if applicable.
• Step 2: Secure licensure from MSDH DHFLC.
• Step 3: Submit proposal packet to DOM within 35 days of licensure.
• Step 4: Complete MESA portal enrollment and execute provider agreement.

10. Common Denials and Survey Findings

Applications are frequently denied if the provider fails to meet the strict gatekeeping prerequisites, such as lacking an existing Title XIX facility license for Institutional Respite.

Survey deficiencies often involve inadequate staff training documentation or failure to comply with the HCBS Settings Rule.

• Prerequisite Failure: Applying for Institutional Respite without an existing hospital or nursing facility license.
• Incomplete Packets: Failing to submit the DOM proposal packet within 35 days of licensure.
• Training Deficiencies: Lack of documented HCBS training for direct care staff.
• EVV Non-Compliance: Improper use or removal of OTP devices from the beneficiary's home.

11. Key Contacts and Resources

Prospective providers should consult the official DOM and MSDH websites for the most current administrative codes, fee schedules, and provider manuals.

The MESA portal serves as the primary hub for enrollment and claims submission.

• Mississippi Division of Medicaid: https://medicaid.ms.gov
• DOM Toll-Free Provider Line: 800-421-2408
• MSDH Licensure Division: https://msdh.ms.gov/page/30.html
• MESA Provider Portal: https://portal.ms-medicaid-mesa.com

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