1. Program Definition and Services

Community Integration Services in Pennsylvania provide Medicaid-funded supports to children and adults with intellectual disabilities, developmental disabilities, and autism. The program aims to help maintain individuals with disabilities in the community, averting the need for long-term institutional services and supports. Services include:

• In-Home Personal Care: Individual support in the individual/family home or community (In-Home and Community Habilitation, 1:1 real-world skill instruction, relationship building, public transit navigation, and social integration)
• Residential Personal Care: Supervision and care in a licensed residential or structured day program environment (Community Participation Support [CPS], mobile community tracking, civic/volunteer engagement, and peer interaction support)

2. Regulations

The program is governed by the following regulations:

• 55 Pa. Code Chapter 6100 (Support for Individuals with an Intellectual Disability or Autism)
• 55 Pa. Code Chapter 2380 (Adult Training Facilities, if operating site-based day services)
• Federal 1915(c) Home and Community-Based Services (HCBS) waiver regulations
• Pennsylvania Employment First Act (Act 36 of 2018) frameworks

3. Licensing or Certification

Providers delivering mobile or in-home integration services do not require a facility license but must obtain standard ODP Provider Qualification. Settings hosting site-based daily activities under Community Participation Support (CPS) must carry a valid facility license under 55 Pa. Code Chapter 2380.

4. Responsible State Agency

The Department of Human Services (DHS) Office of Developmental Programs (ODP) is responsible for reviewing provider qualification applications and issuing service approvals. Local Administrative Entities (AEs) / County MH/ID offices support direct monitoring and regulatory oversight.

5. Application Process

The application process is conducted through the electronic HCSIS Portal and the unified PROMISe™ Medicaid Portal. Providers must submit their credentialing forms online to initiate the formal multi-tiered qualification and enrollment process.

6. Required Documentation

While specific documentation requirements vary based on the target waiver, providers typically need to submit:

• Form DP 1059 (ODP Provider Qualification Application) and the New Provider Self-Assessment Tool
• Agency policies, procedures, and service descriptions aligned with Chapter 6100 rules
• Staff qualifications, mandatory background clearances, and training logs
• Proof of Workers' Compensation and Commercial General Liability insurance

7. Timeline for Approval

The exact timeline for approval fluctuates based on state and county review capacity. Navigating the mandatory ODP training prerequisites, local AE policy screening, and final PROMISe™ Medicaid system enrollment generally takes 3 to 5 months.

8. Pre-Application Process

Prospective providers must complete specific foundation tasks before applying. They must establish their legal business entity structure with the Pennsylvania Department of State (PennFile), secure a federal IRS EIN, and register an organizational Type 2 NPI through the NPPES platform.

9. Pre-Application Training

The state hosts mandatory administrative and compliance training sessions online. The agency CEO must complete the ODP Provider Applicant Orientation on the MyODP portal and pass all associated competency tests before the company can submit an application packet.

10. Additional Notes

• Providers operating site-based CPS locations must secure Noncontiguous Location Clearance under Chapter 6100 rules to ensure proper community dispersion
• All community integration hours must be explicitly detailed and authorized within the participant’s Individual Support Plan (ISP) before services can be billed
• All frontline staff must conduct mandatory background clearances, including PA State Police checks, Child Abuse History clearances, and FBI fingerprint tracking
• Providers must maintain detailed service logs, objective goal tracking data, and exact timestamp records to satisfy state Medicaid documentation standards and audit readiness

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