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Pennsylvania - Home Health Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

In Pennsylvania, Home Health Services are licensed by the Department of Health (DOH) and enrolled in Medicaid through the Department of Human Services (DHS) PROMISe system. The service is defined as intermittent skilled nursing and at least one other therapeutic service (such as physical therapy, occupational therapy, speech therapy, or home health aides) provided in a patient's residence under a physician-ordered plan of care.

To become a Medicaid-enrolled Home Health Agency (HHA) in Pennsylvania, an applicant must first obtain a state license from the DOH Division of Home Health. For providers intending to bill Medicare or Medicaid, federal Medicare certification (via a CMS-855A application and a state or accrediting organization survey) is a mandatory prerequisite before Medicaid enrollment can be finalized.

1. Service Definition and Scope

Pennsylvania defines a Home Health Care Agency as an organization staffed and equipped to provide skilled nursing care and at least one other therapeutic service to persons on a part-time or intermittent basis in their place of residence.

Under Pennsylvania Code Title 55 Chapter 1249, home health services are covered and reimbursable under the Medical Assistance (MA) program only if a physician orders the services and establishes the plan of care.

2. Regulatory and Oversight Agencies

The Pennsylvania Department of Health (DOH) is responsible for the state licensure of Home Health Agencies and conducts surveys for both state licensure and federal Medicare certification.

The Pennsylvania Department of Human Services (DHS) manages the Medicaid program, with provider enrollment handled through the PROMISe (Provider Reimbursement and Operations Management Information System) portal.

3. Gatekeeping Prerequisites: Who Can Even Apply

Pennsylvania does not require a Certificate of Need (CON) for Home Health Agencies. However, state licensure is a strict prerequisite for federal Medicare certification, and Medicare certification is generally required for Medicaid enrollment as a Home Health Agency.

There are no explicit moratoria or closed networks at the state Medicaid enrollment level, but enrollment in state Medicaid does not guarantee enrollment in individual Managed Care Organization (MCO) networks, which may be closed due to network adequacy.

4. Licensure and Certification Requirements

To obtain a state license, applicants must submit the Initial Home Health Application to the DOH Division of Home Health, along with the required fee via check or money order. The application must be physically mailed, though some materials may be emailed.

For federal Medicare certification, applicants must submit CMS Forms 1572(a), 690, and 1561 to the Division of Home Health, and the CMS-855A Enrollment Application to their Medicare Administrative Contractor (MAC).

5. Medicaid Provider Enrollment

After obtaining state licensure and Medicare certification, agencies can enroll as Pennsylvania Medicaid providers through the DHS PROMISe system.

Providers must complete the appropriate MA provider enrollment application for Home Health Agencies and submit all required documentation, including proof of licensure and Medicare certification.

6. Staffing, Training and Background Checks

Home Health Agencies must ensure that all staff meet specific qualification and training standards. Direct care workers must complete approved competency requirements.

Criminal background checks and child abuse clearances are mandatory for owners and office staff, and TB screening is required for those with direct consumer contact.

7. Documentation, Policies and Records

Agencies must maintain comprehensive clinical records for all patients, including the physician-ordered plan of care and assessments of the patient's current status.

Administrative records, including personnel files, background check results, and proof of competency for direct care workers, must be maintained and available for state inspection.

8. Billing, Rates and Claims

Medicaid reimbursement for Home Health Services is governed by PA Code Title 55 Chapter 1249. Services are billed using standard HCPCS/CPT codes through the PROMISe system or directly to the respective MCO.

Payment conditions specify that skilled nursing care and home health aide services are reimbursable only when provided under a physician's plan of care.

9. Approval Sequence and Timeline

The approval process begins with state licensure, followed by Medicare certification, and concludes with Medicaid enrollment. The entire process can take several months to over a year.

After the CMS-855A is approved by the MAC, the DOH will conduct a survey before recommending the agency for Medicare certification.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied due to incomplete forms, missing application fees, or failure to meet physical location requirements.

During surveys, common deficiencies include inadequate clinical documentation, failure to follow the physician's plan of care, and incomplete personnel files (missing background checks or TB tests).

11. Key Contacts and Resources

Providers should utilize the official state websites and contact the respective divisions for guidance on licensure and enrollment.

The DOH Division of Home Health handles licensure, while the DHS Office of Long-Term Living (OLTL) and PROMISe handle Medicaid enrollment.

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