Missouri home health agency license: the DHSS two-service test, Medicare rules and the $600 fee
Missouri requires a home health agency license from the Department of Health and Senior Services (DHSS) for any agency that provides two or more home health services, one of them skilled nursing, on an intermittent basis. The license costs $600 a year. State rule adopts the federal Medicare home health standards, so you have to meet them even if you never bill Medicare.
Contents11 sections
Key takeaways
- You need the license once you provide (or advertise) two or more of six services: nursing, physical, occupational or speech therapy, home health aide, or medical social services. DHSS says one of them must be skilled nursing.28
- 19 CSR 30-26.010 adopts the Medicare Conditions of Participation (42 CFR 484) for every Missouri licensed agency. State licensure surveys use Medicare standards.7
- The fee is $600 for the initial license, $600 for each annual renewal and $600 for a change of ownership (statute and rule, checked October 12, 2026).345
- Your office cannot be in a private residence, and it must keep set business hours.7
- No certificate of need applies to home health. However, CMS has frozen new Medicare home health enrollment nationwide since May 13, 2026.1417
Quick facts
| Agency | DHSS, Bureau of Home Care and Rehabilitative Standards, Jefferson City |
|---|---|
| Law | RSMo 197.400-197.478; 19 CSR 30-26.010; 42 CFR 484 by reference |
| Fee | $600 initial, $600 each year at renewal, $600 on change of ownership (as published on 2026-10-12) |
| License term | One year, renewed after a survey |
| Office | Business location not in a private residence, with set hours |
| Certificate of need | Not required for home health agencies |
| Medicare | New enrollments frozen nationwide since May 13, 2026 |
The $600 fees are set in RSMo 197.410, 197.415 and 197.420 and repeated in 19 CSR 30-26.010. Checked October 12, 2026.
Do you need a home health license or not? Missouri’s two-service test
Missouri licenses home health agencies by counting services. Under RSMo 197.400, “home health services” means six things provided at the patient’s residence on a part-time or intermittent basis: nursing, physical therapy, speech therapy, occupational therapy, home health aide services and medical social services.1 Any agency that provides two or more of these, or holds itself out as a home health agency, must be licensed. The statute says this applies “including Medicare and Medicaid providers”.2
DHSS’s guidance sheet The 3 Types of Care in the Home adds two conditions to the test: one of the services must be skilled nursing, and visits must be intermittent, which the sheet describes as “several times a week 1-2 hours.”8 The statute defines “part-time or intermittent” as services in an interrupted sequence averaging no more than three hours in any 24-hour period.1
The same DHSS sheet lists companies that do not meet the licensure definition. For those, “NO license issued in MO” and there is “No government oversight”:8
- A company that provides only one service, such as nursing alone or aide care alone.
- A company that supplies both nurses and aides, but in shifts of 4 or more hours.
- A company that offers personal care, chore and respite services but only one service (aide) from the home health list.
- Staffing companies that supply nurses to hospitals and similar facilities.
So the choice is in your hands. An agency sending RNs for wound-care visits and aides for bathing visits is a licensed home health agency. An agency offering 8-hour private-duty nursing shifts is not, under DHSS’s reading. If you plan only non-medical care, see the non-medical home care overview. Missouri has no license for that model. State-paid in-home care (homemaker/chore, personal care, respite) runs on a Medicaid contract through Missouri Medicaid Audit and Compliance (MMAC), at 573-751-3399 or [email protected].8
RSMo 197.460 exempts three groups from the licensing law:6
- Individuals who personally provide home health services and are not employed by or under the direct control of an agency.
- Organizations run by and for adherents of a church that relies on prayer or spiritual means for healing.
- Entities that provide services under RSMo 208.152.1(19) or in-home services under RSMo 192.2000.2(18).
A Missouri home health license does not cover 24-hour residential care. Homes where residents live need a residential care facility or assisted living facility license instead. Daytime group programs need an adult day care program license.
Medicare standards apply even to state-only agencies
This is Missouri’s most important design choice. 19 CSR 30-26.010(1)(A) incorporates 42 CFR 484, the Medicare Conditions of Participation for home health agencies, and states that “Missouri licensed home health agencies shall strictly meet the currently applicable Medicare Conditions of Participation and surveys performed for state licensure will be conducted per Medicare standards.”7 The statute requires that DHSS rules be no weaker than the federal Title XVIII standards. They apply to every patient regardless of who pays.25
In practice, a private-pay agency that never enrolls in Medicare still has to meet the federal home health rules on staffing, patient rights, care planning, quality improvement and aide training. Missouri’s own rule text is short (one section, last amended effective June 30, 2009).7 Nearly all the operating detail comes from federal law. DHSS links the federal interpretive guidelines (State Operations Manual Appendix B) and the 42 CFR 484.50 patient-rights text from its licensure page.9
Under the Medicare standards Missouri adopts, the following federal requirements apply:
- Administrator. Anyone hired on or after January 13, 2018 must be a licensed physician, a registered nurse or a holder of an undergraduate degree, and must have at least one year of supervisory or administrative experience in home health care or a related health care program.15
- Clinical manager. This must be a licensed physician, physical therapist, speech-language pathologist, occupational therapist, audiologist, social worker or registered nurse.15
- Home health aides. Training must total at least 75 hours. At least 16 hours of classroom training must come before at least 16 hours of supervised practical training. Each aide needs at least 12 hours of in-service training every 12 months.16
- Aide supervision. For patients receiving skilled care, a registered nurse or other qualified professional must complete a supervisory assessment of aide services at least every 14 days.16
DHSS has its own Home Health Aide Competency Evaluation. The bureau provides it only by phone request, at 573-751-6336.9
Plans of treatment under the 2022 amendment
Missouri defines a home health agency by reference to a written plan of treatment. Since the August 28, 2022 amendments (H.B. 2149, H.B. 2331 and S.B. 710), the plan may be signed by a physician, nurse practitioner, clinical nurse specialist or physician assistant, and podiatrists may also review and sign it. Each plan lasts no more than 60 days and must be reviewed by a physician at least once every six months.1
Missouri’s state-specific add-on: dementia training
The one substantive operating requirement Missouri adds is dementia-specific training under 19 CSR 30-26.010(1)(B). Training applies to employees and independent contractors as follows:7
| Who | Minimum topics |
|---|---|
| Staff and contractors who give direct care | Overview of Alzheimer’s disease and related dementias; communicating with persons with dementia; behavior management; promoting independence in activities of daily living; understanding and dealing with family issues |
| Staff and contractors with daily contact but no direct care | Overview of Alzheimer’s disease and related dementias; communicating with persons with dementia |
The training must be part of orientation for new direct-contact staff. It must be repeated annually and taught by an instructor qualified in dementia care standards.7
Office, name and ownership set-up before you apply
Three set-up requirements come before the application:
- A real business location. The applicant must establish a business location “not in a private residence” with established business hours.7 A home office will not qualify.
- Secretary of State registration. You must do business only under your legal name or a d/b/a properly registered with the Missouri Secretary of State. A copy of that registration goes with your application.7 For a d/b/a, DHSS’s ownership guidance also asks for proof of the fictitious name filing.12
- Ownership disclosure. The State Disclosure of Ownership and Control Interest Statement asks about anyone with a 5% or greater ownership or control interest who has been convicted of an offense related to Medicare, Medicaid or Title XX programs. It also covers other facilities your owners hold, management companies, chain affiliation, and any change of administrator, director of nursing or medical director in the past year.24
No certificate of need applies. Missouri’s CON definition of health care facilities covers facilities licensed under Chapter 198, long-term care beds in a hospital, long-term care hospitals and construction of a new hospital. It does not list home health agencies.14
An agency in a bordering state that is Medicare-certified, and whose state has a reciprocal agreement with Missouri, still needs a Missouri license and a qualifying business location to serve Missouri residents. The area it serves in Missouri must be contiguous to its service area in its home state.7
What goes into the application
The initial package required by 19 CSR 30-26.010(2)(B) is:7
Application for Home Health Agency License
(form MO 580-0437).
Copy of your Secretary of State registration
State Disclosure of Ownership and Control Interest Statement
Evidence of policies and procedures
You must show “sufficient evidence” that the agency has established appropriate policies and procedures for providing home health services under RSMo 197.400-197.478.
The nonrefundable $600 fee
, which must come with the application.3
The application form itself asks for:11
- The administrator and a pre-designated alternate administrator.
- The counties you will serve.
- Your ownership type (governmental, nonprofit or proprietary) and setting (freestanding, hospital-based, SNF/ICF-based or facility-based).
- Every service you offer. Mark “1” for services provided by agency staff or by contract with an individual, and “2” for services provided under arrangement with another agency.
- Your Medicare and Medicaid numbers, if you have them.
- Your deemed-status accreditor, if any: CHAP, ACHC or The Joint Commission.
- Each branch. All branches must operate under the parent agency’s name.
The administrator and the owner, board president or a partner sign a sworn certification. The form warns that its information goes “without further verification” to the Medicare and Medicaid offices and into the state home health directory.11
Send forms to the Bureau of Home Care and Rehabilitative Standards, 920 Wildwood Dr., PO Box 570, Jefferson City, MO 65102-0570. You can also reach the bureau at [email protected] or 573-751-6336, option 3.9
Two routes: state-licensed only, or Medicare-certified too
DHSS runs two application pages, one for state licensure and one for Medicare certification plus state licensure, from the same bureau.9
For the Medicare route, DHSS’s How to Apply memo says you first send the required documents to the bureau. You must then obtain deemed status through a CMS-approved accrediting organization; the bureau can give you the list of three. DHSS requires these accreditors to survey prospective agencies against Missouri’s state rules as well as federal rules during the initial survey. The memo names a bureau contact for initial applications: David Atkinson, [email protected], 573-526-5587.10 By law, DHSS may accept an accreditor’s or another agency’s survey in place of its own if the survey is comparable in scope and follows Title XVIII.4
The memo describes only the Medicare route, and DHSS publishes nothing that says how a state-licensed-only applicant is surveyed before the first license. The statute says only that DHSS licenses applicants who comply and receive its approval, and that renewal requires an inspection.4 Ask the bureau at 573-751-6336 whether it will survey you itself or expect accreditation on that route, before you budget for an accreditor.
DHSS does not publish a processing time for initial applications. The statute says only that DHSS issues a license to applicants who comply and receive department approval.4
The Medicare freeze since May 13, 2026
The Medicare route is blocked for now. Effective May 13, 2026, CMS stopped enrolling new home health agencies, branches and practice locations in Medicare anywhere in the United States. The only exceptions are applications a Medicare contractor received before that date.17 CMS’s survey memo to state agencies sets out what the freeze means:18
- Initial enrollment applications filed during the moratorium are denied and must be filed again after it ends.
- Accreditation from an approved accrediting organization “will not serve as the basis for Medicare participation through deemed status.”
The moratorium lasts six months and may be extended in six-month increments.17 A Federal Register search on October 12, 2026 found no extension notice, so the first period runs to about mid-November 2026 unless CMS announces a lifting or extension. Once it is lifted, agencies that apply within six months get the “high” screening level.17
CMS left Medicaid moratoria to each state.17 No Missouri home health Medicaid moratorium was found as of October 12, 2026. However, at least one Missouri Medicaid program ties eligibility to Medicare certification. MO HealthNet’s July 8, 2024 notice recruiting private duty nursing providers (hourly nursing for Medicaid children under 21) says “Medicare certified and state licensed home health agencies” qualify to enroll. It listed a rate of $60.80 per hour at that time.21
The Missouri state license is not frozen. A private-pay agency can still be licensed and operate under the Medicare standards described above.
Once the freeze lifts, new Medicare agencies must show “initial reserve operating funds” to cover three months of operation after billing privileges are granted, not counting Medicare receivables.20
Staff screening Missouri requires
RSMo 192.2495 applies to every entity licensed under Chapter 197, which includes home health agencies.13 Before a new hire has contact with any patient, you must do the following:
- Request a criminal background check through the Missouri State Highway Patrol.
- Request a fingerprint-based nationwide check if the applicant has not lived in Missouri for five consecutive years. This does not apply if the applicant worked for a licensed Missouri facility during that period.
- Check whether the applicant is on DHSS’s Employee Disqualification List.
Applicants must also sign a consent form and disclose their criminal history, any listing on the Employee Disqualification List, and any listing in the Family Care Safety Registry.13
An agency commits a class A misdemeanor if it knowingly employs someone to provide home health services who refuses to register with the Family Care Safety Registry or who has a disqualifying history. That includes class A or B felonies under RSMo chapters 565, 566 or 569, felonies under chapters 195 or 579, an offense requiring sex-offender registration, or a listing on the DHSS or Department of Mental Health disqualification lists or the child abuse and neglect registry.13
Surveys, deficiencies and annual renewal
Licenses run one year. To renew, you must:47
- Pay the $600 fee before the license expires.
- File a statement of any changes since your last application.
- Show proof of Secretary of State registration.
- Pass a compliance survey.
DHSS will not renew “unless the department has been able to verify compliance through clinical record review and home visits.” If the fee is not paid by the expiration date, DHSS may start revocation.7 The license covers only the agency named on it and must be posted conspicuously in your main office.4
On-site surveys may be unannounced. After a survey, the deadlines in 19 CSR 30-26.010(2)(E) apply:7
| Step | Deadline |
|---|---|
| DHSS sends the deficiency list | Within 15 business days after the survey |
| Agency submits a written plan of correction | Within 10 calendar days after receiving the report |
| Agency disputes findings and requests a resurvey in writing | Within 10 calendar days |
| Further dispute after resurvey | Review by the Administrative Hearing Commission |
DHSS must post each agency’s most recent survey, its deficiencies and the agency’s plan of correction on its website. A disputed survey is held back until the dispute is resolved.23
DHSS must refuse, suspend or revoke a license for noncompliance or for obtaining the license by fraud or misrepresentation.22 After a denial or revocation, DHSS will not consider a new application for 12 months.7
Violating the licensing law is a class A misdemeanor under RSMo 197.475.26
Buying an agency or changing ownership
A Missouri home health license cannot be transferred. A sale, a transfer of ownership or management, or a substantial change in corporate status voids the license. The new owner must apply at least 90 days before the effective date, use the same form as an original applicant and pay $600. DHSS may issue a temporary operating permit for up to 90 days while the survey and application are pending.5
DHSS’s change-of-ownership guidance (revised July 2025) treats a stock sale that changes the controlling interest (50.1%) as a change of ownership. The guidance requires:12
- A letter of intent.
- The application.
- The $600 fee.
- The ownership disclosure statement.
- Secretary of State and fictitious-name proof.
- Pre- and post-sale organizational charts.
After closing, you must also send proof of the transaction. The new license must be issued effective on the first day of new ownership. Patients “are not assets”: they must be told before the change and offered a choice of provider, and both steps must be documented in the clinical record.12
For a Medicare-certified agency, the federal 36-month rule also applies. If majority ownership changes within 36 months of initial Medicare enrollment, or of the last majority change, the provider agreement and billing privileges do not pass to the buyer.19 During the 2026 moratorium, a buyer in that position cannot re-enroll as a new agency.17
To close an agency voluntarily, send DHSS a letter on agency letterhead with your license number and the effective date. Explain what will happen to your active caseload and where medical records will be stored, and enclose the original license.7
Sources
- 1 Missouri Revisor of Statutes, RSMo 197.400, Definitions (home health agencies) Checked 12 Oct 2026 · Back to text ↑
- 2
- 3 Missouri Revisor of Statutes, RSMo 197.410, Application for license, fee Checked 12 Oct 2026 · Back to text ↑
- 4
- 5
- 6
- 7
- 8
- 9 Missouri Department of Health and Senior Services, Home Health State Licensure Checked 12 Oct 2026 · Back to text ↑
- 10
- 11
- 12
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- 14
- 15 eCFR, National Archives, 42 CFR 484.115, Personnel qualifications Checked 12 Oct 2026 · Back to text ↑
- 16 eCFR, National Archives, 42 CFR 484.80, Home health aide services Checked 12 Oct 2026 · Back to text ↑
- 17
- 18
- 19
- 20
- 21
- 22
- 23
- 24
- 25 Missouri Revisor of Statutes, RSMo 197.445, Rules and regulations Checked 12 Oct 2026 · Back to text ↑
- 26 Missouri Revisor of Statutes, RSMo 197.475, Violations, penalty Checked 12 Oct 2026 · Back to text ↑
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Missouri and neighboring states
Compare all 51| State | License | Who needs it | State fee |
|---|---|---|---|
| Missouri (this guide) | Home Health Agency license | Offers 2+ home health services incl. nursing, from a non-home office | $600 initial, $600 each year at renewal, $600 on change of ownership |
| Illinois | Home Health Agency license (Home Nursing Agency license for shift nursing) | Skilled nursing plus one other home health service in clients' homes | $1,500 per two-year license, initial or renewal |
| Kentucky | Home Health Agency License | Own nurses, therapists or aides into homes; license plus certificate of need | $500 initial and annual |
| Tennessee | Home Care Organization Providing Home Health Services license | Own nurses or therapists in homes; certificate of need required | $2.25 per $1,000 of project cost, $3,000 minimum, $45,000 maximum |
| Arkansas | Home Health Agency license | Providing home health services for pay in a patient's home; Permit required | $3,000 per review |
| Oklahoma | Home Care Agency license | Any organization giving skilled or personal care in clients' homes for a fee | $1,000 initial application; $500 annual renewal; $25 per branch |
| Kansas | Home Health Agency license, Skilled Services | Any agency paid to send nurses, therapists or aides into homes | $500 (under 100 patients/clients) or $750 (100 or more), as published on 2026-10-12 |
| Nebraska | Home Health Agency license | Skilled nursing or any therapy or aide service in clients' homes | $650 |
Shortened from each state's guide and our 51-state table, as of each guide's last review. Fees are the state's own; local permits and background checks cost extra.