1. Program Definition and Services

Respite Care Services in South Carolina provide short-term, temporary substitute care to children and adults who are unable to care for themselves due to physical limits, intellectual/developmental disabilities, or chronic medical conditions. The program is designed to deliver scheduled or emergency relief to primary, unpaid family caregivers to prevent burnout and support the individual's long-term community placement. Services include:

• In-Home Personal Care: Shift-based and flexible supervision delivered in the participant's primary family home (Basic ADL/IADL Assistance, Behavioral Support, and Hourly In-Home Respite up to 16 hours per calendar day)
• Residential Personal Care: Temporary substitute support provided in specialized or supervised settings outside the participant's home (Institutional Respite in nursing facilities or ICFs/IID, Center-Based/Adult Day Care Respite, and Out-of-Home Respite in licensed Community Training Homes [CTH I or II])

2. Regulations

The program is governed by the following regulations:

• South Carolina Department of Disabilities and Special Needs (SCDDSN) Respite Program Standards
• SCDDSN Directive 735-02-DD (Relatives/Family Members Serving as Paid Caregivers)
• SCDDSN Directive 406-04-DD (Criminal Record Checks and Reference Checks of Direct Caregivers)
• South Carolina Department of Public Health (SCDPH) Regulation 61-103 (Licensure of Community Residential Care Facilities, where applicable)
• Federal HCBS Settings Final Rule (42 CFR  441.301)

3. Licensing or Certification

Providers delivering standard, agency-directed respite care must be formally qualified and credentialed by SCDDSN or the South Carolina Department of Health and Human Services (SCDHHS). If an agency operates an out-of-home respite facility, overnight center, or Community Residential Care Facility (CRCF), it must also secure a specific health facility operating license from the South Carolina Department of Public Health (SCDPH).

4. Responsible State Agency

The South Carolina Department of Health and Human Services (SCDHHS) coordinates overall Medicaid waiver funding and state plan rules. The South Carolina Department of Disabilities and Special Needs (SCDDSN) manages provider registration, sets operational benchmarks, and conducts contract compliance reviews for I/DD waiver lines. SCDPH manages facility code enforcement.

5. Application Process

The provider application track is initiated by submitting a new provider credentialing packet directly through the SCDDSN Provider Portal or the SCDHHS Medicaid Provider Enrollment System, depending on the target waiver population ( DDSN for ID/RD and Community Supports waivers, or SCDHHS for Community Long Term Care [CLTC]). Once state qualification profiles are accepted, the agency is issued an official Medicaid provider billing contract.

6. Required Documentation

To satisfy state and Medicaid requirements, providers must submit:

• State Business Registration and Articles of Organization from the SC Secretary of State
• Respite Care Policy & Procedure Manual (including critical incident response workflows, Abuse, Neglect, and Exploitation [ANE] protocols, and medication handling guidelines)
• Form E/Form K or generic certificates of commercial general liability, professional liability, and workers' compensation insurance
• Certified South Carolina Law Enforcement Division (SLED) criminal background checks and SC DSS Central Registry child abuse clearances for all personnel
• Certified two-step Tuberculosis (TB) clearance results and verified physical fitness exams for all direct care staff

7. Timeline for Approval

The dual credentialing and enrollment process encompassing SCDDSN or SCDHHS policy reviews, background clearances, and systems integration typically takes 2 to 4 months. Out-of-home facility license processing through SCDPH may add time.

8. Pre-Application Process

Prospective agencies must complete foundational administrative setups before seeking state approval. This includes registering the corporation with the South Carolina Secretary of State, establishing a functional corporate office, procuring required liability insurance policies, and securing a federal EIN along with an Organizational Type 2 NPI.

9. Pre-Application Training

South Carolina enforces strict, competency-based onboarding tracks. Before providing care, administrative leaders and respite staff must pass mandatory examinations covering Abuse, Neglect, and Exploitation (ANE) Prevention, Person-Centered Support Plans, First Aid and CPR, and Crisis Management / Positive Behavior Curricula.

10. Additional Notes

• Respite services are strictly tracked and capped based on waiver guidelines (capped at 68 hours/month for specific waivers unless an institutional emergency exception is granted by SCDHHS)
• Agency-directed respite hours must be delivered directly by the certified provider's employed staff, and no overlapping caregiver hours are permitted within the same household
• All direct care personnel must undergo mandatory SLED criminal record checks at hire, which must be systematically re-checked every three years
• Providers must maintain precise electronic session documentation, capturing 15-minute billing units and integrating all home care visits with state-approved Electronic Visit Verification (EVV) platforms to verify care delivery

Why Choose Waiver Consulting Group?

Starting or expanding your Medicaid waiver-funded agency can feel overwhelming, but it doesn't have to be. At Waiver Consulting Group, we simplify the process by guiding you through licensing, compliance, provider enrollment, policies & procedures, and regulatory approvals in any state.

With proven expertise, a structured process, and ongoing support, we take the guesswork out of launching your healthcare business. Whether you're a first-time entrepreneur or an established provider looking to expand, our team ensures you stay compliant, competitive, and fully operational.

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