1. Program Definition and Services

Attendant and Companion Care Services in South Carolina provide dedicated non-medical, person-centered support to children and adults with physical limits, intellectual/developmental disabilities, or traumatic brain injuries. The program aims to safeguard participant health, foster social connection, and assist with primary personal tasks inside the participant's home or community setting, preventing isolation and institutionalization. Services include:

• In-Home Personal Care: Hands-on daily personal support and safety supervision executed inside the individual's primary residence (Attendant Care assisting with ADLs such as dressing, bathing, grooming, and eating; mobility and transfer assistance; light housekeeping; and non-clinical medication reminders)
• Residential Personal Care: Socialization and structural oversight coordinated through an approved agency framework (Companion Care facilitating meaningful activity engagement, reading, conversation, community integration, and supervised transportation assistance)

2. Regulations

The program is governed by the following regulations:

• South Carolina Department of Public Health (SCDPH) Regulation 60-122 (formerly 61-122) (Standards for Licensing In-Home Care Providers)
• South Carolina Code of Laws  44-70-10 et seq. (In-Home Care Providers Act)
• SCDHHS Home and Community-Based Services (HCBS) Waiver Policy Manuals (including specific Companion/Attendant Care Scopes of Service)
• Federal HCBS Settings Final Rule (42 CFR  441.301)

3. Licensing or Certification

Providers must secure an In-Home Care Provider License issued by the South Carolina Department of Public Health (SCDPH), Bureau of Health Facilities Licensing. In addition to mandatory state facility licensure, the agency must be officially credentialed as an qualified Medicaid waiver provider by the South Carolina Department of Health and Human Services (SCDHHS) or the South Carolina Department of Disabilities and Special Needs (SCDDSN).

4. Responsible State Agency

The South Carolina Department of Public Health (SCDPH) oversees agency licensure, corporate background vetting, and routine health facility quality inspections. The South Carolina Department of Health and Human Services (SCDHHS) handles final Medicaid network enrollment, while partnering with the South Carolina Department of Disabilities and Special Needs (SCDDSN) to monitor programmatic compliance across intellectual disability and brain injury waivers.

5. Application Process

The provider onboarding sequence requires a strict two-stage system. First, agencies file an operational licensing application alongside a non-refundable $1,000 fee to SCDPH and pass an administrative compliance review. Once the SCDPH operating license is active, the provider applies through the electronic SCDHHS Medicaid Provider Enrollment Portal or the SCDDSN Provider Portal to gain network authorization and map specific billing codes.

6. Required Documentation

To fulfill licensing and waiver provider qualification standards, agencies must submit:

• State Business Registration and approved Articles of Organization from the SC Secretary of State
• Valid SCDPH In-Home Care Provider License
• Companion & Attendant Care Operations Policy & Procedure Manual (covering client service planning, safety/supervision workflows, incident logs, and HIPAA privacy rules)
• Certified statewide South Carolina Law Enforcement Division (SLED) background checks and mandatory pre-employment drug screenings for all owners, administrators, and staff
• Verification of a dedicated agency office site situated in a commercially zoned or unzoned area
• Binders for commercial general liability, professional liability, and workers' compensation insurance

7. Timeline for Approval

The end-to-end credentialing loop spanning the progressive SCDPH structural/policy screening, multi-year background clearances, and subsequent SCDHHS electronic portal activation typically requires 2 to 4 months.

8. Pre-Application Process

Before initiating state files, prospective providers must organize their underlying corporate structure. This includes registering the entity with the South Carolina Secretary of State, leasing a business office that complies with state commercial or unzoned requirements, purchasing liability binders, and securing an EIN alongside an Organizational Type 2 NPI. The agency owner or designated administrator must possess a minimum of three (3) years of documented administrative experience within a healthcare field.

9. Pre-Application Training

The state mandates specific onboarding and competency thresholds. Prior to participant contact, companions must complete a minimum of 4 hours of relevant training (within 15 days of hire) and attendant care aides must pass an RN- or LPN-supervised competency evaluation. Training topics must cover Abuse, Neglect, and Exploitation (ANE) Prevention, Infection Control, First Aid/Emergency Protocols, and Electronic Visit Verification (EVV) tracking.

10. Additional Notes

• Providers must ensure that all on-duty caregivers and supervisors continuously display an official, provider-branded photo identification badge while serving participants
• All attendant tasks and companion shifts must be delivered directly by the certified agency's background-cleared, employed personnel
• SLED background checks must be executed prior to initial hire and systematically re-evaluated at least every two years for all direct care and administrative staff
• Providers must maintain precise electronic encounter records, capturing specific 15-minute billing increments and synchronizing all care shifts with state-mandated EVV automated data collections to withstand regular contract compliance reviews

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.