Pennsylvania - Adult Health Transportation — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Pennsylvania Department of Human Services (DHS) funds non-emergency medical transportation (NEMT) and waiver-based non-medical transportation through the county-administered Medical Assistance Transportation Program (MATP) and the Community HealthChoices (CHC) managed care organizations. Providers deliver these services to Medicaid beneficiaries who require specialized transit to covered medical appointments or approved home and community-based waiver services.

Independent transportation companies cannot enroll directly with the state as standalone Medicaid NEMT providers; they must secure a subcontract with a designated county MATP administrator or execute a network agreement with one of the three regional CHC-MCOs. Without this local or managed care authorization, the state's PROMISe Medicaid enrollment portal will not issue a billing number for transportation services.

1. Service Definition and Scope

Pennsylvania divides Medicaid transportation into two distinct categories: MATP for medical appointments and waiver-funded non-medical transportation for community integration. MATP covers trips to any Medicaid-billable service, such as primary care, dental visits, and behavioral health appointments.

Non-medical transportation, authorized under waivers like the Community HealthChoices (CHC) or Consolidated Waiver, allows participants to access community activities, employment, or volunteer opportunities when no other transit options exist. Both services require the provider to be the payor of last resort, utilized only after family, community, and Medicare resources are exhausted.

• MATP Scope: Non-emergency transportation to secure medical care provided under the Medical Assistance program.
• Waiver Non-Medical Scope: Transportation to access waiver services and community activities outlined in the Person-Centered Service Plan (PCSP).
• Exceptional Transportation: Authorized for long-distance or specialized medical trips requiring prior approval.
• Excluded Services: Transportation provided simultaneously with adult daily living services that already include transit.
• Stretcher Transport: CHC-MCOs are specifically responsible for non-emergency medical transportation by stretcher for CHC participants.

2. Regulatory and Oversight Agencies

The Pennsylvania Department of Human Services (DHS) holds ultimate authority over Medicaid transportation, but delegates daily administration to specific offices and county governments. The Office of Long-Term Living (OLTL) oversees the CHC waivers, while the Office of Developmental Programs (ODP) manages ID/A waivers.

Because Pennsylvania does not issue a distinct NEMT facility license, the Pennsylvania Public Utility Commission (PUC) acts as the primary regulatory body for the actual transportation authority, certifying paratransit and taxi operators.

• Department of Human Services (DHS): https://www.dhs.pa.gov
• Medical Assistance Transportation Program (MATP): https://www.matp.pa.gov
• Office of Long-Term Living (OLTL): https://www.dhs.pa.gov/about/DHS-Information/Pages/Office-of-Long-Term-Living.aspx
• Office of Developmental Programs (ODP): https://www.dhs.pa.gov/about/DHS-Information/Pages/Office-of-Developmental-Programs.aspx
• Pennsylvania Public Utility Commission (PUC): https://www.puc.pa.gov

3. Gatekeeping Prerequisites: Who Can Even Apply

Pennsylvania utilizes a highly delegated model for NEMT, meaning direct state enrollment is blocked unless a provider first secures a contract with a managing entity. A provider cannot simply apply to DHS to become an MATP provider.

Applicants must navigate county-level procurement or MCO credentialing. If a county MATP administrator or a CHC-MCO determines their network is adequate, they will not accept new provider applications, effectively barring entry into that specific region.

• County MATP Subcontracting: Required execution of a written subcontract with the designated county MATP administrator for fee-for-service populations.
• CHC-MCO Network Contracting: Required credentialing and network agreement with UPMC, PA Health & Wellness, or AmeriHealth Caritas for CHC participants.
• PUC Authority: Required Certificate of Public Convenience from the PA Public Utility Commission prior to transporting passengers for compensation.
• ODP Qualification: Required submission of the ODP Provider Qualification packet for agencies seeking to provide waiver non-medical transportation.
• PROMISe Enrollment Prerequisite: Required proof of MCO affiliation, county contract, or ODP qualification before the PROMISe portal will process a base enrollment application.

4. Licensure and Certification Requirements

The Pennsylvania Department of Health does not license NEMT providers. Instead, legal operating authority is granted by the Pennsylvania Public Utility Commission (PUC) under paratransit or call-and-demand certificates.

Providers must also comply with PennDOT commercial vehicle regulations and maintain specific insurance thresholds mandated by both the PUC and the contracting MATP/MCO entities.

• PUC Paratransit Certificate: Required legal authority to operate a passenger transportation service for compensation in Pennsylvania.
• Vehicle Registration: Required commercial or omnibus registration through PennDOT for all fleet vehicles.
• Commercial Insurance: Required minimum liability coverage as dictated by PUC regulations and county MATP contract standards.
• ADA Compliance: Required wheelchair lift specifications and securement devices for vehicles designated as accessible.
• Vehicle Inspections: Required annual state safety inspections and daily pre-trip condition reports.

5. Medicaid Provider Enrollment

Once local contracts or waiver qualifications are secured, providers must enroll in PROMISe, Pennsylvania's Medicaid Management Information System. This step registers the provider's legal entity and links them to the appropriate funding streams.

The enrollment process requires the submission of a Base Provider Enrollment application along with specific addenda depending on whether the provider is billing MATP, OLTL, or ODP services.

• Enrollment System: PROMISe (Provider Reimbursement and Operations Management Information System).
• Application Form: PROMISe Provider Enrollment Base Application submitted via the DHS portal.
• Legal Entity Verification: Required IRS-generated document confirming the FEIN and business name.
• Ownership Disclosure: Required completion of the Ownership or Control Interest Pages to identify all managing individuals.
• Application Fee: Required federal Medicaid application fee for institutional providers, unless waived by Medicare enrollment.

6. Staffing, Training and Background Checks

Drivers are the primary point of care in NEMT and must meet strict background and training standards before transporting Medicaid beneficiaries. These requirements are enforced by the contracting MCOs and county MATP administrators.

Clearances must be obtained prior to passenger contact and renewed at intervals specified by DHS and the specific waiver programs.

• Criminal History: Required Pennsylvania State Police criminal record check for all drivers and dispatchers.
• Child Abuse Clearance: Required Pennsylvania Child Abuse History Clearance if the provider transports minors.
• Driving Record: Required PennDOT Motor Vehicle Record (MVR) check to verify a valid license and safe driving history.
• First Aid and CPR: Required current certification in basic First Aid and CPR for all active drivers.
• Passenger Assistance Training: Required training on wheelchair securement, lift operation, and defensive driving.

7. Documentation, Policies and Records

Transportation providers must maintain exhaustive records of every trip to survive state and MCO audits. Missing signatures or incomplete manifests are the leading cause of clawbacks.

Providers must also implement HIPAA-compliant policies for handling trip manifests, which contain protected health information regarding the beneficiary's medical appointments.

• Trip Manifests: Required daily logs detailing the date, time, origin, destination, and mileage of each transport.
• Passenger Signatures: Required physical or electronic signature from the beneficiary verifying the trip occurred.
• Vehicle Maintenance Logs: Required documentation of daily pre-trip inspections and routine mechanical maintenance.
• HIPAA Notice: Required distribution of the Notice of Privacy Practices to all passengers.
• Record Retention: Required retention of all Medicaid-related transportation and billing records for a minimum of five years.

8. Billing, Rates and Claims

Billing procedures depend entirely on the authorizing entity. MATP trips are billed to the county administrator, CHC trips are billed to the specific MCO, and waiver non-medical transportation is billed through PROMISe.

Rates are not uniform statewide; they are negotiated with the county or MCO, or set by the ODP/OLTL fee schedule for waiver-specific procedure codes.

• MATP Reimbursement: Paid at a negotiated per-trip or per-mile rate established by the county MATP administrator.
• Waiver Procedure Code: W6110 utilized for Non-medical Transportation under specific HCBS waivers.
• Payor of Last Resort: Required coordination with Medicare and the Shared Ride Program prior to billing Medicaid.
• Claims Submission: MATP and CHC claims are submitted directly to the county or MCO clearinghouse, not to PROMISe.
• Shared Ride Coordination: Required utilization of PennDOT's Shared Ride Program for eligible seniors before billing MATP.

9. Approval Sequence and Timeline

Becoming a fully operational NEMT provider in Pennsylvania is a multi-stage process that cannot be expedited, as it relies on sequential approvals from different state and local bodies.

Providers must secure their vehicles and PUC authority before they can even approach a county or MCO for a contract.

• Step 1: Entity formation and acquisition of commercial vehicles and insurance (1-2 months).
• Step 2: Application and approval for PUC Paratransit Authority (3-6 months).
• Step 3: Negotiation and execution of a county MATP subcontract or CHC-MCO network agreement (2-4 months).
• Step 4: Submission of the PROMISe Base Provider Enrollment application (30-60 days).
• Step 5: Driver credentialing and vehicle inspections (completed concurrently with enrollment).

10. Common Denials and Survey Findings

Applications are frequently rejected at the local level before they ever reach the state, primarily due to network adequacy. If a county has enough drivers, they will simply deny new subcontracts.

During audits, providers are most often cited for administrative failures rather than safety incidents, particularly regarding documentation and background checks.

• Closed Networks: MCOs or counties denying contracts because their current transportation network is deemed adequate.
• Missing PUC Authority: Operating or applying without the required Public Utility Commission certificate.
• Incomplete Trip Logs: Citations for missing passenger signatures or inaccurate mileage tracking on manifests.
• Lapsed Clearances: Failure to renew driver criminal background checks or MVRs within the required timeframes.
• Unapproved Vehicles: Utilizing vehicles for Medicaid transports that have not been inspected or listed on the provider's commercial policy.

11. Key Contacts and Resources

Providers must interact with multiple portals and agencies to maintain compliance. The DHS PROMISe portal handles the final enrollment, while local entities handle the daily operations.

Familiarity with the specific CHC-MCOs and the state's MATP guidance is essential for accurate billing and policy adherence.

• PA DHS PROMISe Enrollment: https://www.dhs.pa.gov/providers/Providers/Pages/PROMISe-Enrollment.aspx
• MATP Program Information: https://www.matp.pa.gov
• PA Public Utility Commission (Motor Carrier): https://www.puc.pa.gov/transportation/motor-carrier/
• Community HealthChoices (CHC): https://www.dhs.pa.gov/HealthChoices/HC-Services/Pages/CHC-Main.aspx
• PennDOT Commercial Vehicles: https://www.penndot.pa.gov/TravelInPA/Pages/Commercial-Vehicles.aspx

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