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

Last reviewed: 2026-08-16

In South Carolina, Home Health Services provide intermittent skilled nursing, physical therapy, occupational therapy, speech-language pathology, and home health aide services directly in a patient's residence. These services are delivered under a physician-ordered plan of care and are designed to address post-acute care, chronic condition management, and rehabilitation for Medicaid beneficiaries, including those on the Community Choices and HASCI waivers.

The single biggest structural barrier to entry for this service in South Carolina is the Certificate of Need (CON) requirement. Unlike non-medical in-home care, prospective skilled Home Health Agencies cannot simply apply for a license; they must first apply for and be awarded a CON from the South Carolina Department of Public Health (DPH), which strictly limits the approval of new agencies based on a county-by-county need methodology outlined in the State Health Plan.

1. Service Definition and Scope

South Carolina defines a Home Health Agency as a public, nonprofit, or proprietary organization that furnishes skilled home health services on a visiting basis in a place used as a patient's home. This is governed by the Licensure of Home Health Agencies Act (S.C. Code § 44-69-10) and distinct from non-medical "In-Home Care Providers" which provide only companion or personal care.

Medicaid covers these services under the State Plan for medically necessary acute conditions, as well as through Home and Community-Based Services (HCBS) waivers for long-term care populations. Services must be intermittent, part-time, and strictly adhere to a physician's plan of care.

• Skilled Nursing: Provided by an RN or LPN under RN supervision, including wound care, medication management, and disease education.
• Physical Therapy: Restorative therapy provided by a licensed physical therapist or PTA.
• Occupational Therapy: Services to improve activities of daily living, provided by a licensed OT or OTA.
• Speech-Language Pathology: Treatment for speech, language, and swallowing disorders.
• Home Health Aide Services: Hands-on personal care and ADL support provided under the supervision of a registered nurse or therapist.
• Medical Social Services: Counseling and resource coordination provided by a qualified medical social worker.
• Physician Orders: All services must be explicitly ordered by a physician and documented in a formal Plan of Care (CMS-485 or equivalent).

2. Regulatory and Oversight Agencies

The South Carolina Department of Public Health (DPH)—which absorbed the healthcare quality functions of the former DHEC in July 2024—is the primary regulatory body responsible for licensing and inspecting Home Health Agencies. DPH also administers the Certificate of Need program.

The South Carolina Department of Health and Human Services (SCDHHS) manages Medicaid enrollment, waiver administration, and claims processing. Agencies seeking to bill Medicare must also interact with the Centers for Medicare & Medicaid Services (CMS) and their designated Medicare Administrative Contractor (MAC).

• South Carolina Department of Public Health (DPH): [https://dph.sc.gov](https://dph.sc.gov) - Issues state licenses, conducts surveys, and manages the CON program.
• South Carolina Department of Health and Human Services (SCDHHS): [https://www.scdhhs.gov](https://www.scdhhs.gov) - Administers the state Medicaid program and HCBS waivers.
• Centers for Medicare & Medicaid Services (CMS): [https://www.cms.gov](https://www.cms.gov) - Establishes federal Conditions of Participation (CoPs) for Medicare/Medicaid certification.
• South Carolina Law Enforcement Division (SLED): [https://www.sled.sc.gov](https://www.sled.sc.gov) - Processes mandatory state criminal background checks for direct care staff.
• Palmetto GBA: [https://www.palmettogba.com](https://www.palmettogba.com) - The regional Medicare Administrative Contractor (MAC) handling Medicare enrollment and claims for SC.

3. Gatekeeping Prerequisites: Who Can Even Apply

The absolute structural precondition for operating a Home Health Agency in South Carolina is obtaining a Certificate of Need (CON). Under S.C. Code § 44-69-75, DPH will not accept a licensure application for a new skilled home health agency unless the applicant has first been awarded a CON.

CON availability is dictated by the South Carolina Health and Demographic Data division, which publishes a State Health Plan detailing projected need by county. If the state determines a county is adequately served, no CON applications will be accepted for that area, effectively placing a moratorium on new market entrants.

• Certificate of Need (CON): Mandatory pre-approval from DPH required before a license application can be submitted.
• State Health Plan Need Methodology: Applicants must prove a statistical deficit of home health services in their target county based on DPH's published formulas.
• Secretary of State Registration: The business entity must be registered and in good standing with the SC Secretary of State.
• National Provider Identifier (NPI): A Type 2 (Organizational) NPI is required prior to initiating Medicaid or Medicare enrollment.
• Physical Location: The agency must have a commercial office space located within South Carolina (or an approved border area) that meets local zoning requirements.

4. Licensure and Certification Requirements

Once a CON is secured, providers must apply for a state license under DPH Regulation 60-77 (Standards for Licensing Home Health Agencies). This involves submitting a comprehensive application packet, policies, and undergoing an initial on-site readiness survey.

Because Medicaid home health services often overlap with Medicare, most agencies also pursue Medicare Certification under 42 CFR Part 484. DPH acts as the state survey agency for CMS to verify compliance with these federal Conditions of Participation.

• Licensure Regulation: Must comply with DPH Regulation 60-77 (formerly DHEC Reg 61-77).
• Application Form: Submission of DPH Form D-3289 (Licensure Application Home Health Agency) with the required fee.
• Initial On-Site Survey: DPH conducts a comprehensive inspection of the agency's office, policies, and personnel files before issuing the license.
• Medicare Certification (CMS-855A): Optional but standard; requires submitting the CMS-855A application to Palmetto GBA and passing a federal certification survey.
• Annual Renewal: State licenses are valid for a specified period and must be renewed annually with DPH.
• Branch Offices: Any secondary locations must be separately approved by DPH as branch offices or parent agencies depending on their autonomy.

5. Medicaid Provider Enrollment

After obtaining the DPH license, agencies must enroll with SCDHHS as a Medicaid provider. This is completed entirely online through the Provider Enrollment Web (PEW) portal.

Home Health Agencies are classified as institutional providers and are subject to high-risk screening criteria under the Affordable Care Act, which includes an application fee and potential site visits by SCDHHS program integrity staff.

• Enrollment Portal: Applications must be submitted via the SCDHHS Provider Enrollment Web at [https://providerservices.scdhhs.gov/ProviderEnrollmentWeb](https://providerservices.scdhhs.gov/ProviderEnrollmentWeb).
• Provider Type: Must enroll specifically under the "Home Health Agency" taxonomy and provider type.
• Application Fee: Subject to the CMS institutional provider application fee (approximately $709), unless already paid to Medicare or another state's Medicaid program.
• Waiver Program Selection: Providers must indicate if they intend to serve participants in specific HCBS waivers (e.g., Community Choices, ID/RD).
• EFT Enrollment: Mandatory enrollment in Electronic Funds Transfer for Medicaid claims payment.
• Revalidation: SCDHHS requires all enrolled Home Health Agencies to revalidate their enrollment every five years.

6. Staffing, Training and Background Checks

South Carolina mandates strict clinical hierarchies and background screening for home health personnel. All direct care staff must undergo criminal record checks through the South Carolina Law Enforcement Division (SLED) prior to patient contact.

Clinical services must be directed by a qualified professional, and all home health aides must complete a state-approved training program and pass a competency evaluation before providing hands-on care.

• Administrator Qualifications: Must be a licensed physician, RN, or hold an undergraduate degree with at least one year of supervisory experience in a health care setting.
• Clinical Director/Supervising Nurse: Must be a Registered Nurse (RN) licensed in SC with at least one year of clinical experience.
• SLED Background Checks: Mandatory state criminal record checks for all direct care staff under S.C. Code § 44-7-2910.
• Home Health Aide Training: Aides must complete a minimum 75-hour training program and competency evaluation meeting federal/state standards.
• Aide Supervision: An RN or appropriate therapist must conduct an on-site supervisory visit of the home health aide at least every 14 days.
• In-Service Training: Home health aides must receive a minimum of 12 hours of documented in-service training annually.

7. Documentation, Policies and Records

Agencies must maintain a comprehensive Policy and Procedure Manual that dictates clinical operations, emergency preparedness, and infection control. DPH surveyors will heavily scrutinize this manual during the initial and annual surveys.

Clinical records must be meticulously maintained for every patient, demonstrating that care was delivered exactly as ordered by the physician and that the patient's status is continuously monitored.

• Plan of Care (CMS-485): Must be established by a physician, signed, and reviewed at least every 60 days.
• Clinical Records Retention: Patient records must be retained for a minimum of five years following the patient's discharge.
• OASIS Data Collection: Medicare/Medicaid certified agencies must collect and transmit Outcome and Assessment Information Set (OASIS) data for adult patients.
• Service Logs: Detailed documentation of every visit, including date, time in/out, specific tasks performed, and the signature of the staff member and patient/caregiver.
• Emergency Preparedness Plan: Must have a written plan for protecting patients during natural disasters, including a priority list of vulnerable patients requiring immediate rescue.
• Infection Control Policy: Documented protocols for hand hygiene, bag technique, and handling of biohazardous waste in the home setting.

8. Billing, Rates and Claims

Medicaid claims for home health services are processed through the SCDHHS Medicaid Management Information System (MMIS). Services are reimbursed according to the published SCDHHS fee schedule, which dictates rates for nursing visits, therapy visits, and aide hours.

For dually eligible beneficiaries (Medicare and Medicaid), providers must strictly follow third-party liability rules, billing Medicare as the primary payer for skilled episodes before submitting crossover claims to Medicaid.

• Billing System: Claims are submitted electronically to the SCDHHS MMIS via clearinghouse or direct portal entry.
• Claim Format: Institutional claims must be submitted using the UB-04 format or the electronic 837I equivalent.
• Prior Authorization: Many waiver-funded home health services and extended state plan visits require prior authorization from SCDHHS or the designated waiver case management entity.
• Dual Eligibles: Medicare must be billed first for any homebound patient requiring skilled care; Medicaid acts as the payer of last resort.
• Fee Schedule: Reimbursement rates are fixed and published on the SCDHHS website under the Home Health provider manual.
• Visit Increments: Nursing and therapy are typically billed per visit, while home health aide services may be billed in 15-minute or hourly increments depending on the specific waiver.

9. Approval Sequence and Timeline

Launching a Home Health Agency in South Carolina is a multi-year process primarily delayed by the Certificate of Need phase. Providers cannot rush the timeline, as state health plan need determinations are only published periodically.

Once a CON is obtained, the licensure and Medicaid enrollment phases follow a more predictable administrative timeline, provided the agency is fully prepared for its initial DPH survey.

• CON Application and Review: 6 to 12+ months, highly dependent on the state's review cycle and potential appeals from competing agencies.
• Business Setup & Policy Creation: 1 to 2 months, completed concurrently with or immediately following CON approval.
• DPH Licensure Application & Survey: 3 to 5 months from application submission to the completion of the initial on-site inspection.
• Medicare Certification (Optional): 6 to 12 months, involving MAC application processing and a CMS state agency survey.
• SCDHHS Medicaid Enrollment: 30 to 60 days after the DPH license and NPI are active.
• Total Estimated Timeline: 12 to 24 months from the initial CON filing to billing the first Medicaid claim.

10. Common Denials and Survey Findings

The most frequent barrier to entry is a CON denial, which occurs automatically if an applicant applies in a county where the State Health Plan shows zero projected need. Without a CON, the process stops immediately.

During DPH and CMS surveys, agencies are most commonly cited for administrative and clinical documentation failures, particularly regarding physician orders and supervisory visits.

• CON Denial: Applying for a county that does not have a demonstrated statistical need in the current South Carolina State Health Plan.
• Missed Supervisory Visits: Failure of the RN to conduct and document the mandatory on-site supervision of home health aides every 14 days.
• Plan of Care Deviations: Staff providing services or altering visit frequencies without obtaining a signed physician order.
• Incomplete Background Checks: Allowing staff to begin patient care before SLED criminal record check results are fully returned and cleared.
• Infection Control Violations: Surveyors observing staff failing to perform proper hand hygiene or improper "clean bag" techniques during home visits.
• OASIS Transmission Errors: Failure to lock and transmit OASIS data to the state repository within the required 30-day timeframe.

11. Key Contacts and Resources

Prospective providers must closely monitor the websites of DPH and SCDHHS for regulatory updates, fee schedule changes, and CON methodology publications.

Utilizing the official state portals for licensure applications and Medicaid enrollment is mandatory to ensure compliance with South Carolina's specific regulatory framework.

• SC DPH Home Health Agencies Page: [https://dph.sc.gov/professionals/healthcare-quality/licensed-facilities-professionals/home-health-agencies](https://dph.sc.gov/professionals/healthcare-quality/licensed-facilities-professionals/home-health-agencies)
• SC DPH Certificate of Need Program: [https://dph.sc.gov/professionals/healthcare-quality/certificate-need](https://dph.sc.gov/professionals/healthcare-quality/certificate-need)
• SCDHHS Provider Enrollment Web (PEW): [https://providerservices.scdhhs.gov/ProviderEnrollmentWeb](https://providerservices.scdhhs.gov/ProviderEnrollmentWeb)
• SCDHHS Main Provider Portal: [https://www.scdhhs.gov/providers/become-provider](https://www.scdhhs.gov/providers/become-provider)
• SLED CATCH (Background Checks): [https://catch.sled.sc.gov/](https://catch.sled.sc.gov/)
• Palmetto GBA (Medicare MAC for SC): [https://www.palmettogba.com](https://www.palmettogba.com)

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