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

Last reviewed: 2026-09-10

Ohio Administrative Code 5160-46-04 governs Personal Care Aide services delivered under the Ohio Home Care Waiver, while OAC 173-39-02.11 regulates Personal Care Services under the Department of Aging's PASSPORT program. These services provide hands-on assistance with activities of daily living, including bathing, dressing, transferring, and toileting, directly in the Medicaid individual's home.

Applicants must secure a State Tested Nurse Aide (STNA) certification or complete a 75-hour Medicare Competency Evaluation Program, pass a BCI WebCheck background check sent directly to the state, and complete mandatory Electronic Visit Verification (EVV) training through Sandata before the Public Consulting Group (PCG) will approve an application submitted via the Provider Network Management (PNM) module.

1. Service Definition and Scope

In Ohio, Personal Care Aide (PCA) services encompass hands-on assistance with activities of daily living (ADLs) and instrumental activities of daily living (IADLs) when incidental to personal care. The service is designed to allow individuals enrolled in the Ohio Home Care Waiver or PASSPORT programs to remain safely in their community residences.

Services must be delivered according to the individual's person-centered services plan. Providers may deliver services as an agency or as an independent non-agency provider, subject to specific training and oversight requirements.

• Covered ADLs: bathing, dressing, grooming, toileting, transferring, and mobility assistance.
• Incidental IADLs: light housekeeping, laundry, and meal preparation, provided they do not comprise the entirety of the shift.
• Setting Limitations: services must be provided in the individual's home or community, not in a hospital or nursing facility.
• Group Ratios: services can be provided to one individual, or up to three individuals in a group setting during a face-to-face visit.
• Exclusions: PCAs cannot perform skilled nursing tasks unless specifically authorized under Home Care Attendant rules (OAC 5160-44-27).

2. Regulatory and Oversight Agencies

The Ohio Department of Medicaid (ODM) holds the ultimate authority for the Ohio Home Care Waiver, while the Ohio Department of Aging (ODA) administers the PASSPORT waiver for older adults. Both agencies rely on contracted entities for provider enrollment and daily oversight.

Public Consulting Group (PCG) is the contracted vendor responsible for processing provider applications, verifying compliance with OAC qualifications, and conducting structural reviews for ODM.

• Ohio Department of Medicaid (ODM): administers the Ohio Home Care Waiver (https://medicaid.ohio.gov).
• Ohio Department of Aging (ODA): administers the PASSPORT waiver and certifies ODA providers (https://aging.ohio.gov).
• Public Consulting Group (PCG): processes applications and conducts oversight for ODM (https://ohiohcbs.pcgus.com).
• Provider Network Management (PNM): the mandatory portal for all Medicaid provider enrollment (https://ohio.gov/pnm).

3. Gatekeeping Prerequisites: Who Can Even Apply

Ohio does not utilize a Certificate of Need (CON), closed network, or competitive Request for Proposals (RFP) process to restrict the number of Personal Care Aide providers. Enrollment is open year-round to any agency or independent applicant who meets the structural qualifications.

There are no required affiliations with managed care lead agencies to become certified, though providers must eventually contract with Ohio's Medicaid Managed Care Organizations (MCOs) or MyCare Ohio plans to serve individuals enrolled in those specific plans.

• Certificate of Need: none exists for personal care aide services in Ohio.
• Network Status: open enrollment; no moratoria or RFP procurement windows apply.
• Background Check Prerequisite: applicants must complete an Ohio BCI WebCheck before application approval.
• EVV Training Prerequisite: applicants must complete Sandata EVV training prior to submitting the PNM application.
• NPI Requirement: applicants must obtain a National Provider Identifier (NPI) before applying.

4. Licensure and Certification Requirements

Ohio does not issue a traditional "home care license" through the Department of Health for non-medical personal care agencies. Instead, providers achieve Medicaid Certification by meeting the standards outlined in OAC 5160-46-04 (for ODM) or OAC 173-39-02.11 (for ODA).

Agency providers must maintain specific supervisory structures, while independent providers must submit proof of their own training credentials directly to PCG.

• ODA Application Fee: agencies applying for PASSPORT certification must pay a $730 fee for calendar year 2025.
• First Aid Certification: must include hands-on training by a certified instructor; solely internet-based courses are explicitly prohibited.
• CPR Certification: required for all direct care workers prior to service delivery.
• Supervisor Qualifications (Agencies): OAC 173-39-02.11 requires supervisors to be an RN, or an LPN under the direction of an RN.
• Competency Evaluation: workers must hold an active STNA, complete a 75-hour Medicare Competency Evaluation, or complete an equivalent ODA/ODM-approved training program.

5. Medicaid Provider Enrollment

All prospective providers must submit their enrollment applications through the Provider Network Management (PNM) system, which replaced the legacy MITS system. PCG reviews the application for compliance with waiver rules.

During enrollment, providers must select the specific waivers they intend to serve (e.g., Ohio Home Care Waiver) and upload all required training, background check, and EVV certificates directly into the PNM.

• System of Record: Provider Network Management (PNM) module.
• Application Type: Group/Organization for agencies, or Atypical/Independent for non-agency providers.
• EVV Registration: independent providers without a Medicaid ID yet must use '9999999' to register for Sandata training.
• Document Uploads: training certificates, First Aid/CPR cards, and W-9s must be attached in the PNM portal.
• Revalidation: providers must revalidate their Medicaid enrollment every 3 to 5 years depending on the waiver.

6. Staffing, Training and Background Checks

Direct care staff must meet strict training requirements before delivering a single hour of service. Agencies are responsible for maintaining personnel files that prove compliance with OAC 5160-46-04 and OAC 173-39-02.11.

Background checks must be processed electronically via the Ohio Bureau of Criminal Identification and Investigation (BCI) WebCheck system.

• Initial Training: 75 hours via a Medicare Competency Evaluation Program or active STNA status.
• Annual In-Service: OAC requires 6 hours of ODA-approved in-service training every 12 months (agency orientation does not count).
• BCI Routing: WebCheck results must be sent directly from BCI to ODM at P.O. Box 183017, Columbus, OH 43218.
• Reference Checks: agencies must verify and document previous employment experience if used to qualify a PCA.
• Additional Training: required if a PCA is assigned tasks they were not initially evaluated on.

7. Documentation, Policies and Records

Providers must maintain comprehensive records to survive PCG structural reviews and ODA certification reviews. Documentation must prove that services were delivered exactly as authorized in the person-centered services plan.

Electronic Visit Verification (EVV) is mandatory for all personal care services and serves as the primary record of service delivery time and location.

• Service Plans: providers must maintain a copy of the individual's approved all-services plan.
• EVV Compliance: all visits must be logged in the Sandata EVV system or an approved alternate EVV vendor.
• Personnel Files: must contain I-9s, background checks, First Aid/CPR cards, and annual training logs.
• Task Documentation: records must specify which ADLs/IADLs were performed during each shift.
• Retention: records must generally be kept for a minimum of six years or until an audit is resolved.

8. Billing, Rates and Claims

Claims for Personal Care Aide services are submitted through the PNM portal or a clearinghouse, but they will deny if not supported by matching EVV data. Rates are established by ODM and published in the OAC fee schedules.

Providers billing for PASSPORT services submit claims to the regional Area Agency on Aging (AAA), while Ohio Home Care Waiver claims go directly to ODM or the individual's MyCare Ohio managed care plan.

• Procedure Code: T1019 is standard for personal care services (modifiers apply for group settings or specific waivers).
• Unit Measurement: services are typically billed in 15-minute increments.
• EVV Edit: claims lacking a matching EVV visit record in the Sandata aggregator will be denied.
• Rate Lookup: current fee schedules are published on the ODM website under Provider Billing Instructions.
• Third-Party Liability: providers must exhaust Medicare or other commercial insurance before billing Medicaid.

9. Approval Sequence and Timeline

The enrollment process requires sequential completion of external prerequisites before the PNM application can be finalized. PCG processes applications in the order received.

Delays most commonly occur when background checks are mailed to the provider instead of directly to ODM, or when First Aid certificates lack proof of hands-on demonstration.

• Step 1: obtain NPI and complete Sandata EVV training.
• Step 2: complete BCI WebCheck and direct results to ODM.
• Step 3: submit application and upload training credentials in the PNM portal.
• Step 4: PCG conducts a desk review of the application and credentials.
• Step 5: ODM issues a Medicaid Provider ID and effective date upon PCG's recommendation.

10. Common Denials and Survey Findings

PCG and ODA conduct routine structural reviews of enrolled providers. Failure to maintain continuous compliance with OAC rules results in corrective action plans or provider revocation.

Initial applications are frequently returned to the provider for corrections if documentation is incomplete or does not exactly match the applicant's legal name.

• First Aid Denial: application rejected because the First Aid course was solely internet-based without a return demonstration.
• BCI Routing Error: application stalled because BCI results were sent to the provider's office instead of ODM.
• Name Mismatch: training certificates rejected because the name does not exactly match the PNM application.
• Survey Finding: agency cited for failing to complete the mandatory 6 hours of annual in-service training for PCAs.
• Survey Finding: agency cited for utilizing an LPN as a supervisor without documented RN direction.

11. Key Contacts and Resources

Providers should utilize the official state portals and contracted vendor help desks for technical assistance during enrollment. PCG offers dedicated support for Ohio Home Care Waiver applicants.

For PASSPORT specific inquiries, providers must coordinate with ODA and their regional Area Agency on Aging (AAA).

• PCG Provider Oversight: 877-908-1746 (https://ohiohcbs.pcgus.com).
• Ohio Department of Medicaid (ODM): EVV and policy resources (https://medicaid.ohio.gov).
• Ohio Department of Aging (ODA): PASSPORT certification (https://aging.ohio.gov).
• Provider Network Management (PNM): enrollment portal (https://ohio.gov/pnm).
• Sandata EVV Training: registration portal (http://www.sandatalearn.com).

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