1. Program Definition and Services

Personal Care Services in Pennsylvania (Non-Medical Home Care) provide hands-on assistance to individuals with physical or developmental disabilities, chronic illnesses, or age-related limitations. This support allows participants to live safely in their own homes instead of institutional facilities. Services include:

• Activities of Daily Living (ADLs): Hands-on help with bathing, grooming, dressing, toileting, eating, and mobility transfers
• Instrumental Activities of Daily Living (IADLs): Light housekeeping, laundry, grocery shopping, meal preparation, and medication reminders
• Protective Oversight: Monitoring cognitive shifts, preventing social isolation, and ensuring overall home environment safety

2. Regulations

Agencies must operate in full compliance with 28 Pa. Code Chapter 611 (Home Care Agencies and Registries licensing guidelines), 55 Pa. Code Chapter 52 (OLTL Home and Community-Based Services), and federal Electronic Visit Verification (EVV) regulations.

3. Licensing or Certification

To legally deliver hands-on personal care in Pennsylvania, the business must obtain a Home Care Agency License from the Pennsylvania Department of Health (DOH).

4. Responsible State Agency

The Pennsylvania Department of Health (DOH) handles facility compliance and issues the home care license. The Department of Human Services (DHS) Office of Long-Term Living (OLTL) and Office of Developmental Programs (ODP) manage the waiver enrollment portals, while regional Community HealthChoices (CHC) Managed Care Organizations (MCOs) authorize direct service hours.

5. Application Process

• DOH Licensure: Submit a licensing application to the PA DOH, clear the policy review, and pass the pre-licensure administrative site inspection to secure your license
• Medicaid Portal Link: Register inside the PROMISe™ Medicaid Portal to secure active billing status under Provider Type 59 (OLTL Programs) or Provider Type 51 (ODP Habilitation)
• MCO Contracting: Secure network inclusion contracts with operating CHC MCOs in your territory (UPMC, Keystone First, PA Health & Wellness)

6. Required Documentation

• Pennsylvania Business Registration (PennFile)
• IRS EIN letter and Type 2 Organizational NPI
• Approved PA Department of Health Home Care Agency License
• Proof of General and Professional Liability insurance and an employee dishonesty bond
• A Chapter 611-compliant Policy Manual covering consumer rights, infection control, background checks, and EVV workflows

7. Timeline for Approval

Navigating DOH licensing, passing the pre-licensure inspection, completing the electronic PROMISe™ setup, and executing MCO contracts takes an average of 4 to 6 months.

8. Pre-Application Process

Before applying for a health license, register your corporation via the Department of State, secure a federal EIN, establish a physical commercial office with locking file storage for client charts, and register for a Type 2 NPI through the federal NPPES platform.

9. Pre-Application Training

The agency Administrator must verify background clearances. Direct care personnel must clear state criminal background screenings (Act 169), pass FBI fingerprinting (if living outside PA within the past two years), and complete negative Tuberculosis (TB) testing. Care aides must also complete 40 hours of mandated competency training covering personal care, transfers, infection control, and EVV procedures prior to working unsupervised.

10. Additional Notes

• Approval does not guarantee clients, all service hours are explicitly authorized by regional MCO service coordinators
• Agencies must use an approved Electronic Visit Verification (EVV) system to log exact shift timestamps and GPS locations, paper logging results in automated claims denial
• All staff and owners must be screened monthly against the federal OIG Excluded Individuals list and the PA Medicheck database

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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