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

Last reviewed: 2026-09-10

New York regulates personal assistance services under the Licensed Home Care Services Agency (LHCSA) framework, requiring establishment approval by the Public Health and Health Planning Council (PHHPC) and licensure by the Department of Health (DOH) under Public Health Law § 3605. Providers seeking to bill Medicaid for these services must enroll as a Personal Care Agency (PCA) under Category of Service 0264 through the eMedNY system.

Before a Medicaid enrollment application is accepted, a prospective PCA must secure a fully executed contract with the Local District Social Service (LDSS) in their target county. Additionally, DOH restricts new LHCSA approvals and county expansions based on a strict public need methodology, limiting entry to areas demonstrating insufficient existing capacity.

1. Service Definition and Scope

In New York, personal assistance services are delivered primarily through Personal Care Agencies (PCAs) operating under a Licensed Home Care Services Agency (LHCSA) license. These services provide hands-on assistance to eligible individuals in their own homes.

The scope of work includes housekeeping, meal preparation, bathing, toileting, grooming, and other activities of daily living. Services must be supervised by a registered professional nurse.

• Service Category: Personal Care Agency (PCA) under Category of Service 0264.
• Licensure Vehicle: Licensed Home Care Services Agency (LHCSA).
• Scope of Tasks: Housekeeping, meal preparation, bathing, toileting, and grooming.
• Supervision Requirement: Nursing supervision by an RN with at least two years of recent home health care experience.
• Supervisory Frequency: RN visits to the patient's home as needed, but at least every 90 days.

2. Regulatory and Oversight Agencies

The New York State Department of Health (DOH) and the Public Health and Health Planning Council (PHHPC) jointly oversee the establishment and licensure of LHCSAs. The DOH Bureau of Home Care Licensure and Certification handles the application process.

Medicaid enrollment and claims are managed through eMedNY, while the Office of the Medicaid Inspector General (OMIG) enforces compliance program requirements.

• Licensing Agency: New York State Department of Health (DOH) https://www.health.ny.gov/facilities/home_care/lhcsa
• Establishment Authority: Public Health and Health Planning Council (PHHPC) https://www.health.ny.gov/facilities/public_health_and_health_planning_council/
• Medicaid Enrollment Portal: eMedNY Provider Services Portal (PSP) https://www.emedny.org
• Compliance Oversight: Office of the Medicaid Inspector General (OMIG) https://omig.ny.gov/compliance/compliance

3. Gatekeeping Prerequisites: Who Can Even Apply

New York imposes strict structural preconditions on new LHCSA applicants and existing agencies seeking expansion. Applications are subject to a public need methodology, meaning DOH will only approve applications in areas where a quantitative need for additional providers is demonstrated.

For Medicaid enrollment as a Personal Care Agency, providers face a mandatory contracting gate. An agency cannot enroll in Medicaid without first securing a contract with the county LDSS.

• Public Need Review: PHHPC evaluates all new LHCSA applications against a public need methodology to prevent over-saturation.
• County Expansion Rule: Under DAL DHCBS 25-03, adding counties to an existing LHCSA license is restricted to counties where fewer than five LHCSAs actively serve patients.
• Financial Feasibility: Applicants must prove available working capital equal to at least two months of estimated year-one operating expenses, verified by a CPA.
• County Contract Mandate: PCAs must establish a fully executed contract with the Local District Social Service (LDSS) before enrolling in the NYS Medicaid Program.

4. Licensure and Certification Requirements

Organizations seeking to establish a new LHCSA must submit an application through the New York State Electronic Certificate of Need (NYSE-CON) system. The process involves a comprehensive review of character and competence, financial feasibility, and public need.

If approved by the PHHPC, the applicant must then submit a detailed policy and procedure manual to the appropriate Home Care Regional Office for review before the actual license is issued.

• Application System: New York State Electronic Certificate of Need (NYSE-CON).
• Application Form: DOH-1056 (Certificate of Need Application) and DOH-1056a.
• Application Fee: $2,000 submitted with the NYSE-CON application.
• Health Care Experience: At least one principal shareholder or member must have specific health care experience (e.g., RN, LPN, Home Health Aide).
• Policy Manual: Required submission to the Home Care Regional Office post-PHHPC approval.

5. Medicaid Provider Enrollment

Once licensed as a LHCSA and contracted with an LDSS, the agency must enroll in the New York State Medicaid program via the eMedNY Provider Services Portal (PSP). The enrollment category is Personal Care Agency (Category of Service 0264).

The enrollment process requires submission of various federal and state forms, proof of licensure, and an application fee, ensuring the provider meets all program integrity standards.

• Enrollment Portal: eMedNY Provider Services Portal (PSP).
• Category of Service: 0264 (Personal Care Agency).
• Application Fee: $750 required at the time of Medicaid enrollment.
• Required Documentation: Fully executed county contract and LHCSA license issued by DOH.
• Tax Identification: IRS Assignment Letter (Form SS-4) indicating FEIN and Applicant Name (W-9 is not acceptable).
• Electronic Transactions: ETIN Certification Statement and Electronic Funds Transfer (EFT) Authorization.

6. Staffing, Training and Background Checks

New York mandates specific qualifications, health clearances, and background checks for all personal care aides. Agencies must maintain strict personnel files documenting these requirements.

Supervision is a critical component, requiring registered nurses with specific home care experience to oversee aides and conduct regular in-home evaluations.

• Criminal History: Criminal history record check performed to the extent required under Public Health Law § 124.
• Training: Aides must successfully complete a training program approved by the Department of Health.
• Health Clearance: Documentation of good physical health in the personnel file, matching standards for certified home agencies.
• RN Supervisor Qualifications: Must be a licensed RN in NYS with at least two years of satisfactory recent home health care experience.
• Performance Evaluation: RN supervisors must conduct an overall job performance evaluation of the aide annually.

7. Documentation, Policies and Records

LHCSAs must maintain comprehensive operational policies and patient records. A formal policy and procedure manual must be approved by the DOH Regional Office prior to opening.

Additionally, providers must adopt and implement an effective compliance program that meets state statutory requirements to prevent fraud and abuse.

• Policy Manual: Must be submitted to and approved by the Home Care Regional Office prior to license issuance.
• Compliance Program: Must adopt an effective compliance program pursuant to NYS Social Services Law § 363-d and 18 NYCRR Part 521.
• Prior Conduct Disclosure: Completion of a Prior Conduct Questionnaire in the PSP if any disclosure questions are answered 'Yes'.
• Annual Registration: LHCSAs must complete annual DOH registration and statistical reporting to avoid license revocation.

8. Billing, Rates and Claims

Billing for Personal Care Agency services is processed through the eMedNY system or through contracted Medicaid Managed Care Organizations (MCOs). Providers must be fully enrolled to submit claims.

Rates are established by the state or negotiated with MCOs, and providers must ensure all electronic billing authorizations are in place.

• Claims System: eMedNY for fee-for-service or respective MCO portals for managed care claims.
• Managed Care Requirement: Providers serving MCO members must be enrolled in NYS Medicaid to remain in the MCO network.
• Electronic Funds: EFT Authorization is required for payment routing.
• Billing Setup: ETIN Certification Statement must be completed for new enrollments to submit electronic claims.

9. Approval Sequence and Timeline

The path to becoming a billing PCA in New York is sequential and lengthy. It begins with the NYSE-CON application for LHCSA licensure, followed by PHHPC review.

After licensure, the provider must secure a county LDSS contract before finally applying for Medicaid enrollment through eMedNY.

• Step 1: Submit DOH-1056 application and $2,000 fee via NYSE-CON.
• Step 2: Undergo DOH review and PHHPC evaluation for public need and financial feasibility.
• Step 3: Submit policy and procedure manual to the Home Care Regional Office for approval.
• Step 4: Receive LHCSA license from DOH.
• Step 5: Establish and execute a contract with the target county LDSS.
• Step 6: Submit Medicaid enrollment application via eMedNY PSP with the $750 fee.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied due to failure to meet the strict public need methodology or insufficient financial capitalization.

During operations, DOH surveys often cite agencies for incomplete personnel files, lack of required RN supervision visits, or failure to complete annual statistical reporting.

• Need Methodology Denials: Rejection by PHHPC due to adequate existing LHCSA capacity in the requested counties.
• Financial Denials: Failure of the CPA to validate two months of estimated year-one operating expenses.
• Contracting Blocks: Inability to secure the mandatory LDSS contract, preventing Medicaid enrollment.
• Survey Deficiencies: Citations for missing RN supervisory visits (required every 90 days) or incomplete aide health clearances.
• Revocation Risk: Failure to complete the mandatory annual DOH registration and statistical reporting.

11. Key Contacts and Resources

Prospective providers must interact with multiple state systems and bureaus. The DOH Bureau of Home Care Licensure and Certification handles the LHCSA process, while eMedNY handles Medicaid enrollment.

Technical assistance for the application portals and compliance requirements is available through dedicated state help desks.

• DOH Bureau of Home Care Licensure: [email protected] | https://www.health.ny.gov/facilities/home_care/lhcsa
• NYSE-CON Technical Support: [email protected] | https://www.health.ny.gov/facilities/cons/
• eMedNY Provider Enrollment: (800) 343-9000 | https://www.emedny.org
• LDSS Contact Directory: https://www.health.ny.gov/health_care/medicaid/ldss.htm
• OMIG Compliance Program: https://omig.ny.gov/compliance/compliance

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