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Pennsylvania - Housing Stabilization — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

Pennsylvania funds tenancy support and housing search activities not as a standalone Medicaid state plan benefit, but as Housing Transition and Tenancy Sustaining Services within the Office of Developmental Programs (ODP) waivers and the Office of Long-Term Living (OLTL) Community HealthChoices (CHC) waiver. Providers cannot apply for a generic housing stabilization license, as the state does not issue one; instead, agencies must qualify as waiver providers under specific program rules.

Operating in the CHC waiver requires securing a network contract with at least one of the three regional Managed Care Organizations (MCOs) before billing is possible, while ODP waiver participation requires passing a rigorous provider qualification review by a county-level Administrative Entity (AE). Both pathways mandate subsequent enrollment as an atypical or waiver provider through the state's PROMISe Medicaid portal.

1. Service Definition and Scope

In Pennsylvania, housing support is formally designated as Housing Transition and Tenancy Sustaining Services under the state's 1915(c) HCBS waivers. The service is divided into two distinct phases: transition (helping individuals find and secure housing, negotiating with landlords, and assisting with applications) and sustaining (ongoing tenancy retention planning, lease education, and eviction prevention).

This service does not cover the cost of room and board, rent, or deposits. It is strictly an administrative and supportive service designed to help waiver participants maintain independent living in the community rather than in institutional settings.

2. Regulatory and Oversight Agencies

The Pennsylvania Department of Human Services (DHS) oversees all Medicaid operations. Within DHS, two primary program offices manage the waivers that fund housing services: the Office of Long-Term Living (OLTL) for physical disabilities and aging, and the Office of Developmental Programs (ODP) for intellectual disabilities and autism.

Because CHC is a managed care program, direct oversight and credentialing are delegated to the three contracted MCOs. Provider enrollment and claims processing are handled centrally through the PROMISe system.

3. Gatekeeping Prerequisites: Who Can Even Apply

Pennsylvania does not allow open, standalone enrollment for housing stabilization. To provide this service under the CHC waiver, an agency must successfully negotiate a contract with a CHC MCO (UPMC, PA Health & Wellness, or AmeriHealth Caritas). MCOs may close their networks based on geographic adequacy, blocking new applicants entirely.

For ODP waivers, prospective providers must first complete the New Provider Qualification process through their local county Administrative Entity (AE). Without AE sponsorship and approval of the provider's qualification application, DHS will reject the PROMISe enrollment application.

4. Licensure and Certification Requirements

Pennsylvania does not issue a specific facility or agency license for Housing Transition and Tenancy Sustaining Services. It is considered an unlicensed HCBS service. Instead of a license, the state relies on the waiver provider qualification process to ensure agencies meet minimum standards.

Agencies must demonstrate compliance with Chapter 6100 regulations (for ODP) or OLTL waiver requirements, which mandate specific organizational policies, quality management plans, and staff training protocols rather than a formal site license.

5. Medicaid Provider Enrollment

Once qualified by an AE or contracted with an MCO, agencies must enroll in the Pennsylvania Medicaid program via the PROMISe Provider Portal. Applicants must select the correct Provider Type (PT) and Specialty code corresponding to HCBS waiver services.

The application requires submitting the Federal Tax Identification Number (FEIN), proof of insurance, and the qualification letter from ODP or the MCO contract. The system generates an Application Tracking Number (ATN) used to monitor the status.

6. Staffing, Training and Background Checks

Direct support professionals providing housing services must meet minimum education and experience requirements, typically a high school diploma and specific experience in human services or housing navigation. Agencies must maintain personnel files proving these qualifications.

Pennsylvania strictly enforces background check requirements under the Affordable Care Act and state law. All staff and owners with 5% or more interest must undergo comprehensive criminal history clearances before having contact with participants.

7. Documentation, Policies and Records

Providers must maintain comprehensive records that align with the participant's Individual Support Plan (ISP) or Person-Centered Service Plan (PCSP). Every billed unit must be supported by a service note detailing the date, time, duration, and specific housing activity performed.

Agencies are required to have written policies covering grievance procedures, participant rights, emergency backup plans, and HIPAA compliance. Records must be retained for a minimum of five years.

8. Billing, Rates and Claims

Billing for housing services in Pennsylvania depends on the waiver. For CHC, providers submit claims directly to the participant's MCO (UPMC, PA Health & Wellness, or AmeriHealth Caritas) using the MCO's specific clearinghouse. For ODP, claims are submitted through PROMISe.

Services are typically billed in 15-minute increments using specific HCPCS codes (such as H2016 or T2038, depending on the exact waiver definition). Rates are established by DHS for ODP, while CHC rates may be negotiated with the MCOs but generally follow the state fee schedule.

9. Approval Sequence and Timeline

The timeline to become a fully billable provider varies significantly by pathway. For ODP, the AE qualification process can take 30 to 60 days, followed by the PROMISe enrollment which takes an additional 30 to 90 days.

For CHC, MCO credentialing and contracting is the longest phase, often taking 90 to 120 days after PROMISe enrollment is complete. Providers should plan for a 4 to 6 month total lead time before they can accept their first referral.

10. Common Denials and Survey Findings

Applications are frequently denied at the PROMISe level due to missing background checks for owners, mismatched FEIN data, or failure to include the required AE qualification letter. MCOs commonly deny contracts simply because their network for housing services is closed.

During post-payment reviews or ODP QA surveys, providers are most often cited for billing without corresponding service notes, failing to report critical incidents in the EIM system within 24 hours, or delivering services outside the scope of the authorized ISP.

11. Key Contacts and Resources

Prospective providers should begin by reviewing the specific waiver documents and provider manuals available on the DHS website. The PROMISe portal contains the electronic enrollment application and user manuals.

For CHC, providers must contact the network management departments of the three MCOs directly. For ODP, the local county Administrative Entity is the primary point of contact for initial qualification.

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