South Carolina - Adult Companion Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-08-16

In South Carolina, Adult Companion Services are non-medical care, supervision, and socialization provided to seniors and adults with disabilities to ensure their safety and well-being in the community. These services are primarily funded through the South Carolina Department of Health and Human Services (SCDHHS) under the Community Choices Waiver, which allows participants to receive support in their own homes rather than institutional settings.

Becoming an approved provider requires navigating a two-step regulatory process: state licensure followed by Medicaid enrollment. The single biggest structural barrier to entry is obtaining an In-Home Care Provider (IHCP) license from the South Carolina Department of Public Health (DPH) before a Medicaid application can even be submitted. This prerequisite mandates a rigorous initial site inspection, comprehensive policy review, and proof of operational readiness before SCDHHS will consider the agency for waiver network inclusion.

1. Service Definition and Scope

Adult Companion Services in South Carolina provide non-medical assistance, supervision, and socialization for individuals who require a nursing facility level of care but choose to remain in the community. The service is designed to ensure the health and safety of the participant while fostering independence.

Companion care is strictly non-medical. Providers assist with light housekeeping, meal preparation, and community integration, but are prohibited from performing hands-on nursing tasks or medication administration unless specifically delegated under strict nursing board guidelines.

• Waiver Authority: South Carolina Community Choices Waiver (0405.R05.00).
• Target Population: Individuals ages 65 or older, and individuals with physical disabilities ages 18-64.
• Covered Tasks: Socialization, supervision, light housekeeping, meal preparation, and assistance with activities of daily living (ADLs).
• Excluded Tasks: Hands-on medical care, skilled nursing tasks, and the cost of room and board.
• Delivery Models: Companion care-agency (licensed providers) and companion care-individual (participant-directed via a financial management service).

2. Regulatory and Oversight Agencies

Oversight of companion care in South Carolina is divided between the state's public health licensing body and the Medicaid agency. Effective July 2024, the former DHEC was restructured, and health facility licensing now falls under the South Carolina Department of Public Health (DPH).

Medicaid waiver operations, provider enrollment, and claims processing are managed by the South Carolina Department of Health and Human Services (SCDHHS) and its specialized long-term care division.

• Medicaid Authority: South Carolina Department of Health and Human Services (SCDHHS) (https://www.scdhhs.gov).
• Waiver Administrator: SCDHHS Community Long Term Care (CLTC) division (https://www.scdhhs.gov/divisions/community-long-term-care).
• Licensing Body: South Carolina Department of Public Health (DPH) Health Facilities Licensing (https://dph.sc.gov/programs/health-facilities-licensing).
• Background Checks: South Carolina Law Enforcement Division (SLED) (https://www.sled.sc.gov).

3. Gatekeeping Prerequisites: Who Can Even Apply

South Carolina does not require a Certificate of Need (CON) for companion care or in-home care agencies. Furthermore, there are currently no closed networks, moratoria, or RFP-only procurement restrictions for enrolling as a Community Choices Waiver companion care provider.

However, strict structural prerequisites exist that block Medicaid enrollment until satisfied. An applicant cannot simply apply to SCDHHS; they must first establish a fully licensed operational entity under DPH jurisdiction.

• Licensure Prerequisite: Applicants must obtain an active In-Home Care Provider (IHCP) license from SC DPH before SCDHHS will accept a Medicaid enrollment application.
• Business Registration: The agency must be registered and in good standing with the South Carolina Secretary of State.
• Physical Location: Providers must maintain a physical office location in South Carolina or within a designated border-state radius (typically 25 miles).
• Network Status: Open enrollment; SCDHHS accepts applications on a rolling basis without procurement windows.
• NPI Requirement: Must obtain a National Provider Identifier (NPI) specific to the agency's service type before applying.

4. Licensure and Certification Requirements

Because South Carolina does not issue a license specifically named "Adult Companion Agency," providers must be licensed as an In-Home Care Provider (IHCP) under SC Regulation 61-122. This license covers non-medical in-home services including companion and personal care.

The DPH licensing process requires submitting a detailed application, paying licensing fees, and passing an initial on-site inspection where surveyors review the agency's administrative policies, personnel files, and operational readiness.

• License Type: In-Home Care Provider (IHCP) License.
• Regulatory Citation: South Carolina Code of Regulations Chapter 61-122.
• Application Fee: Base fee of $100 plus $10 per full-time equivalent (FTE) employee, up to a maximum of $500.
• Initial Inspection: DPH conducts an on-site survey prior to issuing the license to ensure compliance with state health and safety standards.
• Administrator Qualifications: The agency must designate an administrator with at least one year of supervisory or administrative experience in health or human services.

5. Medicaid Provider Enrollment

Once the DPH IHCP license is secured, the agency must enroll as a Medicaid provider through the SCDHHS Provider Enrollment Web Portal. Companion care providers enroll under the Community Long Term Care (CLTC) provider type.

The enrollment process includes screening, licensure verification, and execution of a Medicaid provider agreement. Providers must maintain their DPH license continuously to remain active in the Medicaid system.

• Enrollment Portal: SCDHHS Provider Enrollment Web Portal (https://providerservices.scdhhs.gov/ProviderEnrollmentWeb/).
• Provider Type: Community Long Term Care (CLTC) Waiver Provider.
• Application Fee: Subject to the federal Medicaid institutional application fee (approximately $732) unless waived or already paid to Medicare/another state.
• Required Documents: IRS CP-575 (EIN confirmation), active DPH IHCP license, and voided check for EFT setup.
• Revalidation: Providers must revalidate their Medicaid enrollment every five years through the SCDHHS portal.

6. Staffing, Training and Background Checks

Direct care workers providing companion services must meet strict state standards before they can have any contact with waiver participants. South Carolina places a heavy emphasis on criminal background checks and communicable disease screenings.

Agencies are responsible for maintaining continuous compliance, meaning background checks and certain trainings must be renewed at specific intervals.

• Background Checks: A South Carolina Law Enforcement Division (SLED) criminal background check is required prior to hire and at least every two years thereafter.
• Health Screening: Tuberculosis (TB) screening is required for all direct care staff prior to client contact, per DPH guidelines.
• Basic Qualifications: Staff must be at least 18 years old; a high school diploma or GED is strongly recommended.
• Training Requirements: Mandatory CPR and First Aid certification, plus onboarding training in abuse/neglect prevention, universal precautions, and ADL support.
• Registry Checks: Providers must check the SC Nurse Aide Registry and the federal OIG Exclusion List prior to hire and monthly.

7. Documentation, Policies and Records

Providers must maintain comprehensive records to satisfy both DPH licensing surveyors and SCDHHS Medicaid auditors. Missing documentation is a primary cause for recoupment of Medicaid funds.

South Carolina mandates the use of Electronic Visit Verification (EVV) for in-home services, requiring agencies to electronically log the exact start and end times of every companion care visit.

• EVV Mandate: Must use the SCDHHS-contracted EVV system (AuthentiCare) or a certified alternate system to capture visit data.
• Service Plans: A copy of the CLTC-approved participant service plan must be maintained in the client's active file.
• Personnel Files: Must contain SLED check results, TB screening records, CPR/First Aid certificates, and annual competency evaluations.
• Incident Reporting: Agencies must have written policies for reporting abuse, neglect, or exploitation to SC Adult Protective Services and SCDHHS within 24 hours.
• Record Retention: All Medicaid billing and client records must be retained for a minimum of five years from the date of service.

8. Billing, Rates and Claims

Companion care services are billed to the South Carolina Medicaid Management Information System (MMIS) based on prior authorizations generated by the participant's CLTC case manager.

Claims will automatically deny if they exceed the authorized units or if they are not supported by matching EVV data confirming the worker's presence in the home.

• Billing System: Claims are submitted via the SCDHHS Web Tool or through an approved clearinghouse to the SC MMIS.
• Procedure Codes: Billed using specific HCPCS codes (e.g., S5135 for companion care) as outlined in the CLTC fee schedule.
• Prior Authorization: 100% of companion care services must be prior-authorized by a CLTC case manager before service delivery.
• EVV Linkage: Claims must match AuthentiCare EVV records; discrepancies will result in claim denial or post-payment recoupment.
• Timely Filing: Claims must be submitted within 365 days of the date of service.

9. Approval Sequence and Timeline

The timeline to become a fully approved, billing companion care provider in South Carolina typically spans 4 to 6 months. The longest variable is the DPH licensing phase, which depends on surveyor availability.

Providers cannot begin delivering Medicaid-reimbursable services until both the DPH license is in hand and the SCDHHS Medicaid enrollment is fully approved with an active effective date.

• Step 1: Business formation, obtaining an EIN, and securing an NPI (1-2 weeks).
• Step 2: Submit IHCP license application and policy manuals to SC DPH (30-60 days for initial review).
• Step 3: DPH initial on-site licensing inspection (scheduled within 30-45 days of application acceptance).
• Step 4: Submit SCDHHS Medicaid Provider Enrollment application via the Web Portal (30-60 days processing).
• Step 5: Complete CLTC regional office orientation and AuthentiCare EVV system setup (2-4 weeks).

10. Common Denials and Survey Findings

Applications and routine surveys frequently fail due to administrative oversights rather than care quality issues. Both DPH and SCDHHS enforce strict compliance with background check and policy requirements.

Understanding these common pitfalls can help new agencies avoid costly delays during the initial licensure and enrollment phases.

• Licensure Denial: Submitting generic, out-of-state policy templates that do not specifically reference SC Regulation 61-122.
• Medicaid Enrollment Rejection: Name or address mismatches between the IRS CP-575, the DPH license, and the Medicaid application.
• Survey Citation: Missing, incomplete, or expired SLED background checks in direct care worker personnel files.
• Survey Citation: Allowing a worker to provide direct client care before their TB screening results are fully documented.
• Claim Denials: Billing for hours that exceed the CLTC prior authorization or failing to capture mandatory EVV check-in/check-out data.

11. Key Contacts and Resources

Providers should rely exclusively on official state resources for the most current regulations, fee schedules, and application portals. Bookmark these South Carolina-specific links for ongoing compliance.

State agency websites are frequently updated, especially following the 2024 restructuring of DHEC into DPH.

• SCDHHS Provider Enrollment Portal: https://providerservices.scdhhs.gov/ProviderEnrollmentWeb/
• SC DPH Health Facilities Licensing: https://dph.sc.gov/programs/health-facilities-licensing
• SCDHHS Community Long Term Care (CLTC): https://www.scdhhs.gov/divisions/community-long-term-care
• SC Law Enforcement Division (SLED) Background Checks: https://www.sled.sc.gov/cjc.html
• AuthentiCare (EVV) SC Portal Information: https://www.scdhhs.gov/providers/electronic-visit-verification-evv

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