Missouri manual section 6.20
In-home respite
Official service name: In-Home Respite
In-Home Respite provides short-term care and supervision in a person's home or private residence when an unpaid caregiver who normally provides care is absent or needs relief. It is caregiver-relief support, not replacement staffing, child care, or day habilitation.
What the manual describes
What this service can help with
- Giving an unpaid customary caregiver planned short-term relief
- Supervising and supporting the person in the person's home or private residence
- Providing overnight respite in the person's own residence when the plan identifies that need
- Serving one person or, when appropriate, assisting as many as three people at the same time
- Including personal-assistance tasks that are necessary for the person to participate in respite
Source-backed working pathway
To establish you'll probably need:
These steps translate the cited manual section into a practical review sequence. Confirm the current local process before acting.
Describe the caregiver-relief need with the support coordinator.
Identify who normally provides unpaid care, why that person will be absent or needs relief, when respite is needed, and why the person cannot safely care for themselves during that time.
Define the setting, schedule, and supervision needs.
Document the home or private residence where support will occur, the expected dates and hours, whether support is one-to-one or shared, and the assistance the person needs while the caregiver is away.
Document overnight and safety details when they apply.
For overnight respite, the person-centered service plan must document the person's required level of care and whether staff may sleep based on elopement risk, medical conditions, and required monitoring. Sleeping staff must remain close to the person.
Confirm that respite is the correct service.
The planning team should confirm that the request is unpaid-caregiver relief and is not replacement staffing, child care, day habilitation, or a request made up entirely of personal-assistance tasks.
Choose a qualified provider and confirm authorization.
Confirm the provider's Department of Mental Health contract, the worker's qualifications and training, the approved schedule and service arrangement, and what progress notes or other documentation are required before services begin. As a practical preparation step, also ask how the provider handles an unavailable scheduled worker.
Important boundaries
Limits that may affect fit or authorization
- The service is for a person who cannot care for themselves and is needed because an unpaid customary caregiver is absent or needs relief.
- It cannot be used to compensate for relief of paid caregivers or as substitute staffing.
- It does not replace child care or day habilitation.
- The service is provided in the person's home or private residence. Overnight respite must be provided in the person's own residence.
- The worker supervises the person throughout the service. Sleeping is permitted only when the person is asleep, the service is in the person's own home, and the person-centered service plan documents whether sleeping staff are appropriate based on support level, elopement risk, and medical monitoring needs.
- Personal-assistance tasks may be part of respite when needed, but they cannot make up the entire service.
- The authorized hours must remain within the overall cost-effectiveness of the person's person-centered service plan.
- The manual's billing table lists a maximum of one day unit per day or 40 fifteen-minute units per day for individual or group respite. Current authorization and billing rules must be confirmed before relying on those amounts.
- Comprehensive and Community Support waivers remain under a temporary renewal extension through December 27, 2026, or until CMS grants final approval. Confirm the currently approved rules with the support coordinator; proposed renewal changes are not automatically active.
Do not assume this part
Questions to confirm locally
- Is the requested support relief for an unpaid customary caregiver rather than replacement for paid staff?
- Is In-Home Respite included and authorized in the current person-centered service plan?
- Which qualified providers currently serve the person's location and can meet the requested schedule?
- Does the person need one-to-one support, or can shared respite safely meet the need?
- If the service is overnight, must staff remain awake, and what monitoring or proximity does the plan require?
- Which personal-assistance tasks are incidental to respite, and could another service be needed if those tasks make up the entire request?
- What current hours, units, documentation, backup coverage, and start procedure are authorized?