PERSONAL CARE SERVICES PROVIDER IN NEW YORK

Fatumata Kaba
Sep 4
4 min read

SUPPORTING INDIVIDUALS IN MAINTAINING INDEPENDENCE THROUGH PERSONAL ASSISTANCE AND DAILY LIVING SUPPORT

Personal Care Services in New York assist individuals with disabilities, chronic conditions, or age-related challenges by providing hands-on support with daily living activities. These services help individuals remain in their homes while maintaining their independence and quality of life. Personal Care Services are authorized under New York Medicaid Home and Community-Based Services (HCBS) Waiver programs.

1. GOVERNING AGENCIES

Agency: New York State Department of Health (NYSDOH)

Role: Administers Medicaid waiver funding for Personal Care Services and oversees provider enrollment, service authorization, and reimbursement.

Agency: Office for People With Developmental Disabilities (OPWDD)

Role: Provides oversight for personal care services targeting individuals with developmental disabilities.

Agency: New York State Office of Mental Health (OMH)

Role: Ensures compliance for personal care programs serving individuals with mental and behavioral health needs.

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight to ensure Medicaid-funded Personal Care Services meet quality, safety, and person-centered care standards.

2. PERSONAL CARE SERVICES OVERVIEW

Personal Care Services involve hands-on assistance and supervision to support individuals with daily living activities, personal hygiene, and household tasks.

Approved providers may deliver:

Personal Hygiene Assistance: Bathing, grooming, oral care, and dressing.
Mobility Support: Assisting with transfers, walking, and positioning.
Meal Preparation and Feeding: Planning, cooking, and assisting with eating.
Medication Reminders: Ensuring adherence to prescribed medication schedules.
Household Tasks: Light housekeeping, laundry, and maintaining a clean environment.
Toileting Assistance: Helping with bathroom needs and continence care.
Companionship: Providing social interaction and emotional support.
Escort and Transportation: Accompanying individuals to medical appointments or community activities.
Safety Monitoring: Ensuring a secure environment to prevent accidents and falls.
Documentation: Maintaining records of care provided and daily activities.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register the business entity with the New York Department of State.
Obtain EIN from the IRS and NPI (Type 2).
Enroll as a Medicaid Waiver Personal Care provider via the New York Medicaid Provider Enrollment Portal (eMedNY).
Maintain general liability and professional liability insurance.
Develop policies for personal care, client safety, and daily living support.
Ensure staff complete required background checks, health screenings, and personal care training.

4. NEW YORK PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

Complete the Provider Enrollment Application via the eMedNY Portal for Personal Care Services under HCBS waivers.

Application and Documentation Submission:

Submit Articles of Incorporation, proof of EIN/NPI, insurance certificates, care policies, and staff training documentation.

Program Readiness Review:

NYSDOH, OPWDD, and OMH evaluate provider readiness, including client safety protocols, staff qualifications, and care standards.

Approval & Medicaid Enrollment:

Upon approval, providers are authorized to bill Medicaid for Personal Care Services using designated billing codes.

5. REQUIRED DOCUMENTATION

Articles of Incorporation or Business License (New York Department of State)
IRS EIN confirmation
NPI confirmation
Proof of general and professional liability insurance
Personal Care Policy & Procedure Manual, including:
- Personal hygiene and daily living assistance protocols
- Safety and mobility support procedures
- Medication reminders and adherence guidelines
- Staff credentialing, background checks, and ongoing training records
- Documentation standards for care tracking and Medicaid billing
- HIPAA compliance, participant rights, and grievance handling
- Emergency response and safety protocols
- Quality assurance and compliance monitoring

6. STAFFING REQUIREMENTS

Role: Personal Care Services Program Director

Requirements: Bachelor’s or Master’s degree in social work, healthcare administration, or a related field; experience in program management and client care.

Role: Personal Care Aides (PCAs)

Requirements: High school diploma or equivalent; completion of an approved personal care training program; experience in direct client care; background clearance.

Role: Certified Home Health Aides (HHAs)

Requirements: Completion of a state-approved HHA training program; certification; experience in personal care and health monitoring.

All staff must complete: