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

Last reviewed: 2026-08-16

In Oklahoma, Respite Care Services provide essential short-term relief to unpaid primary caregivers of SoonerCare (Medicaid) members, ensuring the member continues to receive necessary supervision and support. These services are primarily delivered through Home and Community-Based Services (HCBS) waivers, such as the Community Waiver and In-Home Supports Waivers, which are administered jointly by the Oklahoma Health Care Authority (OHCA) and the Department of Human Services (DHS).

The single biggest structural barrier to entry is that Oklahoma does not issue a standalone "Respite Care Agency" license. Instead, prospective providers face a strict gatekeeping prerequisite: they must either obtain a Home Care Agency license from the Oklahoma State Department of Health (OSDH) or, more commonly for HCBS waivers, secure a direct provider contract approval from the DHS Developmental Disabilities Services (DDS) State Office before OHCA will even accept a Medicaid enrollment application. This DDS approval requires a comprehensive operational plan and strict educational prerequisites for agency leadership.

1. Service Definition and Scope

Respite care in Oklahoma is defined as temporary relief provided to the primary unpaid caregiver of a SoonerCare member. The service is designed to prevent institutionalization by supporting the family unit, and it is authorized based on the member's assessed need for supervision.

Services can be delivered in the member's home, in an approved Agency Companion Services (ACS) home, or in another approved out-of-home setting. The scope of care includes personal care, basic health monitoring, and behavioral support as outlined in the member's individualized care plan.

• Supervision Levels: Authorized as maximum (extensive needs), close (moderate needs), or intermittent (minimum needs) per [317:30-5-517. Description of services](https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/respite-care/description-of-services.html).
• In-Home Respite: Care and supervision provided directly in the participant’s primary residence.
• Out-of-Home Respite: Daily respite provided in an approved ACS home or other licensed facility, subject to the home profile approval process.
• Excluded Populations: Respite is not available to members in DHS custody or in out-of-home placements funded by DHS Child Welfare Services per [317:30-5-518. Coverage limitations](https://aem-prod.oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/respite-care/coverage-limitations.html).
• Service Limits: Generally capped at 30 days or 720 hours annually per member, unless a specific exception is approved by the DHS DDS Director.

2. Regulatory and Oversight Agencies

Oversight of respite services in Oklahoma is bifurcated between the state Medicaid agency, which handles billing and overall waiver authority, and the operating agencies that manage the specific waiver populations and provider certifications.

Providers must maintain compliance with the rules of both the financial authority and the clinical/operational authority to remain active.

• Oklahoma Health Care Authority (OHCA): The state Medicaid agency that manages SoonerCare, operates the MMIS, and handles final provider enrollment (https://oklahoma.gov/ohca.html).
• DHS Developmental Disabilities Services (DDS): The operating agency for the Community and In-Home Supports waivers that reviews and approves HCBS provider applications (https://oklahoma.gov/okdhs/services/dds.html).
• Oklahoma State Department of Health (OSDH): The regulatory body that issues Home Care Agency licenses, which may be required if providing skilled or personal care outside of DDS waivers (https://oklahoma.gov/health.html).
• SoonerSelect Health Plans: The managed care organizations (MCOs) that administer benefits for certain Medicaid populations, requiring separate network credentialing (https://oklahoma.gov/ohca/soonerselect.html).

3. Gatekeeping Prerequisites: Who Can Even Apply

The most critical barrier to entry for HCBS respite providers in Oklahoma is the DHS DDS State Office approval process. You cannot simply apply to OHCA to become a Medicaid provider; you must first pass the DDS programmatic review.

This review acts as a strict structural precondition. If an agency's leadership does not meet the state's educational and experiential mandates, the application will be rejected before Medicaid enrollment is even considered.

• DDS State Office Approval: Providers must submit a comprehensive application to the DHS DDS State Office, including a narrative of service philosophy and an operational plan, per [Oklahoma Administrative Code, Part 1, Section 340:100-3-16 - Provider enrollment | Oklahoma Administrative Code | Justia](https://regulations.justia.com/states/oklahoma/title-340/chapter-100/subchapter-3/part-1/section-340-100-3-16/).
• Executive Director Qualifications: The agency's executive director or program director must possess a Bachelor's degree from an accredited college and a minimum of two years of supervisory or management experience.
• Home Care Agency License: If the provider intends to offer skilled nursing or personal care respite outside of the specific DDS waiver structure, an OSDH Home Care Agency license is a mandatory prerequisite.
• SoonerSelect Credentialing: To serve members transitioned to managed care, providers must secure network contracts with designated SoonerSelect MCOs; OHCA fee-for-service enrollment alone is insufficient.

4. Licensure and Certification Requirements

Because Oklahoma lacks a distinct "Respite Care" license, certification is achieved either through OSDH licensure as a Home Care Agency or through DHS DDS certification as an HCBS provider.

For out-of-home respite, the physical location where care is provided must also pass specific environmental and safety reviews.

• OSDH Home Care Agency License: Required for agencies providing skilled or personal care services to non-DDS waiver populations.
• DDS Certification: Requires submission of an organizational chart, key personnel roster, and a documented quality assurance program committed to DDS processes.
• Home Profile Process: Out-of-home respite provided in an Agency Companion Services (ACS) home must be approved via the home profile process per OAC 317:40-5-40.
• Business Registration: Applicants must register their business entity with the Oklahoma Secretary of State and obtain an IRS Employer Identification Number (EIN).
• Liability Insurance: Providers must maintain and provide proof of general and professional liability insurance.

5. Medicaid Provider Enrollment

Once the prerequisite DDS approval or OSDH license is secured, providers must enroll in SoonerCare through the OHCA Electronic Provider Enrollment (EPE) portal.

This process links the provider's National Provider Identifier (NPI) to the state's MMIS, allowing for claims submission and reimbursement.

• OHCA EPE Portal: The mandatory online system for submitting SoonerCare enrollment applications (https://www.ohcaprovider.com).
• NPI Requirement: Providers must obtain and register an active Type 2 (Organization) NPI via the federal NPPES system before applying.
• Provider Agreement: Applicants must sign a current SoonerCare contract specific to HCBS or Nursing Facility Base Extended Respite.
• Ownership Disclosures: Providers must complete detailed disclosures of ownership and control per 42 C.F.R. § 455.104.
• Application Fee: Subject to the federal Medicaid institutional application fee unless the provider has already paid it to Medicare or another state's Medicaid program.

6. Staffing, Training and Background Checks

Oklahoma enforces strict background and training requirements for all direct support professionals (DSPs) providing respite care to vulnerable populations.

Agencies must maintain pristine personnel files proving that all checks and training modules were completed prior to the staff member providing unsupervised care.

• OSBI Background Check: Mandatory Oklahoma State Bureau of Investigation background search for all executive, management, and direct care staff.
• Registry Clearance: Staff must clear the Oklahoma Community Services Worker Registry prior to employment per OAC 340:100-3-39.
• Age Requirement: Direct care respite providers must be at least 18 years of age.
• DDS Required Training: Staff must complete specific training modules outlined in OAC 340:100-3-38 before delivering care.
• First Aid and CPR: All direct care staff must hold and maintain current certifications in First Aid and CPR.

7. Documentation, Policies and Records

To maintain certification and survive OHCA audits, respite providers must implement comprehensive operational policies and maintain exact service records.

Documentation must clearly link the hours billed to the specific supervision needs outlined in the member's care plan.

• Service Narrative: A required written plan describing the applicant's service and support philosophies for persons with intellectual disabilities.
• Operational Plan: Must document the anticipated number of persons served, counties covered, and include a key personnel roster.
• Time and Attendance Logs: Exact electronic or written records detailing the start and stop times of respite care, the participant's condition, and services rendered.
• Incident Reporting Policy: Documented procedures for reporting critical incidents, abuse, or neglect to DHS and OHCA within mandated timeframes.
• Corporate Records: Must retain board of director meeting minutes listing the authorized individual who has the provider agency's signature authority.

8. Billing, Rates and Claims

Respite services are billed to SoonerCare (or the applicable SoonerSelect MCO) using specific HCPCS codes and modifiers that denote the level of supervision provided.

Providers must strictly adhere to annual service caps and concurrent billing prohibitions to avoid claim denials and recoupments.

• Billing System: Claims are submitted electronically via the OHCA Provider Portal or through an approved clearinghouse.
• Annual Limits: Respite is strictly limited to 30 days or 720 hours annually per member per [317:30-5-518. Coverage limitations](https://aem-prod.oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/respite-care/coverage-limitations.html).
• Concurrent Billing Ban: Payment is not made for daily respite care and specialized foster care or ACS for the same member on the same date of service.
• ACS Provider Cap: Providers are limited to delivering a maximum of 52 days of respite per year when they concurrently provide Agency Companion Services.
• Prior Authorization: All respite services must be prior-authorized by the waiver case manager and reflected in the member's approved care plan before billing.

9. Approval Sequence and Timeline

Becoming a respite provider in Oklahoma is a sequential process. Attempting to enroll with OHCA before securing DHS DDS approval will result in immediate denial.

The entire process from business formation to billing activation typically takes 3 to 6 months, depending on the speed of the DDS review.

• Step 1: Business Formation: Register with the OK Secretary of State, obtain an EIN, and secure a Type 2 NPI (1-2 weeks).
• Step 2: DDS Application: Submit the narrative, operational plan, and background checks to the DHS DDS State Office (30-90 days).
• Step 3: OHCA Enrollment: Submit the EPE application via ohcaprovider.com once the DDS approval letter is received (approx. 15 business days per [Provider Enrollment Home](https://www.ohcaprovider.com/Enrollment/Site/Home/Home.aspx)).
• Step 4: SoonerSelect Credentialing: Apply to individual managed care organizations for network inclusion (60-120 days).

10. Common Denials and Survey Findings

Applications are frequently delayed or denied due to missing prerequisites, particularly regarding leadership qualifications and background checks.

During post-enrollment audits, OHCA and DHS frequently cite providers for documentation failures related to timekeeping and staff training.

• Missing DDS Approval: Submitting an OHCA EPE application without the mandatory DHS DDS State Office approval letter.
• Unqualified Director: The proposed Executive Director lacks the required Bachelor's degree or the two years of supervisory experience.
• Background Check Gaps: Failing to run or properly document the OSBI or Community Services Worker Registry checks prior to a staff member's first day.
• Exceeding Limits: Billing beyond the 720-hour or 30-day annual limit without a documented exception from the DDS Director.
• Incomplete Disclosures: Failure to properly disclose ownership and control percentages per federal regulations on the OHCA application.

11. Key Contacts and Resources

Prospective providers should utilize the official state portals and contact numbers to navigate the dual requirements of DHS and OHCA.

Always verify current waiver limits and training requirements directly with the operating agency before submitting an application.

• OHCA Provider Enrollment Portal: The EPE system for SoonerCare applications (https://www.ohcaprovider.com).
• OHCA Provider Contracts: Phone support available at (800) 522-0114, option 5 per [Provider Enrollment - Oklahoma.gov](https://oklahoma.gov/ohca/providers/provider-enrollment.html).
• DHS Developmental Disabilities Services (DDS): Operating agency for HCBS waivers and initial provider approvals (https://oklahoma.gov/okdhs/services/dds.html).
• Oklahoma State Department of Health (OSDH): Licensing authority for Home Care Agencies (https://oklahoma.gov/health.html).
• SoonerSelect Managed Care: Information and credentialing links for Oklahoma's MCOs (https://oklahoma.gov/ohca/soonerselect.html).

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