HOME HEALTH CARE SERVICES PROVIDER IN PENNSYLVANIA

Fatumata Kaba
Oct 8
4 min read

DELIVERING CLINICAL CARE AT HOME TO SUPPORT RECOVERY, CHRONIC CONDITION MANAGEMENT, AND INDEPENDENT LIVING

Home Health Care Services in Pennsylvania are Medicaid-funded clinical services provided in an individual’s home for the purpose of treating illness, managing chronic health conditions, or aiding recovery after surgery or hospitalization. These services must be medically necessary, ordered by a physician, and delivered by licensed professionals. Home Health Care is authorized through the Pennsylvania Medical Assistance Program (via PROMISe™), the Office of Long-Term Living (OLTL), Community HealthChoices (CHC) Managed Care Organizations (MCOs), and in some cases, via private insurance or Medicare.

1. GOVERNING AGENCIES

Agency: Pennsylvania Department of Health (DOH) – Division of Home Health

Role: Licenses Home Health Agencies (HHAs) and ensures compliance with state and federal regulations.

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

Role: Coordinates Medicaid-funded home health services and authorizations through waiver programs and CHC.

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

Role: Authorize and reimburse for home health services for individuals in CHC.

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal regulation and oversight for home health care reimbursement through Medicaid and Medicare.

Agency: Pennsylvania Department of State

Role: Handles legal registration of provider businesses.

2. HOME HEALTH CARE SERVICES OVERVIEW

Home Health Care includes intermittent, short-term, or ongoing skilled care provided in a residential setting, under a physician's order.

Approved providers may deliver:

Skilled Nursing: Wound care, medication administration, IV therapy, chronic disease monitoring.
Home Health Aide Services: Assistance with ADLs under the supervision of a nurse.
Physical Therapy (PT): Post-operative rehabilitation, mobility improvement.
Occupational Therapy (OT): ADL skill-building and adaptive strategies.
Speech Therapy (ST): Communication and swallowing therapy.
Medical Social Services: Counseling and coordination of care and services.
Documentation & Care Coordination: Plan of care development, visit notes, electronic charting, and billing.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Pennsylvania Department of State.
Obtain an EIN and a Type 2 NPI.
Apply for a Home Health Agency License from the PA Department of Health.
Enroll as a Medicaid provider via PROMISe™ and contract with CHC MCOs.
Obtain accreditation (e.g., CHAP, ACHC, Joint Commission – recommended but not required).
Maintain general liability, workers’ compensation, and malpractice insurance.
Develop a Home Health Care Services Policy & Procedure Manual in accordance with Pennsylvania DOH and CMS standards.

4. PENNSYLVANIA PROVIDER ENROLLMENT PROCESS

Step 1: Register your business entity and obtain EIN, NPI, and insurances.

Step 2: Apply for a Home Health Agency License through the DOH.

Step 3: Enroll in PROMISe™ as a home health provider.

Step 4: Contract with Community HealthChoices MCOs (UPMC, Keystone First, PA Health & Wellness).

Step 5: Complete credentialing and readiness reviews to begin receiving referrals.

5. REQUIRED DOCUMENTATION

Articles of Incorporation and business registration
Home Health Agency License (PA DOH)
Accreditation certificate (if applicable)
EIN and NPI confirmation
Insurance certificates (general liability, malpractice, workers’ comp)
Home Health Policy & Procedure Manual including:
- Admission and discharge criteria
- Physician order tracking and plan of care development
- Medication administration and nursing protocols
- Infection control, emergency preparedness, and patient safety
- HIPAA compliance and documentation standards
- Visit note templates and electronic charting formats
- Billing processes and audit readiness tools

6. STAFFING REQUIREMENTS

Role: Registered Nurse (RN) / Clinical Supervisor

Requirements: Active PA license; develops care plans, supervises aides, delivers skilled care.

Role: Home Health Aide (HHA)

Requirements: Completion of state-approved training program; background check and CPR certification.

Role: Therapists (PT, OT, ST)

Requirements: Active PA licensure; provides therapy as prescribed by a physician.

Role: Medical Social Worker

Requirements: MSW; supports psychosocial aspects of care.

All staff must complete:

HIPAA and patient rights training
Infection control and universal precautions
Documentation and billing compliance education
Annual continuing education and performance evaluations

7. MEDICAID WAIVER PROGRAMS

Home Health Care Services are covered under:

State Plan Medicaid Home Health Benefit: Physician-ordered, medically necessary services.
Community HealthChoices (CHC): Skilled care services authorized through MCOs.
Aging Waiver (OLTL): For seniors requiring skilled care to remain at home.
OBRA and Independence Waivers (OLTL): Home health for younger adults with physical disabilities.
Act 150 Program (non-Medicaid): Similar to waivers, but state-funded.