The short answer Missouri licenses home health agencies under 19 CSR 30-26, which incorporates the federal Conditions of Participation (75-hour aide standard), but does not license private-pay/private-duty personal care agencies. Medicaid in-home services aides must complete 20 hours of basic training under 13 CSR 70-91.010, and dementia-specific training is mandated for direct-care staff.
What Missouri requires
Missouri
HHA licensure. Home health agencies must be licensed by DHSS under 19 CSR 30-26; the licensure rule incorporates 42 CFR Part 484 by reference, so home health aides follow the federal 75-hour training/competency standard.
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No private-duty license. Missouri does not license private-duty or private-pay non-medical home care agencies; state caregiver training mandates attach only to licensed home health agencies and Medicaid-enrolled in-home services providers.
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Medicaid aide training (20 hrs). Under the MO HealthNet Personal Care Program rule (13 CSR 70-91.010), in-home aides must complete 20 hours of basic training within 30 days of employment, including 8 classroom hours before client contact, agency orientation, and supervised on-the-job training.
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Dementia training mandate. Missouri requires dementia-specific training on Alzheimer's disease and related dementias for direct-care employees and contractors of licensed home health agencies and Medicaid in-home services providers.
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In-service. Home health aides at licensed/certified agencies must receive 12 hours of in-service per 12-month period per the incorporated federal standard.
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The federal baseline (applies in every state)
Federal
75-hour HHA training standard. Under 42 CFR 484.80(b), home health aides at Medicare-certified home health agencies must complete a training program of at least 75 hours, including at least 16 hours of classroom training completed before beginning at least 16 hours of supervised practical (hands-on) training.
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Competency evaluation / CNA pathway. 42 CFR 484.80(a) allows aides to qualify by completing the 75-hour training and competency evaluation program, by passing a competency evaluation alone, or by completing a state nurse aide training and competency evaluation program (CNA) and being in good standing on the state nurse aide registry.
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12-hour annual in-service. 42 CFR 484.80(d) requires home health aides to receive at least 12 hours of in-service training during each 12-month period, which may occur while the aide is furnishing care and must be supervised by a registered nurse.
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RN trainer requirements. Under 42 CFR 484.80(b)(3) and (c)(2), classroom and supervised practical training must be performed by or under the general supervision of a registered nurse with at least 2 years of nursing experience, at least 1 year of which must be in home health care; competency evaluations must likewise be performed by an RN in consultation with other professionals.
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Primary sources for this page
- https://health.mo.gov/safety/homecare/hhstatelicensure.php
- https://health.mo.gov/safety/homecare/
- https://www.sos.mo.gov/cmsimages/adrules/csr/current/13csr/13c70-91.pdf
- https://www.sos.mo.gov/cmsimages/adrules/csr/current/19csr/19c30-26.pdf
- https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-G/part-484/subpart-B/section-484.80
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