1.Program Definition and Services 

Home Health Services in New York support individuals with medical, therapeutic, and personal care needs, allowing them to receive healthcare at home rather than in a hospital or care facility. The program aims to help maintain individuals with disabilities and chronic conditions in the community, averting the need for long-term institutional services and supports. Services include:

• In-Home Skilled Clinical Care: Professional medical interventions, including skilled nursing, wound management, physical therapy, occupational therapy, and speech therapy delivered directly in the individual/family home.
• Personal and Supportive Care Tracking: Delivery of personal care assistance, hygiene maintenance, home health aide support, and chronic condition monitoring across individual homes or community settings.

2. Regulations 

The program is governed by the following regulations: 

• New York Codes, Rules and Regulations (NYCRR) Title 10 (Department of Health Regulations governing Home Care Services)
• New York Codes, Rules and Regulations, Title 14, Part 635 (OPWDD General Quality Control and Administrative Requirements)
• Mental Hygiene Law (MHL Articles 16 & 33)
• Social Services Law (Protection of People with Special Needs)
• Child Protective Services Act (State Central Register Reporting)

3. Licensing or Certification 

Providers must be certified/licensed by the New York State Department of Health or partner state agencies and strictly follow all Home and Community-Based Services (HCBS) clinical and personal care requirements.

4. Responsible State Agency 

The New York State Department of Health (NYSDOH), the Office for People With Developmental Disabilities (OPWDD), and the New York State Office of Mental Health (OMH) are jointly responsible for reviewing applications, issuing designations, and certifying home health service providers.

5. Application Process 

The application process is conducted through the electronic New York Medicaid Provider Enrollment Portal (eMedNY). Providers must submit specialized provider enrollment forms online to initiate the official review process.

6. Required Documentation 

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

• Proof of compliance with state safety, clinical care, and operational rules 
• Agency policy and procedure manuals (including clinical care and medication management protocols) 
• Staff qualifications, clinical licensures, background screenings, and professional training records
• Proof of general and professional liability insurance

7. Timeline for Approval 

The exact timeline for approval fluctuates based on state agency capacity and specific waiver designation workflows. Providers should contact their regional office or specific waiver designation team for detailed information on current processing timeframes.

8. Pre-Application Process 

Prospective providers must complete specific foundation tasks before applying. They must officially establish their business entity with the New York Department of State and secure necessary federal identification numbers (EIN and NPI Type 2).

9. Pre-Application Training 

The state hosts mandatory administrative, compliance, Electronic Visit Verification (EVV), and billing systems training sessions online. Access details are sent to qualified applicants once preliminary enrollment paperwork is reviewed and accepted.

10. Additional Notes 

• Providers must ensure that home health administrative spaces meet all state accessibility and environmental safety guidelines 
• In-Home Home Health Services must be provided directly by the certified agency's qualified, employed personnel and licensed clinicians 
• All clinical staff, field nurses, and home health aides must clear mandatory background checks, criminal history screenings, and fingerprinting protocols
• Providers must maintain detailed records of face-to-face services, explicit clinical notes, and updated electronic care plans for Medicaid documentation and audit compliance

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.