How to start a hospice in Missouri

Missouri requires a Missouri hospice state certification (temporary operating permit, then annual certificate) from Missouri Department of Health and Senior Services, Home Care and Rehabilitative Standards to operate a hospice. Fee: $500. Processing time: After policy review, DHSS issues a temporary operating permit of up to 90 days; the unannounced initial survey occurs after about 90 days of operation once the hospice has served at least three patients for at least three weeks.

License required

Yes

License

Missouri hospice state certification (temporary operating permit, then annual certificate)

Issuing agency

Missouri Department of Health and Senior Services, Home Care and Rehabilitative Standards

Fee

$500

Fee details

Initial state hospice certification fee $500.

Renewal

Every year · Annual renewal fee by admissions: 0-50 $250; 51-150 $400; 151-250 $550; 251+ $750. Renewal application due before the prior certificate expires.

Processing time

After policy review, DHSS issues a temporary operating permit of up to 90 days; the unannounced initial survey occurs after about 90 days of operation once the hospice has served at least three patients for at least three weeks.

Survey and inspection

Annual DHSS survey; deficiency report within 15 business days and plan of correction within 10 business days; compliance within 60 days.

Medicare certification

Medicare certification is separate from the state license (state survey or CMS-approved accreditor). CMS imposed a nationwide 6-month moratorium on new Medicare hospice enrollments (including new practice locations) effective 2026-05-13, extendable in 6-month increments; applications received by the Medicare contractor before that date are still processed, accreditation cannot be used for deemed-status entry during the moratorium, and a hospice undergoing a non-exempt ownership change within 36 months of enrollment must re-enroll as new and is therefore blocked. The federal notice leaves Medicaid/CHIP hospice moratoria to each state.

Regulation

RSMo 197.250-197.280; 19 CSR 30-35.010-30-35.030

1. Submit the Application for Hospice Certification with the $500 initial fee
2. Provide policies and procedures and show qualified staff
3. Receive a temporary operating permit (up to 90 days, extendable)
4. Serve at least three patients for at least three weeks, then request the unannounced initial survey
5. Receive state certification; renew annually with the sliding-scale fee and annual survey

Training

• Alzheimer's/dementia-specific training (RSMo 192.2000)
• Criminal background checks (RSMo 192.2495)
• Home health aide competency evaluation

Program

MO HealthNet (Missouri Medicaid, Department of Social Services)

Enrollment portal

MMAC online provider enrollment application / eMOMED

Fiscal agent

None named on the enrollment pages — Missouri Medicaid Audit & Compliance (MMAC) runs provider enrollment; eMOMED is the provider web portal

Application fee

MMAC charges new and revalidating institutional providers $750 (Missouri began collecting July 1, 2015). Proof of payment through the state's payment vendor must come with the application; providers that paid Medicare or another state within the past two years are exempt, and if CMS grants a hardship waiver MMAC refunds the fee. Federal rule (42 CFR 455.460): the state must collect the CMS application fee from institutional providers that are newly enrolling or re-enrolling; individual physicians and non-physician practitioners are exempt, as are providers already enrolled in (or that already paid the fee to) Medicare or another state's Medicaid/CHIP. CMS set the fee at $750 for calendar year 2026.

Fingerprinting

Missouri requires two sets of fingerprints from every 5%+ owner of a high-risk provider, taken through MACHS/IDEMIA and checked by the FBI and Missouri State Highway Patrol; owners fingerprinted by Medicare or another state in the past two years are exempt. Federal rule (42 CFR 455.434, 455.450(c)): providers the state places in the 'high' categorical risk level, and anyone owning 5% or more of such a provider, must submit fingerprints for a criminal background check.

Site visit

MMAC has done pre- and post-enrollment site visits for new, re-enrolling and revalidating moderate- and high-risk providers since July 1, 2015, skipping them if Medicare or another state did one in the past two years. Federal rule (42 CFR 455.432, 455.450(b)-(c)): the state must do site visits before and after enrollment for providers in the 'moderate' or 'high' risk levels, and any enrolled provider must allow unannounced on-site inspections.

Revalidation

MMAC revalidates every active provider at least every five years through eMOMED and rejects revalidations that lack required documents. Enrollment is deactivated if missing documents are not sent within 30 days of notice. Federal rule (42 CFR 455.414): every enrolled provider must be revalidated at least once every 5 years.

Full Missouri Medicaid enrollment guide →

CON program

Yes

Program

Certificate of Need

Agency

Missouri Health Facilities Review Committee, staffed by the Certificate of Need Program in the Missouri Department of Health and Senior Services

Services covered

• beds in long-term care facilities licensed under RSMo chapter 198 and hospital long-term care beds (expenditure minimum $600,000 capital / $400,000 major medical equipment)
• long-term care hospitals (no expenditure minimum)
• other health care facilities, new institutional health services and beds, including hospitals ($1,000,000 capital / $1,000,000 major medical equipment)

Missouri certificate of need details →

State minimum wage

$15.00 an hour

Effective

2026-01-01

Scheduled increases

No inflation adjustment scheduled: HB 567 (2025) ended the CPI adjustments that were to start 2027-01-01, so $15.00 stays in place.

HCBS 80/20 rule

Federal baseline: 42 CFR 441.302(k) requires the state to show that each provider spends at least 80% of Medicaid payments for homemaker, home health aide and personal care services under 1915(c) waivers on direct care worker pay and benefits. Compliance starts 2030-07-09 (for managed care, the first rating period starting on or after that date); annual payment-adequacy reporting under 441.311(e) starts 2028-07-09. A state may set a lower share for state-defined small providers and exempt providers facing hardship, each only through a public notice-and-comment process. The eCFR text has not changed since 2024-07-09. No state-published 80/20 implementation step (small-provider criteria, hardship exemption or reporting guidance) was found for this state in the official sources reviewed.

Hospice agencies (community based) — active organization NPIs (NPPES)

323 (as of Sep 13, 2026)

Medicare-certified hospices (CMS Care Compare)

132 (as of Aug 19, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

1,243,023 (as of Jun 1, 2026)

All Missouri Hospice Medicaid rates, ranked →