Delaware - Personal Assistance Services — 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 entities as Personal Assistance Services Agencies (PASAs) to deliver hands-on activities of daily living support under 16 Del. Admin. Code § 3345. Medicaid funding for these services flows primarily through the Diamond State Health Plan-Plus (DSHP-Plus) managed care program and the Division of Developmental Disabilities Services (DDDS) Lifespan Waiver.

Approval requires submitting a written statement of intent to DHCQ to obtain the licensure application, passing a DHCQ survey, and subsequently enrolling through the Delaware Medical Assistance Portal. Providers must then secure network contracts with Delaware's Medicaid Managed Care Organizations (MCOs) to bill for DSHP-Plus participants.

1. Service Definition and Scope

Under Delaware regulation 16 Del. Admin. Code § 3345, Personal Assistance Services include individual assistance with or supervision of activities of daily living (ADLs) such as bathing, grooming, transferring, and toileting. Agencies referring direct care workers to provide these services in a consumer's private residence must be licensed as a PASA.

These services are strictly non-medical and do not include skilled nursing tasks.

• Regulatory Definition: 16 Del. Admin. Code § 3345 defines PAS as assistance with ADLs in the home.
• Service Area: Agencies may only provide services within their approved Delaware service area, with exceptions for time-limited travel.
• Medication Assistance: Direct care workers may assist with prepackaged medications labeled with the consumer's name, dosage, and time.
• Exclusions: PAS does not include skilled nursing or services requiring the judgment of a licensed professional.

2. Regulatory and Oversight Agencies

The Division of Health Care Quality (DHCQ) handles the licensure and regulatory enforcement for PASAs in Delaware. The Division of Medicaid and Medical Assistance (DMMA) and the Division of Developmental Disabilities Services (DDDS) oversee the Medicaid waiver programs that fund these services.

• Licensing Authority: Division of Health Care Quality (DHCQ) (https://dhss.delaware.gov/dhss/dhcq/)
• Medicaid Authority: Division of Medicaid and Medical Assistance (DMMA) (https://dhss.delaware.gov/dhss/dmma/)
• Waiver Operator: Division of Developmental Disabilities Services (DDDS) (https://dhss.delaware.gov/dhss/ddds/)
• Medicaid Portal: Delaware Medical Assistance Portal (https://medicaid.dhss.delaware.gov)

3. Gatekeeping Prerequisites: Who Can Even Apply

Delaware does not impose a Certificate of Need (CON) or county-level sponsorship requirement for Personal Assistance Services Agencies. The DDDS waiver accepts provider applications on an open and continuous basis without procurement moratoriums.

The primary structural gate is the requirement to submit a written statement of intent to DHCQ before an application is even issued.

• Statement of Intent: Applicants must submit a written statement of intent to DHCQ describing proposed services before receiving a licensure application.
• Office Location: A separate license is required for each physical office maintained by the PASA.
• MCO Contracting: DSHP-Plus participation requires securing a network contract with at least one of Delaware's Medicaid MCOs.
• Change of Ownership: Any agency undergoing a change of ownership must re-apply as a new agency; licenses are non-transferable.

4. Licensure and Certification Requirements

PASA licensure is governed by 16 Del. Admin. Code § 3345. The process begins with the statement of intent, followed by a detailed application including policies, procedures, and ownership disclosures.

• Application Form: Issued by DHCQ only after acceptance of the written statement of intent.
• Policy Manual: Applicants must submit a complete policies and procedures manual as outlined in subsection 4.3 of the regulations.
• Ownership Disclosure: Must identify each officer, director, and individual with ownership interest.
• License Display: The issued license must be posted in a conspicuous place on the licensed premises.

5. Medicaid Provider Enrollment

After obtaining a DHCQ license, agencies enroll as Medicaid providers through the Delaware Medical Assistance Portal. Providers serving DSHP-Plus members must complete the MCO-Only Provider Enrollment Application to satisfy federal screening requirements.

• Enrollment Portal: Delaware Medical Assistance Portal (https://medicaid.dhss.delaware.gov/provider/).
• MCO-Only Application: Streamlined application for providers registering to participate with Delaware MCOs.
• NPI Requirement: Providers must obtain and register a National Provider Identifier (NPI) via NPPES.
• DDDS Application: Providers targeting the Lifespan Waiver must follow the DDDS Provider Application Manual process.

6. Staffing, Training and Background Checks

Delaware requires PASAs to ensure all direct care workers are competent to perform assigned tasks safely. Training must cover specific topics, including dementia care, and workers must pass competency evaluations.

• Competency Testing: Direct care workers must pass a competency test prior to providing care and annually thereafter.
• Dementia Training: Must include communication strategies, psychological/physical needs, and safety measures for individuals with Alzheimer's or dementia.
• Confidentiality Training: Workers must be trained on the confidentiality of consumer information.
• Service Plan Training: Workers must receive training specific to the consumer's individual service plan.

7. Documentation, Policies and Records

PASAs must maintain comprehensive consumer records and operational policies. 16 Del. Admin. Code § 3345 mandates specific intake data and daily activity logs.

• Intake Data: Records must include consumer demographics, primary physician contact, and emergency contacts.
• Service Plan: An initial individual service plan and subsequent reviews must be maintained in the consumer's file.
• Activity Logs: Direct care worker activity logs documenting services provided on a daily basis are required.
• Case Closure: Agencies must provide a minimum of 2 weeks' notice prior to discharge and develop a written summary of services provided and needed.

8. Billing, Rates and Claims

Billing for Personal Assistance Services is processed either through the contracted MCOs for DSHP-Plus or through the state's MMIS for fee-for-service/DDDS waivers. Rates are established by DMMA or negotiated with the MCOs.

• MCO Claims: Claims for DSHP-Plus members are submitted directly to the respective MCO.
• DDDS Billing: Lifespan Waiver claims are processed according to the DDDS authorized service levels and published rate schedules.
• Activity Documentation: Claims must be supported by the daily direct care worker activity logs.
• Third-Party Billing: Consumer intake records must include identification for third-party billing purposes if applicable.

9. Approval Sequence and Timeline

The approval sequence starts with DHCQ licensure, moves to Medicaid enrollment, and concludes with MCO credentialing. Timelines vary based on application completeness and DHCQ survey scheduling.

• Step 1: Submit written statement of intent to DHCQ.
• Step 2: Receive and submit the DHCQ PASA licensure application with policy manuals.
• Step 3: Undergo DHCQ initial licensing survey.
• Step 4: Submit Medicaid enrollment application via the Delaware Medical Assistance Portal.
• Step 5: Complete credentialing and contracting with Delaware MCOs.

10. Common Denials and Survey Findings

DHCQ conducts periodic, unannounced inspections to evaluate real-time performance. Deficiencies require a formal Plan of Correction with acceptable timeframes.

• Training Deficiencies: Failure to document annual competency testing for direct care workers.
• Record Keeping: Incomplete daily activity logs or missing emergency contact information in consumer files.
• Policy Non-Compliance: Failure to adhere to the agency's own approved policies and procedures manual.
• Unapproved Locations: Operating or storing records in an office location not explicitly licensed by DHCQ.

11. Key Contacts and Resources

Prospective PASAs should utilize the official Delaware state portals and division websites for the most current manuals, regulations, and enrollment forms.

• DHCQ Website: Division of Health Care Quality (https://dhss.delaware.gov/dhss/dhcq/)
• Medicaid Portal: Delaware Medical Assistance Portal (https://medicaid.dhss.delaware.gov)
• DDDS Providers: Division of Developmental Disabilities Services Provider Page (https://dhss.delaware.gov/ddds/homepage/providers/)
• Regulations: 16 Del. Admin. Code § 3345 (https://regulations.delaware.gov/AdminCode/title16/3345.shtml)

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