Delaware - Adult Companion Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-08-15

Adult Companion Services in Delaware provide essential non-medical socialization, supervision, and light household assistance to enable functionally impaired adults to remain safely in their own homes and communities. These services are primarily funded through the Division of Developmental Disabilities Services (DDDS) Lifespan Waiver for individuals with intellectual and developmental disabilities, and the Diamond State Health Plan Plus (DSHP-Plus) managed long-term services and supports (MLTSS) program for the elderly and physically disabled. Providers deliver these services by employing Direct Care Workers to monitor safety, prepare meals, and assist with daily routines without performing hands-on clinical nursing.

The single biggest structural barrier to entry in Delaware is a dual-layered gatekeeping system: an agency must first obtain a Personal Assistance Services Agency (PASA) license from the Division of Health Care Quality (DHCQ), which requires operating under a 90-day provisional license and passing an on-site survey with an active client census. Following licensure, Medicaid reimbursement for the state's largest elderly/disabled population is strictly gated by Managed Care Organization (MCO) credentialing for the DSHP-Plus program; providers cannot simply enroll and bill the state, but must successfully secure network contracts with private MCOs, which can close their networks to new PASAs at any time if they determine adequate capacity exists in a given county.

1. Service Definition and Scope

Delaware defines Companion Services under its Personal Assistance Services regulations as social interaction and supervision provided to an individual primarily in their place of residence. The service supports safety and independence without crossing into licensed clinical care.

• Permitted Activities: Socialization, supervision, meal preparation, light housekeeping, running errands, transportation, and medication reminders.
• Excluded Activities: Hands-on clinical nursing care, wound care, and heavy lifting transfers requiring mechanical lifts (unless performed by a licensed professional under a different license type).
• Target Population: Functionally impaired adults, the elderly, and individuals with intellectual or developmental disabilities.
• Service Setting: Primarily the consumer’s private residence, though community integration and accompaniment to appointments are standard.
• Waiver Coverage: Billed under the DDDS Lifespan Waiver and the DMMA DSHP-Plus MLTSS program.

2. Regulatory and Oversight Agencies

A mix of state divisions under the Delaware Department of Health and Social Services (DHSS) and private managed care entities govern this service.

• Delaware Department of Health and Social Services (DHSS): The umbrella state agency managing Medicaid and public health.
• Division of Health Care Quality (DHCQ): The regulatory body that licenses and surveys Personal Assistance Services Agencies (PASAs) in Delaware.
• Division of Medicaid and Medical Assistance (DMMA): The state Medicaid authority overseeing the Delaware Medical Assistance Program (DMAP) and the Diamond State Health Plan Plus.
• Division of Developmental Disabilities Services (DDDS): The operating agency that administers the Lifespan Waiver and authorizes providers for the I/DD population.
• Managed Care Organizations (MCOs): Highmark Health Options, AmeriHealth Caritas Delaware, and Delaware First Health administer the DSHP-Plus program and act as the direct payers and credentialing bodies for adult companion services.

3. Gatekeeping Prerequisites: Who Can Even Apply

Delaware utilizes strict structural prerequisites that block standalone Medicaid enrollment for adult companion care. Applicants must clear these hurdles before any Medicaid billing can occur.

• PASA Licensure Requirement: You must hold a Personal Assistance Services Agency (PASA) license from DHCQ. Delaware does not allow unlicensed entities to enroll as waiver providers for this service.
• MCO Network Contracting (DSHP-Plus): To serve the elderly and physically disabled, providers must apply for network inclusion with Delaware’s Medicaid MCOs. MCOs utilize closed networks and can deny applications based on "Network Adequacy" (meaning they already have enough PASAs in your county).
• DDDS Provider Network Approval: To serve the Lifespan Waiver population, providers must submit a New Provider Application to the DDDS Provider Authorization Committee and receive formal approval to join the DDDS network.
• Active Census for Licensure: DHCQ grants an initial 90-day PASA license. During this 90-day window, the agency must be actively operating and caring for consumers to undergo and pass the mandatory on-site survey to receive a standard license.
• Separate Licensure per Office: Delaware requires a distinct PASA license and separate approval for each physical office location maintained by the agency.

4. Licensure and Certification Requirements

Agencies must secure a PASA license under Title 16 Delaware Administrative Code, Section 3345.

• Statement of Intent: Applicants must first submit a written statement of intent to DHCQ describing the proposed services to request a licensure application.
• Application Submission: Requires identity of officers, directors, a copy of the agency's policies and procedures manual, and a list of all facilities owned or managed by the applicant.
• Director Designation: The agency must appoint an administrator/director who is available to consumers at all times during operating hours; DHCQ must be notified in writing within 15 days of any change in management.
• Provisional License: An initial license is granted for 90 calendar days to allow the agency to legally accept non-Medicaid or self-pay clients.
• On-Site Survey: DHCQ surveyors will conduct an operational review during the 90-day period to ensure the agency is successfully implementing care plans and following regulations before converting the license to a standard term.

5. Medicaid Provider Enrollment

Once licensed, agencies must formally enroll in the Delaware Medical Assistance Program (DMAP) before they can bill fee-for-service or join MCO networks.

• System Portal: Provider enrollment is processed through the Delaware Medicaid Enterprise System (DMES) provider portal, managed by Gainwell Technologies.
• NPI Requirement: The agency must possess a Type 2 National Provider Identifier (NPI) matching the exact legal name on the PASA license.
• Application Fee: Providers must pay the federal Medicaid application fee (unless waived by proof of Medicare enrollment or prior payment in another state).
• MCO Credentialing: After DMES issues a Delaware Medicaid ID, the provider must separately submit credentialing packets to AmeriHealth Caritas DE, Delaware First Health, and Highmark Health Options.
• DDDS Enrollment: Providers seeking Lifespan Waiver participants must sign a Memorandum of Understanding (MOU) with DDDS following their Provider Authorization Committee approval.

6. Staffing, Training and Background Checks

Delaware imposes strict personnel standards for the Direct Care Workers (DCWs) providing companion services under a PASA license.

• Background Checks: All staff must pass Delaware State Police fingerprinting, FBI criminal history checks, and checks against the Delaware Adult Abuse and Child Protection Registries prior to patient contact.
• Drug Testing: Delaware state law requires mandatory pre-employment drug screening for all home care and PASA workers.
• Training Plan: The agency must provide and document training on body mechanics, infection control, emergency protocols, consumer rights, and HIPAA.
• Contractor Use: PASAs are permitted by regulation to use independent contractors (1099), but those contractors must hold a valid business license and meet the exact same background and training requirements as W-2 employees.
• Health Clearances: Personnel must have documented screening for communicable diseases, including tuberculosis (PPD/Mantoux test), upon hire.

7. Documentation, Policies and Records

DHCQ PASA regulations dictate specific operational workflows and record-retention policies that must be in the agency manual and actively followed.

• Initial Evaluation: A "Home Visit" must be conducted by the agency director or designee to evaluate consumer needs and develop the service plan prior to or at the start of care.
• Service Plan Revision: The consumer’s service plan must be updated and revised continuously as the consumer’s condition or environment changes.
• Daily Billable Notes: At least one billable note must be maintained for each service delivered, each service day, documenting the exact tasks performed in alignment with the service plan.
• Incident Reporting: The agency must establish written policies for handling accidents and medical emergencies. All incident reports must be kept on file at the agency for a minimum of 6 years.
• Consumer Rights: Written policies regarding the rights and responsibilities of consumers must be established and provided to the consumer upon intake.

8. Billing, Rates and Claims

Reimbursement structures depend entirely on the waiver program authorizing the consumer.

• Clearinghouses: Fee-for-service claims (DDDS) are submitted to DMES via Gainwell Technologies. MCO claims (DSHP-Plus) are routed through the respective MCO’s designated clearinghouse (e.g., Change Healthcare, Availity).
• Claim Format: Billed using the standard 837P (Professional) electronic transaction or CMS-1500 paper claim form with the appropriate HCPCS codes (often S5135 for companion care).
• EVV Mandate: Delaware requires Electronic Visit Verification (EVV) for personal care and companion services to capture the exact time, location, and staff member providing the service via GPS or telephony.
• DSHP-Plus Rates: Reimbursement rates for MCO participants are negotiated individually between the PASA and the MCO during the contracting phase.
• Lifespan Waiver Rates: DDDS utilizes a standardized fee schedule for fee-for-service reimbursement, subject to legislative rate adjustments.

9. Approval Sequence and Timeline

Opening a companion care agency in Delaware requires sequencing state licensure before Medicaid enrollment.

• Step 1: Corporate Formation (1-2 weeks): Register with the Delaware Division of Corporations, obtain an EIN, and secure a Type 2 NPI.
• Step 2: DHCQ Statement of Intent (1-2 weeks): Submit the initial statement of intent to DHSS to request the PASA licensure application packet.
• Step 3: PASA Licensure (90 Days): Submit the full application. Upon approval, receive a 90-day provisional license and begin admitting private-pay clients.
• Step 4: DHCQ On-Site Survey (During 90-day window): Pass the active operational survey to receive a standard PASA license.
• Step 5: DMES Enrollment (30-60 Days): Apply through the DMAP portal for a Medicaid ID using the permanent PASA license.
• Step 6: MCO Contracting / DDDS Authorization (90-120 Days): Complete credentialing with DSHP-Plus MCOs or the DDDS Provider Authorization Committee.

10. Common Denials and Survey Findings

Deficiencies in Delaware typically stem from failing the rigorous PASA operational survey or getting blocked by MCO network adequacy limits.

• Network Closed Denials: Perfectly qualified agencies are frequently denied DSHP-Plus Medicaid contracts simply because an MCO determines it already has enough PASA providers in New Castle, Kent, or Sussex counties.
• DHCQ Survey Failure - Census: Agencies failing to admit private-pay consumers during their 90-day provisional license window cannot be surveyed and will lose their provisional license.
• Incident Log Violations: DHCQ frequently cites agencies for failing to maintain incident, accident, and emergency logs for the mandated 6-year period.
• Incomplete Background Checks: Allowing a Direct Care Worker to perform a home visit before the FBI background check or Adult Abuse Registry check fully clears.
• EVV Non-Compliance: Claims denied by MCOs or DMES because the electronic visit verification timestamp or GPS ping failed to match the billed claim data.

11. Key Contacts and Resources

The following state agencies, divisions, and regulatory codes are essential resources for prospective Adult Companion Services providers in Delaware.

• Division of Health Care Quality (DHCQ): Oversees PASA licensing, regulations, and on-site surveys. (302) 421-7400.
• Delaware Medical Assistance Program (DMAP): Provider enrollment portal managed by Gainwell Technologies via the DMES system. (800) 999-3371.
• Division of Developmental Disabilities Services (DDDS): Manages Lifespan Waiver provider applications and authorizations. (302) 744-9600.
• DSHP-Plus Managed Care Organizations: Provider relations departments for Highmark Health Options, AmeriHealth Caritas Delaware, and Delaware First Health.
• Delaware Administrative Code Title 16, Section 3345: The statutory rulebook for operating a Personal Assistance Services Agency in the state.

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