Delaware - Personal Assistance Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-08-16

In Delaware, Personal Assistance Services (PAS) provide essential, non-medical, hands-on support with activities of daily living (ADLs) such as bathing, dressing, transferring, and toileting in a person's own home. These services are heavily regulated to ensure consumer safety and are overseen by the Delaware Department of Health and Social Services (DHSS), with licensure managed by the Division of Health Care Quality (DHCQ) and Medicaid enrollment handled through the Delaware Medical Assistance Portal (DMAP).

The single biggest structural barrier to entry for a new provider in Delaware is the strict sequencing of approvals: an applicant must first secure a Personal Assistance Services Agency (PASA) license from DHCQ before they can even apply for Medicaid enrollment. Furthermore, to serve the majority of Medicaid clients, the licensed and enrolled provider must secure network contracts with Delaware's Managed Care Organizations (MCOs) under the Diamond State Health Plan Plus (DSHP-Plus) waiver, which may restrict new enrollments based on closed networks or regional network adequacy requirements.

1. Service Definition and Scope

Delaware defines Personal Assistance Services under 16 DE Admin. Code 3345 as individual assistance with or supervision of activities of daily living. This is a non-medical service model designed to keep individuals safely in their own homes and communities.

Because PAS is strictly non-medical, providers are prohibited from performing skilled nursing tasks. The scope is limited to hands-on ADL support and instrumental activities of daily living (IADLs) that directly relate to the individual's care plan.

• Regulatory Definition: 16 DE Admin. Code 3345 defines PAS as individual assistance with activities of daily living, including bathing, grooming, and transferring.
• Included Tasks: Hands-on help with bathing, dressing, transferring, toileting, shopping, and transportation support.
• Excluded Tasks: Skilled nursing care, wound care, and medication administration (only non-administration medication reminders are permitted).
• Physician Orders: Under Delaware regulations, Personal Assistance Services do not require a physician's order.
• Service Setting: Services must be delivered in the individual's own home or community setting, not in a licensed facility.

2. Regulatory and Oversight Agencies

The Delaware Department of Health and Social Services (DHSS) is the umbrella agency governing health and human services. Within DHSS, distinct divisions handle facility licensure, Medicaid policy, and specific waiver operations.

Providers must interact with multiple divisions depending on the specific waiver program they intend to serve, such as the Lifespan Waiver for individuals with intellectual and developmental disabilities or the DSHP-Plus managed care program.

• Licensing Authority: DHSS Division of Health Care Quality (DHCQ) issues the PASA license (https://dhss.delaware.gov/dhcq/).
• Medicaid Authority: DHSS Division of Medicaid and Medical Assistance (DMMA) oversees Medicaid policy and funding (https://dhss.delaware.gov/dmma/).
• Waiver Operator: DHSS Division of Developmental Disabilities Services (DDDS) operates the Lifespan Waiver (https://dhss.delaware.gov/ddds/).
• Medicaid Portal: Delaware Medical Assistance Portal (DMAP) processes fee-for-service enrollments and claims (https://medicaid.dhss.delaware.gov/provider).
• Background Checks: Delaware Background Check Center (BCC) for Healthcare processes mandatory staff clearances (https://backgroundcheckcenter.dhss.delaware.gov/).

3. Gatekeeping Prerequisites: Who Can Even Apply

Delaware does not utilize a Certificate of Need (CON) program for Personal Assistance Services Agencies. However, there are strict structural prerequisites that block an applicant from entering the Medicaid market if not completed in the exact required order.

The most significant gatekeeping mechanism is the separation of licensure and MCO contracting. A provider cannot bill Medicaid without first obtaining a state license, and even with a license and DMAP enrollment, access to clients is gated by MCO network needs.

• Certificate of Need: Genuinely none exists for PASAs in Delaware.
• Licensure Prerequisite: An active Personal Assistance Services Agency (PASA) license from DHCQ is a mandatory prerequisite; DMAP will not accept a Medicaid enrollment application without it.
• MCO Contracting: To serve DSHP-Plus members, providers must secure contracts with AmeriHealth Caritas Delaware or Highmark Health Options, which may impose closed networks based on regional adequacy.
• DDDS Authorization: To serve the Lifespan Waiver, providers must be explicitly authorized and enrolled through DDDS prior to DMAP billing setup.
• Business Registration: Applicants must be registered with the Delaware Division of Corporations and obtain a Type 2 NPI before initiating the DHCQ Statement of Intent.

4. Licensure and Certification Requirements

To operate legally in Delaware, an agency must obtain a Personal Assistance Services Agency (PASA) license from the Division of Health Care Quality (DHCQ). The process begins with a formal Statement of Intent rather than a direct application submission.

DHCQ reviews the agency's ownership, leadership, and comprehensive policy manual. A provisional license is typically issued first, allowing the agency to begin operations pending a successful on-site survey.

• Governing Regulation: Licensure is governed by 16 DE Admin. Code 3345 (Personal Assistance Services Agencies).
• Statement of Intent: Applicants must first submit a written Statement of Intent to DHCQ describing the services to be offered to request the official licensure application.
• Application Fee: A nonrefundable application fee (typically $500) must accompany the formal application to DHCQ.
• Required Disclosures: Applicants must submit the identity of each officer, director, general partner, and governing body member.
• Policy Submission: A complete copy of the applicant's policies and procedures manual must be submitted to DHCQ for review.
• Provisional License: DHCQ may issue a provisional license, requiring the agency to pass an on-site survey before full licensure is granted.

5. Medicaid Provider Enrollment

Once licensed by DHCQ, the agency must enroll as a Delaware Medicaid provider through the Delaware Medical Assistance Portal (DMAP). This step is required even if the provider ultimately intends to bill Managed Care Organizations.

The DMAP enrollment process standardizes the screening for both fee-for-service and MCO networks. Providers must complete all steps in the portal and submit the application for processing by the state's fiscal agent.

• Enrollment System: Applications are submitted electronically via the Delaware Medical Assistance Portal (DMAP) (https://medicaid.dhss.delaware.gov/provider).
• Application Tracking: DMAP assigns an Application Tracking Number (ATN) to allow providers to resume unsubmitted applications.
• Required Uploads: Providers must upload their active DHCQ PASA license, W-9 tax form, and proof of liability and workers' compensation insurance.
• Screening Level: PASA providers are subject to ACA risk-based screening, which may include site visits and federal application fees depending on their risk category.
• MCO Standardization: DMAP enrollment is required as a baseline screening process before an MCO will finalize a network contract.

6. Staffing, Training and Background Checks

Delaware enforces strict background check requirements for all healthcare and home care workers. Agencies must utilize the state's centralized electronic system to clear staff before they have any direct contact with clients.

Direct Support Professionals (DSPs) and Home Care Aides must meet specific training and experience thresholds outlined in 16 DE Admin. Code 3345 and waiver-specific guidelines.

• Background Check System: Mandatory use of the Delaware Background Check Center (BCC) for Healthcare to process all employee clearances (https://backgroundcheckcenter.dhss.delaware.gov/).
• Experience Requirement: Aides typically must have at least 1 year of practical experience in a licensed setting or have completed a state-approved training program.
• Prohibited Offenses: Staff are disqualified if they have convictions for specific crimes outlined in 16 Del. C. ch. 11, including abuse, neglect, or financial exploitation.
• Supervision: The agency must designate a qualified director or supervisor to oversee PAS staff and ensure care plan compliance.
• Temporary Staff: Any temporary staff working for a licensed provider must meet the exact same regulatory requirements as permanent employees.

7. Documentation, Policies and Records

DHCQ and DMMA require PASA providers to maintain rigorous documentation of both agency operations and individual client care. HIPAA-compliant record-keeping systems are mandatory.

Agencies must have Delaware-specific policies. Using generic or out-of-state policy templates will result in application rejection during the DHCQ licensure phase.

• Policy Manual: A comprehensive, Delaware-specific policies and procedures manual must be maintained and approved by DHCQ.
• Service Plans: A written care plan must be developed for each client, detailing the specific ADL tasks, frequency, and duration of visits.
• Visit Documentation: Caregivers must document the specific tasks completed and the exact time spent per visit.
• Location Changes: Per 16 DE Admin. Code 3351-2.0, agencies must advise DHCQ in writing at least 30 calendar days prior to any change in office location.
• Disaster Preparedness: Agencies must maintain a written disaster preparedness plan to ensure continuity of care during emergencies.
• Ownership Changes: A license is not transferable; any modification of ownership and control requires the agency to re-apply as a new agency.

8. Billing, Rates and Claims

Reimbursement for Personal Assistance Services in Delaware depends on the client's waiver enrollment. Claims are either submitted directly to the state's MMIS for fee-for-service clients or to the respective MCO for DSHP-Plus members.

Delaware mandates the use of Electronic Visit Verification (EVV) for all personal care services to combat fraud and ensure services are delivered as authorized.

• Claims System: Fee-for-service claims are processed through the Medicaid Management Information System (MMIS) via the DMAP portal.
• MCO Billing: Claims for DSHP-Plus members must be submitted directly to the contracted MCO (e.g., Highmark Health Options or AmeriHealth Caritas Delaware).
• Electronic Visit Verification (EVV): Mandatory for all PAS visits to electronically capture the date, time, location, and caregiver identity.
• Prior Authorization: All PAS hours must be prior-authorized by the MCO care coordinator or DDDS case manager before services are rendered.
• Revalidation: Providers must revalidate their Medicaid enrollment through DMAP at least every 5 years in accordance with federal CMS regulations.

9. Approval Sequence and Timeline

Becoming a fully operational and billing PASA provider in Delaware is a multi-phase process that typically takes 6 to 9 months from start to finish. Steps cannot be taken out of order.

Delays in the DHCQ policy review or missing documents in the DMAP portal are the most common causes of extended timelines.

• Phase 1: Business Registration: Register with the Delaware Division of Corporations and obtain an IRS EIN and Type 2 NPI (1-2 weeks).
• Phase 2: DHCQ Licensure: Submit the Statement of Intent, application, and policy manual to DHCQ to obtain a provisional PASA license (3-5 months).
• Phase 3: DMAP Enrollment: Submit the provider enrollment application through the DMAP portal once the DHCQ license is in hand (approximately 2-4 weeks for processing).
• Phase 4: MCO Contracting: Apply for credentialing and network contracting with Delaware MCOs for DSHP-Plus (90-120 days, subject to network adequacy).

10. Common Denials and Survey Findings

Applications are frequently delayed or denied at both the DHCQ licensure stage and the DMAP enrollment stage due to administrative errors or non-compliant documentation.

During on-site surveys, DHCQ inspectors heavily scrutinize personnel files to ensure all background checks were completed prior to the employee's first day of patient contact.

• Policy Rejections: DHCQ will reject applications that submit blank templates, generic manuals, or policies containing a different agency's name.
• BCC Non-Compliance: Surveyors frequently cite agencies for failing to clear staff through the Delaware Background Check Center before they provide care.
• Missing Uploads: DMAP applications are often denied or returned because the provider failed to upload the active DHCQ license or current liability insurance.
• EVV Failures: Claims are routinely denied by MCOs if the Electronic Visit Verification data does not perfectly match the prior authorization.
• Unapproved Location Changes: Agencies face sanctions if they move their physical office without providing the required 30-day written notice to DHCQ.

11. Key Contacts and Resources

Providers must maintain active communication with Delaware's oversight agencies and utilize official state portals for compliance and billing.

The following official resources are essential for navigating the licensure and enrollment landscape in Delaware.

• DHCQ Licensing: Division of Health Care Quality (https://dhss.delaware.gov/dhcq/)
• Medicaid Enrollment: Delaware Medical Assistance Portal (DMAP) (https://medicaid.dhss.delaware.gov/provider)
• Background Checks: Delaware Background Check Center (BCC) (https://backgroundcheckcenter.dhss.delaware.gov/)
• Waiver Information: Division of Developmental Disabilities Services (DDDS) (https://dhss.delaware.gov/ddds/)
• State Regulations: 16 DE Admin. Code 3345 for PASA (https://regulations.delaware.gov/AdminCode/title16/3345.shtml)

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