ADULT HEALTH SERVICES PROVIDER IN PENNSYLVANIA

Fatumata Kaba
Oct 8
4 min read

SUPPORTING THE HEALTH, WELLNESS, AND INDEPENDENCE OF ADULTS THROUGH MEDICALLY NECESSARY AND PERSON-CENTERED CARE

Adult Health Services in Pennsylvania are Medicaid-funded supports that help individuals with disabilities, chronic illnesses, and aging-related needs maintain their health, function, and independence at home or in the community. These services are delivered through the Pennsylvania Department of Human Services (DHS), primarily under the Office of Long-Term Living (OLTL), Office of Developmental Programs (ODP), and Community HealthChoices (CHC) Managed Care Organizations (MCOs). Services range from medical oversight and monitoring to personal care and therapeutic supports.

1. GOVERNING AGENCIES

Agency: Pennsylvania Department of Human Services (DHS) – Office of Long-Term Living (OLTL)

Role: Manages Medicaid waivers and coordinates services for older adults and adults with physical disabilities.

Agency: DHS – Office of Developmental Programs (ODP)

Role: Administers adult health supports for individuals with intellectual and developmental disabilities.

Agency: Community HealthChoices (CHC) Managed Care Organizations (MCOs)

Role: Authorize and reimburse services for Medicaid-eligible adults enrolled in CHC.

Agency: Centers for Medicare & Medicaid Services (CMS)**

Role: Provides federal guidance and oversight for adult health services delivered through Medicaid HCBS waivers.

Agency: Pennsylvania Department of State

Role: Registers legal business entities and ensures licensure for healthcare professionals and facilities.

2. ADULT HEALTH SERVICES OVERVIEW

Adult Health Services address a range of medical and supportive needs to ensure safe, dignified, and independent living.

Approved providers may deliver:

Skilled Nursing Care: Medication administration, chronic disease management, and wound care (by licensed RNs or LPNs).
Home Health Aide Support: Assistance with bathing, hygiene, dressing, and mobility under RN supervision.
Personal Assistance Services (PAS): Non-medical support with ADLs/IADLs such as meal prep, housekeeping, and errands.
Nutrition & Meal Services: Dietary planning, feeding support, or home-delivered meals based on medical needs.
Adult Day Services (optional): Structured activities, medical oversight, and meals in a licensed facility.
Health Monitoring & Coordination: Wellness checks, symptom reporting, and communication with healthcare teams.
Documentation: Daily notes, plan of care updates, incident reports, and Medicaid billing records.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Pennsylvania Department of State.
Obtain an EIN and Type 2 NPI.
Apply for a Home Care or Home Health Agency License (as applicable) through the PA Department of Health.
Enroll in the PROMISe™ system as a Medicaid provider.
Contract with CHC MCOs and/or receive qualification through ODP or OLTL.
Maintain liability, workers’ compensation, and malpractice insurance.
Develop an Adult Health Services Policy & Procedure Manual aligned with DHS and CMS standards.

4. PENNSYLVANIA PROVIDER ENROLLMENT PROCESS

Step 1: Register your entity and obtain EIN, NPI, and required insurance.

Step 2: Apply for licensure with the PA Department of Health (if providing skilled services).

Step 3: Enroll in PROMISe™ as a home health, PAS, or waiver service provider.

Step 4: Contract with MCOs or qualify through your AE (for ODP services).

Step 5: Submit required staff credentials, policies, and compliance documentation.

Step 6: Begin receiving service authorizations and referrals upon approval.

5. REQUIRED DOCUMENTATION

Articles of Incorporation and business registration
EIN and NPI confirmations
Home Care/Home Health license (if applicable)
Insurance certificates (liability, workers’ comp, malpractice if skilled)
Adult Health Policy & Procedure Manual including:
- Plan of care development and service authorization protocols
- ADL/IADL support procedures and staff supervision
- Medication administration and health monitoring
- Emergency response, infection control, and participant safety
- Staff credentialing and training guidelines
- HIPAA, client rights, and abuse prevention policies
- Medicaid billing forms, EVV (if applicable), and shift note templates

6. STAFFING REQUIREMENTS

Role: Registered Nurse (RN) / Clinical Supervisor

Requirements: Active PA license; responsible for clinical oversight, care planning, and supervision of direct care staff.

Role: Home Health Aide / Personal Care Aide

Requirements: CPR/First Aid certification, background check, completion of approved training (Home Health Aide or PAS curriculum).

Role: Program Coordinator

Requirements: Oversees service delivery, schedules, documentation compliance, and staff coordination.

Optional Roles: Licensed Therapists, Dietitians, or Social Workers (depending on scope of services)

All staff must complete:

Orientation and annual training in HIPAA, safety, and abuse prevention
EVV documentation training (if applicable)
Role-specific continuing education and skill competency checks

7. MEDICAID WAIVER PROGRAMS

Adult Health Services are supported through:

Community HealthChoices (CHC): For dual-eligible individuals age 21+ needing long-term services.
Aging Waiver (OLTL): For individuals 60+ requiring health and personal care supports.
Independence Waiver (OLTL): For adults with physical disabilities who need assistance at home.
OBRA Waiver (OLTL): For adults with developmental physical disabilities who began services before age 60.
Consolidated and Community Living Waivers (ODP): Includes medical and personal health supports for individuals with IDD.
Medicaid State Plan Services: Includes personal care, skilled nursing, and home health benefits (physician-ordered).