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

Last reviewed: 2026-09-10

The Pennsylvania Department of Health (DOH) licenses Personal Assistance Services (PAS) providers as Home Care Agencies under 28 Pa. Code Chapter 611 to deliver non-medical hands-on assistance in a participant's home. Funding for these services is primarily administered by the Department of Human Services (DHS) Office of Long-Term Living (OLTL) through the Community HealthChoices (CHC) 1915(c) waiver.

Because Pennsylvania operates its primary adult HCBS program through a mandatory managed care model, obtaining a state license and enrolling in the PROMISe Medicaid portal only qualifies an agency to seek contracts with the three regional CHC Managed Care Organizations (MCOs). These MCOs control network access, authorize all PAS hours, and may close their networks to new providers if they determine adequate capacity exists in a given county.

1. Service Definition and Scope

In Pennsylvania, Personal Assistance Services (PAS) provide hands-on assistance with Activities of Daily Living (ADLs) such as bathing, dressing, transferring, and toileting, as well as Instrumental Activities of Daily Living (IADLs). These services are designed to allow individuals with physical disabilities or age-related frailties to remain in their own homes.

The state distinguishes PAS from Home Health services; PAS is strictly non-medical. Providers delivering PAS cannot provide skilled nursing or therapeutic services unless they hold a separate Home Health Agency license.

2. Regulatory and Oversight Agencies

The Pennsylvania Department of Health (DOH) is responsible for the licensure and ongoing regulatory surveying of Home Care Agencies. The Department of Human Services (DHS) oversees Medicaid enrollment and the waiver programs.

Within DHS, the Office of Long-Term Living (OLTL) manages the Community HealthChoices program, while the actual day-to-day administration and provider contracting are handled by the designated Managed Care Organizations (MCOs).

3. Gatekeeping Prerequisites: Who Can Even Apply

Pennsylvania requires providers to navigate a multi-tiered approval process where state licensure is merely the first step. The most definitive structural precondition is the requirement to contract with a Community HealthChoices (CHC) Managed Care Organization (MCO).

Enrollment in the state's Medicaid program does not guarantee an MCO contract. MCOs utilize network adequacy standards and may enact closed networks or moratoria in specific counties, blocking new PAS providers from receiving authorizations regardless of their licensure status.

4. Licensure and Certification Requirements

To operate as a PAS provider, an entity must obtain a Home Care Agency license from the DOH Division of Home Health. The application process requires submission of specific state forms and a non-refundable fee.

The DOH mandates that all applications be typed and mailed physically; handwritten applications are rejected. The state currently advises that processing times for initial applications are extended.

5. Medicaid Provider Enrollment

Once licensed, providers must enroll in Pennsylvania Medicaid through the PROMISe Provider Portal. This step establishes the provider's Medicaid ID, which is required before approaching MCOs for contracting.

During enrollment, the system generates an Application Tracking Number (ATN) used to resume or check the status of the application. High-risk screening requirements apply to all PAS applicants.

6. Staffing, Training and Background Checks

Direct care workers providing PAS must meet specific screening and training standards outlined in 28 Pa. Code Chapter 611. Agencies are responsible for maintaining documentation of these requirements in personnel files.

Before independent client contact, workers must demonstrate competency and pass health and background screenings to ensure consumer safety.

7. Documentation, Policies and Records

Home Care Agencies must maintain comprehensive records for both consumers and staff. DOH surveyors will review these records during initial and renewal inspections.

Additionally, Pennsylvania mandates the use of Electronic Visit Verification (EVV) for all personal care services to comply with the 21st Century Cures Act.

8. Billing, Rates and Claims

Because PAS under the CHC waiver is managed by MCOs, providers do not bill the state directly through PROMISe for these services. Instead, claims are submitted to the specific MCO's clearinghouse.

Reimbursement rates are negotiated directly between the provider and the MCO, though the state publishes a Medical Assistance fee schedule that often serves as a baseline.

9. Approval Sequence and Timeline

Becoming a fully operational PAS provider in Pennsylvania is a sequential process that can take 6 to 12 months from start to finish, heavily dependent on MCO contracting timelines.

Providers cannot skip steps; licensure must precede Medicaid enrollment, which must precede MCO contracting.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied due to administrative errors or failure to meet the high-risk background check requirements. DOH is strict about application formatting.

During operational surveys, DOH frequently cites agencies for incomplete personnel files, particularly missing health screenings or competency documentation.

11. Key Contacts and Resources

Providers should rely on official Commonwealth of Pennsylvania websites for the most current forms, fee schedules, and regulatory updates.

The PROMISe portal and DOH Home Care pages are the primary hubs for enrollment and licensure activities.

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