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

Last reviewed: 2026-09-10

The Missouri Department of Mental Health (DMH) Division of Developmental Disabilities (DD) and the Department of Health and Senior Services (DHSS) administer Respite Care Services through MO HealthNet Home and Community-Based Services (HCBS) waivers, requiring providers to secure a Purchase of Service (POS) contract before Medicaid enrollment. Respite provides short-term relief to unpaid primary caregivers, delivered either in the participant's home or in an approved out-of-home facility.

Approval requires passing the Missouri Medicaid Audit and Compliance (MMAC) screening and registering all staff with the Family Care Safety Registry (FCSR). Out-of-home respite providers face the additional requirement of holding a distinct facility license, such as a foster home or residential care facility license, prior to offering services.

1. Service Definition and Scope

In Missouri, Respite Care Services provide temporary relief to an unpaid primary caregiver, ensuring the waiver participant continues to receive necessary supervision and support. This service is authorized under MO HealthNet HCBS waivers, including the Comprehensive Waiver, Community Support Waiver, and the DHSS Aged and Disabled Waiver.

Services can be delivered in the individual's home (in-home respite) or in an approved facility (out-of-home respite). Respite cannot be used to substitute for regular daycare or while the primary caregiver is at work.

• In-Home Respite: delivered in the participant's primary residence
• Out-of-Home Respite: delivered in a licensed facility or approved foster home
• Waiver Authority: funded through MO HealthNet HCBS waivers
• Service Limits: capped annually based on the specific waiver appendix
• Exclusions: cannot be billed concurrently with residential habilitation

2. Regulatory and Oversight Agencies

Multiple state agencies oversee respite care depending on the target population. The Department of Mental Health (DMH) manages services for individuals with developmental disabilities, while the Department of Health and Senior Services (DHSS) oversees aging populations.

The Missouri Medicaid Audit and Compliance (MMAC) unit handles all provider enrollment and program integrity functions for MO HealthNet.

• Department of Mental Health (DMH): manages DD waivers (https://dmh.mo.gov)
• Department of Health and Senior Services (DHSS): manages aging waivers (https://health.mo.gov)
• Missouri Medicaid Audit and Compliance (MMAC): processes provider enrollment (https://mmac.mo.gov)
• MO HealthNet Division (MHD): state Medicaid agency (https://dss.mo.gov/mhd)
• Children's Division (CD): oversees foster care respite (https://dss.mo.gov/cd)

3. Gatekeeping Prerequisites: Who Can Even Apply

Prospective providers cannot simply enroll in MO HealthNet to bill for respite. They must first secure a Purchase of Service (POS) contract with DMH or DHSS, depending on the waiver.

For out-of-home respite, the provider must already hold an active facility license (such as a residential care facility or licensed foster home) before applying for the HCBS respite contract.

• POS Contract: required agreement with DMH or DHSS prior to MMAC enrollment
• Facility Licensure: out-of-home providers must hold an active state license
• Business Registration: must be registered with the Missouri Secretary of State
• NPI Number: must obtain a National Provider Identifier before applying
• FCSR Registration: agency owners must be registered with the Family Care Safety Registry

4. Licensure and Certification Requirements

Missouri does not issue a standalone 'Respite Care License.' Instead, in-home providers operate under HCBS certification standards set by DMH or DHSS.

Out-of-home providers must comply with physical facility standards, such as 13 CSR 35-60 for foster homes, ensuring fire safety, adequate sleeping arrangements, and general environmental safety.

• In-Home Certification: governed by DMH DD or DHSS HCBS provider standards
• Out-of-Home Licensure: requires compliance with 13 CSR 35-60 or DHSS facility rules
• Fire Safety: out-of-home facilities must pass local fire marshal inspections
• Capacity Limits: foster respite homes are limited to a maximum of 5 placements
• Home Visit: Resource Development Workers must complete the CS-RC-2 checklist for foster respite

5. Medicaid Provider Enrollment

Once the POS contract is secured, providers must enroll through the Missouri Medicaid Audit and Compliance (MMAC) unit. Applications are submitted electronically.

Providers must use the eMOMED portal to manage their enrollment, update information, and eventually submit claims.

• MMAC Application: submitted via the MMAC provider enrollment portal
• eMOMED Portal: required system for managing MO HealthNet enrollment
• Application Fee: subject to federal Medicaid application fee unless waived
• Site Visit: MMAC may conduct pre-enrollment site visits for moderate/high-risk providers
• Revalidation: required every 5 years to maintain active Medicaid status

6. Staffing, Training and Background Checks

All respite staff must pass comprehensive background checks through the Missouri Family Care Safety Registry (FCSR) before having contact with participants.

Training requirements include basic CPR/First Aid, medication administration (if applicable), and specific modules like the Introduction to Foster Care and Respite Care Provider Training for CD providers.

• FCSR Check: mandatory background screening for all direct care staff
• Fingerprinting: required every two years for Children's Division respite providers
• Basic Training: CPR and First Aid certification required
• Age Requirement: direct care staff must typically be at least 18 years old
• Disqualifying Offenses: felony convictions for child abuse or violence bar employment

7. Documentation, Policies and Records

Providers must maintain strict documentation to support all billed respite services. This includes service logs detailing the start and end times of care.

Agencies must also keep personnel files demonstrating completed background checks, training certificates, and signed agreements like the Safe Sleep Practices (CD-117).

• Service Logs: must document date, start time, end time, and activities
• Form CS-RC-1: Application to Provide Respite Care for CD providers
• Form CM-10: Cooperative Agreement for the Purchase of Respite Care Services
• Personnel Files: must contain FCSR results and training records
• Retention: records must be kept for a minimum of 5 years

8. Billing, Rates and Claims

Respite services are billed to MO HealthNet using specific HCPCS codes, typically in 15-minute increments or as a per diem rate for full-day out-of-home care.

Claims are submitted electronically through the eMOMED portal or via an approved clearinghouse using the 837P format.

• Billing System: claims submitted via eMOMED
• Increments: typically billed in 15-minute units for in-home care
• Per Diem: daily rates apply for out-of-home stays exceeding a certain hour threshold
• Prior Authorization: services must be included in the participant's approved care plan
• Electronic Remittance: providers must sign up for ERA through eMOMED

9. Approval Sequence and Timeline

The approval process begins with securing the necessary facility license (if out-of-home) or applying for a POS contract with DMH/DHSS.

For Children's Division respite, policy dictates that the application must be processed within 90 days. MMAC enrollment adds additional processing time.

• Step 1: Obtain facility license (if applicable)
• Step 2: Apply for POS contract with DMH or DHSS
• Step 3: Complete FCSR and fingerprinting
• Step 4: Submit MMAC provider enrollment application
• Timeline: CD respite applications processed within 90 days

10. Common Denials and Survey Findings

Applications are frequently delayed or denied due to incomplete background checks or failure to secure the prerequisite POS contract before applying to MMAC.

During audits, common findings include missing service log signatures, overlapping billing times, and expired staff CPR certifications.

• Missing POS Contract: applying to MMAC without prior state agency approval
• FCSR Failures: employing staff with disqualifying background hits
• Documentation Errors: missing start/stop times on service logs
• Lapsed Training: failure to renew CPR/First Aid or fingerprinting
• Capacity Violations: exceeding the maximum allowed placements in a foster home

11. Key Contacts and Resources

Providers should utilize the official state portals and division websites for the most current manuals, forms, and enrollment instructions.

The eMOMED portal is the central hub for Medicaid billing and enrollment updates.

• MMAC Provider Enrollment: https://mmac.mo.gov/providers/provider-enrollment
• eMOMED Portal: https://www.emomed.com
• DMH Developmental Disabilities: https://dmh.mo.gov/dev-disabilities
• DHSS Senior & Disability Services: https://health.mo.gov
• Family Care Safety Registry: https://health.mo.gov/safety/fcsr

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