Midwest
Missouri Home Care, Home Health & Hospice Licensing
No Certificate of Need barrier — but every category has its own pathway, survey, and Medicaid enrollment queue.
RegulatorDHSS / BHCRS
Typical timelineHome Health Agency or Hospice state licensure typically takes three to six months from a complete application to license issuance, depending on DHSS survey scheduling and deficiency resolution. Adding Medicare certification through CMS typically extends the process by an additional two to four months. In-Home Services Providers pursuing MMAC enrollment for MO HealthNet billing should budget approximately nine months from proposal submission to provider number issuance, per MMAC's own published estimate.
License routes3
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Licensing in Missouri
Missouri does not require a Certificate of Need for home health agencies — RSMo 197.305 explicitly excludes home health services from CON review — making it one of the more accessible states for new entrants seeking a skilled-care license. All three service lines (Home Health Agency, Hospice, and In-Home Services Provider) require a separate state license or certificate issued by the Missouri Department of Health and Senior Services, Bureau of Home Care and Rehabilitative Standards, and each involves at least one on-site survey before services may begin. Agencies that intend to bill MO HealthNet (Missouri Medicaid) must also complete a distinct MMAC provider-enrollment process, which adds roughly nine months to the timeline for the In-Home Services pathway.
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
Public or private agencies delivering two or more home health services at the residence of a patient on a part-time or intermittent basis under a plan of treatment signed by a physician, nurse practitioner, clinical nurse specialist, physician assistant, or podiatrist — one of the two services must be skilled nursing per DHSS policy; governed by RSMo 197.400-197.478 and 19 CSR 30-26.010.
Hospice Certificate
Any person or entity providing palliative, end-of-life care to terminally ill patients and their families; state certificate required under RSMo 197.250-197.280 and 19 CSR 30-35.010-30-35.030.
In-Home Services (IHS) Provider License
Agencies delivering personal care, homemaker, chore, respite, or authorized nurse-visit services to elderly or disabled adults in their homes, typically under DSDS authorization and MO HealthNet funding — regulated by 19 CSR 15-7.021 and 13 CSR 70-91.010.
How we get you licensed
- 1Register the business entity
Form an LLC or corporation with the Missouri Secretary of State and obtain a federal EIN. DHSS requires a copy of the Secretary of State registration as part of the license application packet.
- 2Assemble the application packet
Download the current application from health.mo.gov/safety/homecare/appsforms.php. The packet must include the completed license application, State Disclosure of Ownership and Control Interest Statement, proof of business registration, evidence of compliant policies and procedures, administrator/supervisor qualifications, proof of insurance, and background screening documentation. Applications must be submitted to the Bureau of Home Care and Rehabilitative Standards (PO Box 570, Jefferson City, MO 65102-0570).
- 3Pay the state license fee
Home Health Agency: $600 nonrefundable fee accompanying the initial application (RSMo 197.410), with the same $600 fee due annually at renewal (RSMo 197.415). Hospice: sliding-scale fee of $250-$750, with the exact amount determined by the Department of Health and Senior Services with input from the state hospice advisory council (RSMo 197.254); the statute does not specify the metric used to set the fee within that range — confirm the current amount with BHCRS. In-Home Services: fee amount not separately published in regulation; confirm with BHCRS at 573-751-6336.
- 4Complete the pre-licensure on-site survey
After DHSS accepts the application, a state surveyor conducts an unannounced or scheduled pre-licensure visit to inspect the office, review policies and procedures, verify staff credentials, and confirm regulatory compliance. DHSS issues a deficiency list; applicants have ten days to submit a correction plan.
- 5Obtain the license and pursue Medicare or Medicaid enrollment
Once the survey is passed, DHSS issues the license or certificate. Agencies seeking Medicare certification must also submit CMS-855A to the applicable Medicare Administrative Contractor (MAC) and pass a CMS initial certification survey. Agencies billing MO HealthNet for In-Home Services must separately submit a proposal to MMAC and complete their nine-month enrollment process.
- 6Implement ongoing compliance requirements
Enroll all direct-care workers with the Missouri Family Care Safety Registry (RSMo 192.2495) before the first client contact, implement an approved Electronic Visit Verification (EVV) system for any Medicaid-reimbursed visits, and complete required dementia-awareness training for all staff.
Key Missouri requirements
- Two-skilled-services minimum: a Missouri Home Health Agency license requires the agency to offer at least two home health services on an intermittent basis, one of which must be skilled nursing per DHSS policy and 19 CSR 30-26.010 (RSMo 197.400 defines the eligible services).
- Medicare Conditions of Participation incorporated by reference: Missouri's home health licensure rule (19 CSR 30-26.010) expressly incorporates 42 CFR 484, meaning state-licensed agencies must meet full federal CoPs even if they do not seek Medicare certification.
- Family Care Safety Registry enrollment: every employee or contractor providing direct care must be registered with the Missouri Family Care Safety Registry and cleared of disqualifying findings before serving clients (RSMo 192.2495; formerly cited as RSMo 660.317, which was transferred and renumbered in 2014).
- Electronic Visit Verification (EVV): all Medicaid-reimbursed personal care and home health visits require EVV through an MMAC-approved vendor; manual adjustments must be made by a supervisor or administrator.
- Administrative supervisor qualifications for IHS: the designated day-to-day supervisor must be at least 21 years of age and hold a current Missouri RN license, a current Missouri LPN license with one year of relevant direct-care experience, a baccalaureate degree, or at least two years of direct care experience with elderly or disabled populations (19 CSR 15-7.021).
- Dementia training: all direct-care staff at licensed home health agencies must complete dementia-specific training covering disease overview, communication with persons with dementia, behavior management, promoting independence in activities of daily living, and understanding and dealing with family issues — integrated into orientation and provided annually (19 CSR 30-26.010).
Traps that catch new owners
- Conflating the state license with MMAC enrollment: obtaining a DHSS In-Home Services license does not automatically enroll an agency with MMAC or authorize MO HealthNet billing. The MMAC proposal, site visit, contract execution, and provider enrollment are entirely separate steps with their own nine-month queue — agencies that skip this step cannot bill Medicaid even after receiving their DHSS license.
- Incomplete application packets cause cascading delays: DHSS will not schedule the pre-licensure survey until the application is deemed complete. Missing items such as an unsigned disclosure statement, policies that reference outdated regulation versions, or insufficient proof of insurance push the entire timeline back by weeks or months — and the survey-within-one-year clock still runs from initial submission.
- Assuming that non-medical home care requires no oversight: while Missouri does not require a state license for purely companionship or housekeeping agencies, any agency that adds even one personal care task (bathing, dressing, medication reminders) likely triggers the In-Home Services licensure and MMAC enrollment requirements, and noncompliance carries immediate removal from the Medicaid program.
Missouri licensing packages
Fixed price, agreed in writing before any work begins. Each package is prepared and submitted for you, fully online.
Missouri licensing FAQs
Does Missouri have a Certificate of Need requirement for home health agencies or hospices?
No. Missouri's CON law (RSMo 197.300-197.366) explicitly excludes home health services from the definition of 'new institutional health service' that triggers CON review (RSMo 197.305(9)(f)). Hospice and in-home services are likewise not subject to CON review. New agencies may apply for a DHSS license without first obtaining CON approval.
Can I operate a personal care or homemaker agency in Missouri without a state license?
Only if you restrict services to pure companionship, housekeeping, and chore tasks with no personal care component. The moment your workers assist with activities of daily living — bathing, dressing, grooming, or similar tasks — the agency falls under the In-Home Services licensure framework administered by DHSS and must also complete the MMAC enrollment process to bill MO HealthNet.
How long does it realistically take to go from application to first billable visit in Missouri?
For a Home Health Agency seeking both a state license and Medicare certification, budget five to nine months total. For an In-Home Services Provider planning to bill MO HealthNet, MMAC itself states that provider numbers are typically issued approximately nine months after a complete proposal is submitted, and that timeline can extend further if the proposal has gaps or MMAC staff workload is heavy.
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