Pennsylvania - Homemaker Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Pennsylvania Department of Human Services (DHS) Office of Long-Term Living (OLTL) oversees Homemaker Services under the Community HealthChoices (CHC) and OBRA waivers. Approval requires establishing a legal entity, enrolling through the PROMISe portal as a Provider Type 59 (or similar HCBS type), and securing network contracts with regional CHC Managed Care Organizations (MCOs).

Because Pennsylvania transitioned most adult HCBS to the managed care model under CHC, securing a Medicaid provider ID is only the preliminary step. Providers cannot bill or receive participant referrals until they successfully negotiate and execute a network participation agreement with at least one of the state's designated CHC MCOs (AmeriHealth Caritas, PA Health & Wellness, or UPMC Community HealthChoices).

1. Service Definition and Scope

Homemaker Services in Pennsylvania provide routine household assistance to waiver participants who are unable to perform these tasks independently. The service is authorized when the individual lacks an informal support network to manage household maintenance.

Under OLTL guidelines, this service is strictly non-medical and does not include hands-on personal care or assistance with Activities of Daily Living (ADLs).

• In-Home Household Support: Light housekeeping, dusting, vacuuming, mopping, and tidying living areas.
• Routine Daily Living Assistance: Basic meal preparation according to dietary needs and laundry support.
• Community Errands: Running essential household errands and grocery shopping.
• Exclusions: Hands-on personal care, medication administration, and heavy chore services.
• Authorization: Must be explicitly detailed in the participant’s person-centered service plan by an MCO Service Coordinator.

2. Regulatory and Oversight Agencies

Multiple state entities govern the delivery and reimbursement of Homemaker Services. The primary authority is the DHS Office of Long-Term Living.

Direct oversight of service delivery and provider networks is delegated to the CHC MCOs.

• Department of Human Services (DHS): Administers the state Medicaid program (https://www.dhs.pa.gov).
• Office of Long-Term Living (OLTL): Manages HCBS waivers and sets provider qualifications (https://www.dhs.pa.gov/about/Pages/OLTL.aspx).
• PROMISe Portal: The state's Medicaid Management Information System for provider enrollment (https://promise.dpw.state.pa.us).
• Community HealthChoices (CHC): The mandatory managed care program for dually eligible individuals and older adults (https://www.dhs.pa.gov/HealthChoices/Pages/CHC.aspx).

3. Gatekeeping Prerequisites: Who Can Even Apply

Pennsylvania requires prospective Homemaker providers to establish their business infrastructure before submitting a PROMISe application.

The definitive structural precondition is the CHC MCO contracting requirement; without an MCO contract, a PROMISe ID generates no revenue.

• Business Registration: Must establish a legal entity with the Pennsylvania Department of State via PennFile.
• Federal Identifiers: Must secure an IRS Employer Identification Number (EIN) and a Type 2 Organizational NPI.
• MCO Network Contracting: Must secure a network participation agreement with AmeriHealth Caritas, PA Health & Wellness, or UPMC Community HealthChoices.
• Physical Location: Must maintain a functional business office space within or adjacent to the intended service region.

4. Licensure and Certification Requirements

Pennsylvania does not require a Home Care Agency License from the Department of Health for providers strictly delivering non-medical homemaker services without hands-on ADL assistance.

Instead, providers are certified directly through the OLTL waiver enrollment process under 55 Pa. Code Chapter 52.

• Licensure Exemption: DOH Home Care Agency license is not required for pure homemaker services.
• Regulatory Framework: Governed by 55 Pa. Code Chapter 52 (OLTL Home and Community-Based Services).
• Policy Manual: Must develop an operational manual featuring client intake workflows, task log templates, and grievance protocols.
• Insurance: Must maintain active Workers' Compensation and Commercial General Liability insurance.

5. Medicaid Provider Enrollment

Enrollment is conducted electronically through the PROMISe Provider Portal.

Applicants must submit a complete Base Provider Enrollment application along with specific HCBS addenda.

• System: PROMISe (Provider Reimbursement and Operations Management Information System).
• Application Type: Base Provider Enrollment form with HCBS-specific addenda.
• Required Documentation: IRS EIN confirmation, Type 2 NPI, and business registration documents.
• Ownership Disclosure: Must complete the Ownership or Control Interest form.

6. Staffing, Training and Background Checks

Agencies must employ vetted personnel to deliver Homemaker Services; independent contractors are generally prohibited.

Frontline staff must meet state-mandated background and training requirements before providing care.

• Criminal Background Checks: Mandatory Pennsylvania State Police criminal history clearance for all direct care workers.
• Child Abuse Clearances: Required if the worker will be in contact with minors.
• Pre-Service Training: Modules covering consumer privacy, fraud prevention, and task documentation.
• Employment Status: Services must be provided directly by the certified agency's employed personnel.

7. Documentation, Policies and Records

Providers must maintain comprehensive records to satisfy OLTL and MCO audit requirements.

Documentation must verify that services were delivered in accordance with the person-centered service plan.

• Task Logs: Detailed records of specific household tasks completed during each visit.
• Time Tracking: Precise visit timestamps and signed service verification forms.
• EVV Compliance: Electronic Visit Verification logging is required if shifts are layered with personal assistance models.
• Record Retention: Must retain all service and billing records for a minimum of five years.

8. Billing, Rates and Claims

Reimbursement for Homemaker Services is managed through the CHC MCOs for the vast majority of participants.

While OLTL publishes fee-for-service rate schedules, actual reimbursement rates are negotiated with the MCOs.

• Billing System: Claims are submitted directly to the authorizing CHC MCO (e.g., UPMC, PA Health & Wellness).
• Rate Setting: OLTL establishes baseline HCBS rates, but MCO contracts dictate final payment terms.
• Prior Authorization: All services must be prior-authorized by the MCO Service Coordinator before billing.
• Unit of Service: Typically billed in 15-minute increments using specific HCPCS codes defined in the MCO contract.

9. Approval Sequence and Timeline

The approval process involves sequential steps across multiple state and private entities.

The entire process from business formation to active billing status generally takes several months.

• Phase 1: Business formation and NPI/EIN acquisition (1-2 weeks).
• Phase 2: PROMISe portal application submission and OLTL review (30-60 days).
• Phase 3: CHC MCO credentialing and contract negotiation (60-90 days).
• Total Timeline: Typically 2 to 4 months depending on state review capacity and MCO responsiveness.

10. Common Denials and Survey Findings

Applications and ongoing compliance reviews frequently fail due to administrative oversights or incomplete documentation.

OLTL's Quality Management Enterprise Team (QMET) conducts biennial reviews to ensure ongoing compliance.

• Application Denials: Missing ownership disclosures or mismatched IRS/NPI information in PROMISe.
• Training Deficiencies: Failure to document mandatory pre-service training for frontline staff.
• Documentation Errors: Incomplete task logs or missing participant signatures on service verification forms.
• Background Check Gaps: Allowing staff to provide services before criminal history clearances are fully processed.

11. Key Contacts and Resources

Prospective providers should utilize official state resources for the most current enrollment and compliance information.

The DHS Provider Enrollment unit and specific MCO provider relations departments are the primary points of contact.

• DHS Provider Enrollment: 1-800-537-8862 for PROMISe application assistance (https://www.dhs.pa.gov/providers/Providers/Pages/PROMISe.aspx).
• OLTL Provider Helpline: For waiver qualification and policy questions (https://www.dhs.pa.gov/about/Pages/OLTL.aspx).
• PennFile: Pennsylvania Department of State business registration portal (https://file.dos.pa.gov).
• UPMC Community HealthChoices: Provider network contracting (https://www.upmchealthplan.com/chc/providers/).

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