HOME HEALTH CARE SERVICES PROVIDER IN VIRGINIA

BRINGING SKILLED MEDICAL CARE AND THERAPEUTIC SUPPORT TO INDIVIDUALS IN THE COMFORT OF THEIR OWN HOMES

Home Health Care Services in Virginia provide short-term or long-term skilled nursing and therapeutic support for individuals recovering from illness, injury, surgery, or managing chronic health conditions. These services help prevent unnecessary hospitalization, support faster recovery, and allow clients to remain independent at home.

Home Health is covered under Virginia Medicaid State Plan services, the Commonwealth Coordinated Care Plus (CCC Plus) Waiver, and may also be available through EPSDT for children under 21. Oversight is provided by the Virginia Department of Medical Assistance Services (DMAS) and the Virginia Department of Health (VDH).

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1. GOVERNING AGENCIES

Agency: Virginia Department of Medical Assistance Services (DMAS)

Role: Administers Medicaid enrollment, reimbursement, and claims for home health providers.

Agency: Virginia Department of Health (VDH) – Office of Licensure and Certification (OLC)

Role: Issues Home Care Organization (HCO) licenses and enforces regulations for skilled home health agencies.

Agency: Managed Care Organizations (MCOs)

Role: Handle referrals and service authorization for Medicaid recipients under the CCC Plus program.

2. HOME HEALTH CARE SERVICES OVERVIEW

Home health services are provided under a physician’s order and must be documented in a Plan of Care (POC). Services are delivered by licensed professionals and are designed to be intermittent, not continuous.

Covered services may include:

• Skilled Nursing: IV therapy, wound care, injections, chronic condition monitoring

• Physical Therapy (PT)

• Occupational Therapy (OT)

• Speech-Language Pathology (SLP)

• Home Health Aide Services: Personal care under RN supervision

• Medical Social Work

• Medication Management and Health Education

• Discharge planning and care coordination

All services must be medically necessary and align with federal Conditions of Participation (CoPs) if Medicare-certified.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register your business with the Virginia State Corporation Commission (SCC)

• Obtain an EIN and Type 2 NPI

• Apply for a Home Care Organization (HCO) license via VDH Office of Licensure and Certification (OLC)

• Hire a Registered Nurse (RN) as Director of Nursing

• Secure general liability, professional, and workers’ compensation insurance

• Develop a Home Health Care Policy & Procedure Manual per DMAS and CMS standards

• Enroll as a Medicaid provider through the MES portal

• Optionally pursue Medicare certification (if seeking dual reimbursement)

4. VIRGINIA PROVIDER ENROLLMENT PROCESS

Step 1: Register entity, obtain EIN and NPI

Step 2: Apply for HCO license via VDH

Step 3: Hire clinical leadership and develop policy manual

Step 4: Submit Medicaid provider enrollment via MES

Step 5: Contract with MCOs for CCC Plus referrals

Step 6: Complete site readiness inspections and credentialing

Step 7: Begin accepting physician referrals and create POCs

5. REQUIRED DOCUMENTATION

• SCC registration, EIN, and NPI

• HCO license and VDH inspection report

• Medicaid enrollment confirmation

• MCO contracts or referrals

• Home Health Care Policy & Procedure Manual including:

  • Scope of skilled services and therapy programs

  • Plan of Care documentation and physician order tracking

  • Medication management and nursing protocols

  • Staff credentialing and supervision policies

  • Infection control, wound care, and emergency response

  • Client rights, grievance policy, and HIPAA compliance

  • Shift notes, MARs, billing logs, and discharge summaries

6. STAFFING REQUIREMENTS

Role: Registered Nurse (RN)

Requirements:

• Active Virginia RN license

• Oversees assessments, care plans, and supervision

Role: Licensed Practical Nurse (LPN)

Requirements:

• Active Virginia license

• Provides skilled services under RN direction

Role: Certified Home Health Aide (CHHA)

Requirements:

• Trained and supervised by RN

• Provides hands-on personal care

Role: Physical/Occupational/Speech Therapists (PT/OT/SLP)

Requirements:

• Licensed in Virginia

• Service must be prescribed and authorized

Role: Medical Social Worker (optional)

Requirements:

• Licensed for care coordination and patient counseling

All staff must complete:

• HIPAA, safety, and emergency training

• Annual clinical competency validation

• Documentation and infection control protocols

7. MEDICAID WAIVER PROGRAMS

Home Health Services are covered under:

• Virginia State Plan Medicaid

• CCC Plus Waiver – For individuals with complex medical needs

• EPSDT – For children under age 21 who require skilled care

• CL and FIS Waivers – May authorize in-home skilled services in special cases

All services must be included in a physician-authorized Plan of Care and approved by the payer (DMAS, MCO, or CSB).

8. TIMELINE TO LAUNCH

Phase: Business Formation & HCO Licensing

Timeline: 2–3 months (includes inspections and credentialing)

Phase: Medicaid Enrollment & MCO Contracting

Timeline: 1–2 months

Phase: Staff Hiring, Training & Clinical Readiness

Timeline: 30–60 days

Phase: Launch of Services

Timeline: Begins upon physician referral and POC approval

9. CONTACT INFORMATION

Virginia Department of Health – Office of Licensure and Certification (OLC)

Website: https://www.vdh.virginia.gov/olc/home-care/

Virginia Department of Medical Assistance Services (DMAS)

Website: https://www.dmas.virginia.gov

MES Provider Portal

Website: https://vamedicaid.dmas.virginia.gov/provider

CCC Plus MCO Plan Information

Website: https://www.virginiamanagedcare.com

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — VIRGINIA HOME HEALTH CARE PROVIDER

WCG helps healthcare entrepreneurs and clinical teams launch fully licensed, compliant Home Health programs with confidence.

Scope of Work:

• HCO license application and VDH compliance support

• Medicaid enrollment and MCO contracting guidance

• CMS-compliant Policy & Procedure Manual creation

• Plan of Care templates and clinical documentation tools

• Staff credentialing packets and shift logs

• Infection control, HIPAA, and emergency preparedness systems

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