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

Last reviewed: 2026-09-10

Nevada Medicaid designates Respite Care as Provider Type 191, requiring mandatory Electronic Visit Verification (EVV) for all claims submitted to the Division of Health Care Financing and Policy (DHCFP) [Nevada Medicaid Provider Enrollment - Information Booklet](https://www.medicaid.nv.gov). This service provides short-term relief for unpaid primary caregivers, ensuring the recipient maintains continuous supervision and support under waivers such as the Frail Elderly or Individuals with Intellectual and Developmental Disabilities (IDD) programs.

Before submitting a Provider Enrollment Application (FA-31) to Nevada Medicaid, an agency must first secure a license as an Agency to Provide Personal Care Services in the Home from the Division of Public and Behavioral Health (DPBH) [agency to provide personal care services in the home](https://www.dpbh.nv.gov/siteassets/regulatory/hcqc/healthfacilities/hf---non-medical/agency-to-provide-personal-care-services-in-the-home-files/PCS_Interpretive_Guidelines.pdf). Providers seeking to serve the IDD population must also obtain specific certification from the Aging and Disability Services Division (ADSD) prior to Medicaid enrollment.

1. Service Definition and Scope

In Nevada, Respite Care provides temporary, short-term relief to an unpaid primary caregiver. The service ensures the recipient's health, safety, and supervision needs are met while the caregiver steps away.

The service can be delivered in the recipient's home or in an approved facility setting, depending on the specific waiver authorization and the provider's licensure.

• Provider Type: Designated as Provider Type 191 (Respite Care) by Nevada Medicaid.
• Delivery Setting: Can be provided in-home or in licensed out-of-home settings like Adult Day Care facilities.
• EVV Mandate: Electronic Visit Verification is strictly required for in-home respite delivery.
• Service Limits: Capped at a specific number of annual hours based on the recipient's approved waiver care plan.

2. Regulatory and Oversight Agencies

Multiple state divisions under the Department of Health and Human Services oversee respite providers. Licensing is handled by public health, while Medicaid enrollment and waiver operations are split between financing and aging divisions.

Providers must interact with all three entities depending on the populations they intend to serve.

• Division of Public and Behavioral Health (DPBH): Issues the base agency license [https://dpbh.nv.gov/].
• Division of Health Care Financing and Policy (DHCFP): Manages Medicaid policy and provider enrollment [https://dhcfp.nv.gov/].
• Aging and Disability Services Division (ADSD): Operates the HCBS waivers and certifies IDD providers [https://adsd.nv.gov/].
• Nevada Medicaid Provider Portal: The MMIS system for enrollment and claims [https://www.medicaid.nv.gov].

3. Gatekeeping Prerequisites: Who Can Even Apply

Nevada does not require a Certificate of Need (CON) for personal care or respite agencies. However, structural prerequisites exist regarding licensure and waiver-specific certifications.

An applicant cannot simply enroll in Medicaid; they must hold the appropriate state operating authority first.

• Certificate of Need: Genuinely none exists for this service in Nevada.
• Licensure Prerequisite: Must hold an active DPBH license (e.g., Agency to Provide Personal Care Services in the Home) before Medicaid enrollment is accepted.
• ADSD Certification: Required as a prerequisite if the provider intends to serve the IDD waiver population.
• Business Registration: Must hold an active Nevada Secretary of State Business ID.

4. Licensure and Certification Requirements

In-home respite is typically provided under the Agency to Provide Personal Care Services in the Home license, governed by Nevada Revised Statutes (NRS) 449.0021.

The license is location-specific and requires designated administrative oversight.

• Statutory Authority: Governed by NRS 449.0021 for personal care agencies.
• Location Specificity: Each license is separate, distinct, and issued to a specific person at a specific location.
• Administrator: The name of the person designated as responsible for the conduct of the agency must appear on the license.
• Fingerprinting: Applicants must submit two complete sets of fingerprints to the Central Repository for Nevada Records of Criminal History.

5. Medicaid Provider Enrollment

Providers enroll using the FA-31 Provider Enrollment Application through the Nevada Medicaid portal. Enrollment requires proof of licensure, insurance, and business registration.

Contracts must be revalidated periodically to maintain active billing status.

• Application Form: FA-31 Provider Enrollment Application.
• Provider Type: Enroll under PT 191 for Respite Care.
• Insurance Requirement: Commercial General Liability of not less than $2 million aggregate and $1 million per occurrence, naming DHCFP as an additional insured.
• Revalidation: A new Enrollment Application and Contract must be submitted 36 months from the date of DHCFP approval.

6. Staffing, Training and Background Checks

Nevada strictly enforces background checks for all agency employees and independent contractors under NRS 449.176 to 449.188.

Staff must be cleared before providing any direct care to Medicaid recipients.

• Background Checks: Mandatory submission to the Central Repository for Nevada Records of Criminal History and the FBI.
• Clearance Timing: Staff cannot provide unsupervised care until background clearance is confirmed.
• Basic Training: Direct care workers must hold current CPR and First Aid certifications.
• OIG Exclusion: Agencies must verify staff are not on the OIG List of Excluded Individuals/Entities (LEIE).

7. Documentation, Policies and Records

Agencies must maintain comprehensive personnel and recipient files. State surveyors require these records to be housed at the specific location designated on the license.

Providers must also adhere to strict change-reporting timelines.

• Record Location: Recipient and employee files must be maintained at the location of the licensed agency.
• Personnel Checklist: Must document the review of all staff working in the agency for compliance with NRS 449.176.
• Change Reporting: Must report in writing within five working days any change in ownership, address, or addition/removal of practitioners.
• EVV Documentation: Must electronically capture the six federally required data points for every in-home visit.

8. Billing, Rates and Claims

Claims are processed through the Nevada Medicaid MMIS. Because Respite Care (PT 191) is subject to the Cures Act, EVV compliance is a hard gate for claim payment.

Providers must also adhere to state fraud and abuse reporting mandates.

• Billing System: Nevada Medicaid MMIS via the Provider Web Portal.
• EVV Mandate: Claims for PT 191 will deny if not matched with compliant EVV visit data.
• Fraud Reporting: Providers must report any suspicion of fraud or abuse as outlined in MSM Chapter 3300.
• Rates: Reimbursed according to the DHCFP fee schedule published on the Nevada Medicaid website.

9. Approval Sequence and Timeline

The approval process is strictly sequential. A provider cannot apply for Medicaid enrollment until the DPBH license is fully issued.

The entire process from business formation to first billable claim typically spans several months.

• Step 1: Obtain a Nevada Secretary of State Business ID.
• Step 2: Apply for and receive the DPBH Agency to Provide Personal Care Services in the Home license.
• Step 3: Obtain ADSD certification (only if serving the IDD waiver).
• Step 4: Submit the FA-31 Provider Enrollment Application to Nevada Medicaid.

10. Common Denials and Survey Findings

Applications and surveys frequently fail due to administrative oversights, particularly regarding insurance formatting and background check timing.

Medicaid enrollment will be rejected if the application signature is stale.

• Insurance Errors: Failing to explicitly name DHCFP (4070 Silver Sage Dr, Carson City, NV 89701) as an additional insured.
• Signature Expiration: Submitting an FA-31 application where the signature date is older than 60 days.
• Background Violations: Allowing staff to work before the Central Repository confirms they have no disqualifying convictions.
• Record Location: Storing required personnel or client files off-site from the licensed location.

11. Key Contacts and Resources

Providers must utilize official state portals for licensing, enrollment, and policy updates.

Maintaining contact with these agencies is critical for compliance.

• DPBH Health Care Quality and Compliance: [https://dpbh.nv.gov/]
• Nevada Medicaid Provider Portal: [https://www.medicaid.nv.gov]
• Division of Health Care Financing and Policy (DHCFP): [https://dhcfp.nv.gov/]
• Aging and Disability Services Division (ADSD): [https://adsd.nv.gov/]

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