RESPITE CARE SERVICES PROVIDER IN PENNSYLVANIA

Fatumata Kaba
Oct 7
4 min read

OFFERING TEMPORARY RELIEF FOR CAREGIVERS WHILE ENSURING SAFE, COMPASSIONATE SUPPORT FOR INDIVIDUALS WITH DISABILITIES AND CHRONIC CONDITIONS

Respite Care Services in Pennsylvania are Medicaid-funded supports that provide short-term, temporary care for individuals with disabilities or complex health needs so their primary caregivers can rest, attend to personal matters, or prevent burnout. Respite may occur in the individual’s home, a provider-operated facility, or a community-based setting. These services are covered under the state’s Home and Community-Based Services (HCBS) waivers through the Office of Developmental Programs (ODP) and the Office of Long-Term Living (OLTL).

1. GOVERNING AGENCIES

Agency: Pennsylvania Department of Human Services (DHS) – Office of Developmental Programs (ODP)

Role: Manages respite services under the Consolidated, Community Living, and P/FDS waivers for individuals with intellectual/developmental disabilities (IDD).

Agency: DHS – Office of Long-Term Living (OLTL)

Role: Oversees respite care for older adults and individuals with physical disabilities via Aging and Independence Waivers.

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

Role: Authorize and reimburse respite services for CHC participants.

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal regulation and funding oversight under 1915(c) waiver authority.

Agency: Pennsylvania Department of State

Role: Registers provider businesses operating in Pennsylvania.

2. RESPITE CARE SERVICES OVERVIEW

Respite care offers temporary coverage for primary caregivers and is tailored to the individual’s care plan and safety needs.

Approved providers may deliver:

Planned Respite: Scheduled short-term care based on caregiver needs (e.g., weekly breaks).
Emergency Respite: Unplanned or urgent coverage due to caregiver illness, crisis, or absence.
In-Home Respite: Delivered at the individual’s home with trained staff or aides.
Out-of-Home Respite: Provided at a licensed community residence, camp, or host home.
Overnight, Hourly, or Day-Based Models: Based on the individual's ISP or service plan.
Documentation: Daily logs, shift reports, and Medicaid billing records.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Pennsylvania Department of State.
Obtain an EIN from the IRS and a Type 2 NPI.
Enroll in the PROMISe™ system as a Medicaid respite provider.
If operating a facility, obtain Residential Habilitation or Respite Licensure (via ODP or DOH).
Contract with MCOs (if serving CHC participants) and get approved through your Administrative Entity (AE) or County MH/ID program.
Develop a Respite Care Services Policy & Procedure Manual per ODP/OLTL standards.

4. PENNSYLVANIA PROVIDER ENROLLMENT PROCESS

Step 1: Register your entity, secure EIN/NPI, and insurance policies.

Step 2: Apply for provider qualification through HCSIS (ODP) or MCO contract (OLTL/CHC).

Step 3: Complete PROMISe™ Medicaid enrollment.

Step 4: Submit your policy manual, staff credentials, and background checks.

Step 5: Receive approval and begin coordinating with SCs or MCOs for referrals.

5. REQUIRED DOCUMENTATION

Business registration and Articles of Incorporation
EIN and NPI confirmations
Licensure (if providing out-of-home care)
Insurance certificates (liability, workers’ comp)
Respite Services Policy & Procedure Manual including:
- Intake and caregiver coordination forms
- Supervision and safety protocols
- Staffing ratios and training policies
- HIPAA compliance and client rights
- Incident reporting and risk mitigation
- Service documentation templates
- Medicaid billing and encounter logs

6. STAFFING REQUIREMENTS

Role: Respite Aide / Direct Support Professional (DSP)

Requirements: Background check, CPR/First Aid, state-mandated training for the specific waiver population.

Role: Program Supervisor

Requirements: Oversees care quality, client documentation, and scheduling; may require supervisory training.

Role: Nurse / Behavioral Support (optional)

Requirements: Required only for high-acuity clients; must be licensed in PA.

All staff must complete:

Mandatory reporter and abuse prevention training
HIPAA and person-centered care modules
Emergency procedures and behavior support training
Annual skills review and service documentation training

7. MEDICAID WAIVER PROGRAMS

Respite Care is funded through:

ODP Waivers:
- Consolidated Waiver – Includes 24/7 out-of-home and in-home respite
- Community Living Waiver – For individuals living with family
- P/FDS Waiver – Subject to individual spending limits
OLTL Waivers:
- Aging Waiver – For seniors requiring intermittent caregiver relief
- Independence & OBRA Waivers – For adults with physical disabilities
Community HealthChoices (CHC):
- Managed respite authorizations for Medicaid/Medicare dual-eligibles

8. TIMELINE TO LAUNCH

Phase: Business Registration & Policy Manual Creation

Timeline: 1–2 months

Phase: Medicaid Enrollment & MCO/ODP Qualification

Timeline: 2–3 months

Phase: Staff Hiring, Credentialing & Training

Timeline: 30–60 days

Phase: Referral Activation & Service Launch

Timeline: Begins once service authorization and documentation system are in place

9. CONTACT INFORMATION

PA DHS – Office of Developmental Programs (ODP)

Website: https://www.myodp.org

PA DHS – Office of Long-Term Living (OLTL)

Website: https://www.dhs.pa.gov

PROMISe™ Medicaid Provider Portal

Website: https://promise.dpw.state.pa.us

Community HealthChoices MCOs:

UPMC CHC – https://www.upmchealthplan.com
PA Health & Wellness – https://www.pahealthwellness.com
Keystone First CHC – https://www.keystonefirstchc.com

Centers for Medicare & Medicaid Services (CMS)

Website: https://www.cms.gov

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — PENNSYLVANIA RESPITE CARE PROVIDER

WCG supports new Respite Care providers in Pennsylvania with tools and training to offer safe, reliable services that support both families and individuals.

Scope of Work: