Delaware - Home Health Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

The Delaware Department of Health and Social Services (DHSS), Division of Health Care Quality (DHCQ) licenses Skilled Home Health Agencies under 16 DE Admin. Code 3350 to provide intermittent skilled nursing and therapy under a physician-ordered plan of care. Applicants must first submit a formal written statement of intent to DHCQ describing their proposed services and service area simply to request and receive the official licensure application form.

Approval requires securing a 90-day initial license, passing a mandatory on-site survey during that 90-day window to achieve full licensure, and obtaining Medicare certification to enroll as a provider through the Delaware Medical Assistance Portal (DMAP). Because Delaware Medicaid operates under a managed care delivery system, agencies must subsequently complete credentialing and contracting with the state's designated Managed Care Organizations (MCOs) to receive reimbursement for services.

1. Service Definition and Scope

In Delaware, a Skilled Home Health Agency is defined under 16 DE Admin. Code 3350 as an organization that provides skilled nursing services and at least one other therapeutic service (such as physical therapy, speech-language pathology, or occupational therapy) to patients in their place of residence.

These services must be intermittent, ordered by a physician, and delivered under a formal, written plan of care. This licensure category is distinct from Aide-Only Home Health Agencies (governed by 16 DE Admin. Code 3351), which do not provide skilled clinical care.

• Service Location: Care must be provided in the patient's residence or a permitted community setting, not in a hospital or nursing facility.
• Skilled Nursing: Must be provided by or under the supervision of a Delaware-licensed Registered Nurse (RN).
• Therapeutic Services: Includes physical therapy, occupational therapy, speech therapy, and medical social services.
• Physician Orders: All skilled care must be explicitly ordered by a physician licensed to practice medicine, surgery, or osteopathy.
• Plan of Care: Must be established by the physician in consultation with an RN and reviewed periodically.
• Service Area: Agencies may only provide services within the specific geographic service area approved by DHCQ.

2. Regulatory and Oversight Agencies

The Delaware Department of Health and Social Services (DHSS) oversees both the licensure and Medicaid funding of home health agencies through two distinct divisions.

The Division of Health Care Quality (DHCQ) handles facility and agency licensure, while the Division of Medicaid and Medical Assistance (DMMA) manages Medicaid policy and provider enrollment.

• Licensing Authority: DHSS Division of Health Care Quality (DHCQ) (https://dhss.delaware.gov/dhss/dhcq/)
• Medicaid Authority: DHSS Division of Medicaid and Medical Assistance (DMMA) (https://dhss.delaware.gov/dhss/dmma/)
• Enrollment Portal: Delaware Medical Assistance Portal (DMAP) (https://medicaid.dhss.delaware.gov)
• Managed Care Oversight: Delaware Diamond State Health Plan (DSHP) manages the MCO contracts that administer home health benefits.

3. Gatekeeping Prerequisites: Who Can Even Apply

Delaware does not require a Certificate of Need (CON) for Home Health Agencies. However, DHCQ utilizes a strict pre-application gatekeeping process.

An entity cannot simply download a licensure application; they must submit a written statement of intent to DHCQ. Furthermore, to bill Medicaid for skilled home health services, the agency must typically obtain Medicare certification, which requires an initial period of operation and a separate federal survey.

• Statement of Intent: Required written submission to DHCQ describing proposed services before an application is issued.
• Certificate of Need: Not required in Delaware for Home Health Agencies.
• Medicare Certification: Required by DMMA for enrollment as a skilled home health provider.
• Physical Location: The parent agency must maintain a physical office within the State of Delaware.
• MCO Network Status: Medicaid enrollment requires contracting with Delaware's MCOs, which may have closed networks based on regional adequacy.

4. Licensure and Certification Requirements

Under 16 DE Admin. Code 3350, DHCQ issues an initial license for a period of 90 calendar days to applicants who submit a complete application and demonstrate compliant policies and procedures.

During this 90-day initial licensure period, DHCQ conducts a mandatory on-site survey. Full licensure is only granted if the agency passes this survey and corrects any identified deficiencies.

• Initial License Duration: 90 calendar days.
• On-Site Survey: Conducted by DHCQ during the first 90 days of operation.
• Director Qualifications: Must name a qualified individual responsible for the daily management of the agency.
• Management Roster: Application must include a complete list of management personnel and their credentials.
• Training Plan: Must submit a plan for providing continuing education and training for personnel during the first year.
• Change of Ownership: Any modification of ownership requires the agency to re-apply as a new agency.

5. Medicaid Provider Enrollment

Once licensed and Medicare-certified, agencies must enroll in the Delaware Medicaid program via the Delaware Medical Assistance Portal (DMAP).

Because most Delaware Medicaid beneficiaries are enrolled in managed care, providers must complete the MCO-Only Provider Enrollment Application on DMAP to satisfy federal screening requirements before contracting with individual MCOs.

• Enrollment System: Delaware Medical Assistance Portal (DMAP).
• Application Type: MCO-Only Provider Enrollment Application for managed care participation.
• Screening Level: High risk for new home health agencies, requiring fingerprint-based background checks.
• Application Tracking Number (ATN): Issued by DMAP to track the status of the submitted enrollment application.
• Revalidation: Required every 5 years under federal Medicaid rules.

6. Staffing, Training and Background Checks

Delaware regulations require skilled home health agencies to employ qualified clinical staff and maintain strict supervision protocols.

All personnel must undergo comprehensive background checks, and skilled services must be directed by a Registered Nurse or appropriate therapist.

• RN Assessments: All initial and ongoing assessments of the patient must be performed by a Registered Nurse.
• Therapy Staff: Physical therapists and assistants must be currently licensed in Delaware.
• Background Checks: Mandatory state and federal criminal background checks for all patient-facing staff.
• Supervision of Services: Requires authoritative procedural guidance with initial direction and periodic inspection by a qualified person.
• Contracted Personnel: Agency must maintain written agreements specifying how contracted staff are supervised and evaluated.

7. Documentation, Policies and Records

16 DE Admin. Code 3350 mandates rigorous clinical recordkeeping for all patients receiving skilled home health services.

Records must be updated contemporaneously, and original notes must be incorporated into the central agency record on a strict schedule.

• Plan of Care: Must be established by a physician and developed in consultation with a registered nurse.
• Clinical Notes: Must include date, hours of service, type of activities, and observations.
• Authentication: All notes must be signed, dated, and authenticated on the day service is rendered.
• Record Incorporation: Original notes must be incorporated into the patient's record at the agency no less often than every 2 weeks.
• Emergency Contacts: Records must include names and numbers of family or designated contacts for emergencies.

8. Billing, Rates and Claims

Medicaid reimbursement for skilled home health services in Delaware is primarily administered through the state's contracted MCOs (e.g., Highmark Health Options, AmeriHealth Caritas).

Agencies must negotiate rates and submit claims directly to the MCOs, adhering to each plan's specific prior authorization and billing guidelines.

• MCO Contracting: Required to bill for the majority of Delaware Medicaid beneficiaries.
• Prior Authorization: MCOs typically require prior authorization for skilled nursing and therapy visits.
• Billing Entity: Only the contracting home health agency may bill for services; contracted personnel cannot bill directly.
• Patient Payments: All payments must be made directly to the agency, not to individual contractors.
• Fee-for-Service: Limited to specific carve-out populations, billed directly through DMAP.

9. Approval Sequence and Timeline

The pathway to becoming a fully operational and billing Medicaid home health provider in Delaware is sequential and can take 9 to 18 months.

The process begins with DHCQ licensure, proceeds to Medicare certification, and concludes with DMAP enrollment and MCO contracting.

• Step 1: Submit written statement of intent to DHCQ.
• Step 2: Submit completed licensure application and required policies.
• Step 3: Receive 90-day initial/probationary license from DHCQ.
• Step 4: Pass DHCQ on-site survey during the 90-day window for full licensure.
• Step 5: Complete Medicare certification survey (often via an accrediting organization).
• Step 6: Submit MCO-Only Provider Enrollment Application via DMAP.
• Step 7: Complete credentialing and contracting with Delaware Medicaid MCOs.

10. Common Denials and Survey Findings

DHCQ and MCOs frequently deny applications or issue survey citations due to administrative omissions and clinical documentation failures.

Strict adherence to the physician-ordered plan of care and timely record incorporation are the most common areas of regulatory scrutiny.

• Application Denial: Failure to submit a compliant training plan or management roster.
• Survey Citation: Failure to incorporate clinical notes into the main agency record every 2 weeks.
• Survey Citation: Missing physician signatures on the established Plan of Care.
• Survey Citation: RN failing to conduct or document required supervisory visits.
• Claim Denial: Providing services without securing MCO prior authorization.

11. Key Contacts and Resources

Providers should rely on official State of Delaware portals and regulatory codes for the most current requirements.

The following links provide direct access to the licensing division, the Medicaid enrollment portal, and the administrative code.

• DHCQ Home Page: https://dhss.delaware.gov/dhss/dhcq/
• DMAP Provider Enrollment: https://medicaid.dhss.delaware.gov
• Delaware Regulations Title 16, 3350: https://regulations.delaware.gov/AdminCode/title16/3350.shtml
• Business First Steps (Delaware): https://firststeps.delaware.gov
• DMMA Home Page: https://dhss.delaware.gov/dhss/dmma/

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