Midwest
Missouri Home Care, Home Health & Hospice Licensing
No Certificate of Need to clear. Home health and hospice need a DHSS license and survey, while in-home services run on an MMAC contract.
RegulatorDHSS / BHCRS
Typical timelineVaries by survey
License routes3
Delivery100% Virtual
Licensing in Missouri
Missouri needs no Certificate of Need for home health; RSMo 197.305 excludes it from CON review. Home health agencies and hospices need a DHSS license from the Bureau of Home Care and Rehabilitative Standards, plus an on-site survey. In-home services (IHS) providers get no state license; they send a proposal to MMAC, which makes a site visit and then signs a contract, and MMAC estimates about nine months to provider numbers.
Your regulator
Missouri Department of Health and Senior Services, Bureau of Home Care and Rehabilitative Standards (DHSS / BHCRS)
Official licensing page →License routes we cover in Missouri
Home Health Agency License
Agencies giving two or more home health services under a plan signed by a physician, NP, CNS, PA, or podiatrist; one service must be skilled nursing. RSMo 197.400-197.478, 19 CSR 30-26.010.
Hospice Certificate
Anyone providing palliative, end-of-life care to terminally ill patients and their families. RSMo 197.250-197.280, 19 CSR 30-35.010-30-35.030.
In-Home Services (IHS) Provider Contract
Agencies giving personal care, homemaker, chore, respite, or nurse-visit services to elderly or disabled adults, usually under DSDS authorization and MO HealthNet. 19 CSR 15-7.021, 13 CSR 70-91.010.
How we get you licensed
- 1Register your business
Form an LLC or corporation with the Missouri Secretary of State and get an EIN. DHSS needs proof of registration.
- 2Assemble the application packet
Download the form at health.mo.gov/safety/homecare/appsforms.php. Include the application, Ownership Disclosure statement, business proof, policies, staff credentials, insurance, and background checks. Mail to BHCRS, PO Box 570, Jefferson City, MO 65102-0570.
- 3Pay the state license fee
Home Health Agency: $600 nonrefundable, plus $600 each year at renewal (RSMo 197.410, 197.415). Hospice: $250-$750 sliding scale set by DHSS with the hospice advisory council (RSMo 197.254). In-Home Services: no DHSS license or license fee, because IHS providers contract with MMAC instead.
- 4Pass the initial survey
DHSS requires a new home health agency to get deemed status through a CMS-approved accrediting organization, which surveys you against both federal and Missouri rules. DHSS may accept that survey in place of its own (RSMo 197.415.4).
- 5Get licensed and enroll in Medicare or Medicaid
Once you meet every requirement, DHSS issues your license. For Medicare, file CMS-855A with your MAC; deemed status from your accrediting organization supports certification. In-home services providers skip DHSS licensing and submit a proposal to MMAC, which makes a site visit before the first contract (about nine months to provider numbers).
- 6Meet ongoing compliance rules
Register all direct-care workers with the Family Care Safety Registry (RSMo 192.2495) before first contact, use approved EVV for Medicaid visits, and complete dementia training.
How long does a Missouri home health license take?
Typical time to a live license in Missouri. Times assume a complete, accurate application; missing items add time.
- Home Health license
- No published processing time
- Initial survey (accrediting organization)
- Depends on accreditor availability
- In-Home Services (Medicaid billing)
- About 9 months
Key Missouri home health license requirements
- Offer at least two home health services, one being skilled nursing (RSMo 197.400; 19 CSR 30-26.010).
- Rule 19 CSR 30-26.010 adopts 42 CFR 484, so state-licensed agencies meet full federal CoPs even without Medicare.
- Register every direct-care worker with the Family Care Safety Registry and clear them first (RSMo 192.2495, formerly RSMo 660.317, renumbered 2014).
- Medicaid personal care and home health visits need EVV via an MMAC-approved vendor; only a supervisor or administrator makes manual edits.
- The IHS day-to-day supervisor must be 21 or older with a Missouri RN license, a Missouri LPN license plus one year of care experience, a bachelor's degree, or two years of experience with elderly or disabled adults (19 CSR 15-7.021).
- All direct-care staff at home health agencies complete dementia training (disease, communication, behavior, daily living, family issues) at orientation and annually (19 CSR 30-26.010).
Traps that catch new owners
- Looking for a DHSS In-Home Services license. Missouri does not issue one; IHS providers enter through MMAC's proposal, site visit and contract, which MMAC says takes about nine months.
- Choosing an accrediting organization late. New home health agencies need deemed status, so the accreditor's survey schedule shapes your timeline.
- Underestimating the MMAC contract rules. Serving MO HealthNet participants with personal care requires a certified designated manager, a Missouri-licensed RN on staff or as a consultant, and liability coverage of at least $1 million per event and $3 million in total.
Free checklist
Free: the Missouri home care licensing checklist
Every form, fee and deadline for Missouri on one printable page, plus the traps that delay most new agencies.
- Every document you must file
- Real state fees to budget
- Who can own and run it
- Traps that cause delays
Missouri licensing packages
Fixed price, agreed in writing before any work begins. Each package is prepared and submitted for you, fully online.
Missouri home health license FAQs
Does Missouri require a Certificate of Need for home health or hospice?
No. Missouri's CON law (RSMo 197.300-197.366) excludes home health from CON review (RSMo 197.305(9)(f)). Hospice and in-home services are also exempt. You can apply for a DHSS license without CON approval.
Can I run a personal care or homemaker agency without a state license?
Missouri does not license in-home services providers. To serve MO HealthNet (Medicaid) or state-funded participants with personal care, homemaker or chore services, you need an MMAC in-home services contract instead. Skilled care is different: it needs a DHSS home health agency license.
How long from application to first billable visit?
For a Home Health Agency, DHSS does not publish a processing time, and the initial survey depends on your accrediting organization's schedule. For In-Home Services billing MO HealthNet, MMAC says provider numbers usually issue about nine months after a complete proposal, and longer if it has gaps.
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