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

Last reviewed: 2026-09-10

The South Carolina Department of Public Health (DPH) licenses agencies providing hands-on assistance under the In-Home Care Provider license (Regulation 61-122), which serves as the mandatory prerequisite for billing South Carolina Department of Health and Human Services (SCDHHS) waivers. Providers must secure this DPH license and pass an initial state survey before submitting a Medicaid enrollment application through the SCDHHS web portal.

Personal Care Services deliver direct assistance with activities of daily living to waiver participants in their own homes. Agencies must utilize the state-mandated Electronic Visit Verification (EVV) system and ensure all aides pass State Law Enforcement Division (SLED) background checks prior to delivering care.

1. Service Definition and Scope

Personal Care Services in South Carolina provide hands-on assistance with activities of daily living (ADLs) such as bathing, dressing, transferring, and toileting. These services are authorized by SCDHHS case managers and delivered in the participant's home, excluding institutional or adult day health care settings.

The scope of service is defined by the participant's Service Plan and requires strict adherence to authorized units. Providers must ensure that care is delivered only by qualified aides who meet state competency standards.

• Service Name: Personal Care Services, which also encompasses HASCI Agency Attendant Care and Respite services.
• Scope: Assistance with ADLs and instrumental activities of daily living as specified in the participant's Service Plan.
• Location Restrictions: Services are not reimbursable when the participant is in an institutional setting, Adult Day Health Care, or Pediatric Medical Day Care.
• Family Caregiver Limits: Spouses, parents of minor participants, and legal guardians cannot be paid caregivers under the South Carolina Family Caregiver Policy.

2. Regulatory and Oversight Agencies

Two primary state agencies govern Personal Care Services in South Carolina. DPH handles facility and agency licensure, while SCDHHS manages Medicaid waiver funding, provider enrollment, and policy enforcement.

• Licensing Agency: South Carolina Department of Public Health (DPH) [In-Home Care Providers | South Carolina Department of Public Health](https://dph.sc.gov/professionals/healthcare-quality/licensed-facilities-professionals/home-care-providers).
• Medicaid Authority: South Carolina Department of Health and Human Services (SCDHHS) [Become a Provider | SCDHHS](https://www.scdhhs.gov/providers/become-provider).
• Background Checks: State Law Enforcement Division (SLED) [COMPANION (AGENCY) SERVICES](https://www.scdhhs.gov/sites/dhhs/files/documents/Companion%20Agency%20Final%20Draft%207-1-25.pdf).
• Nurse Aide Registry: South Carolina Nurse Aide Registry [Nurse Aide](https://www.scdhhs.gov/resources/programs-and-initiatives/long-term-living/nursing-facilities/nurse-aide).

3. Gatekeeping Prerequisites: Who Can Even Apply

South Carolina requires agencies to obtain an In-Home Care Provider license from DPH before applying for Medicaid enrollment. There is no Certificate of Need (CON) requirement for non-medical personal care, unlike skilled home health agencies.

• Licensure Prerequisite: Active In-Home Care Provider license under S.C. Code § 44-70-10 is required prior to Medicaid enrollment.
• Certificate of Need: Not required for In-Home Care Providers (only applies to skilled Home Health Agencies under Reg. 61-77).
• Waiver Enrollment: Open enrollment; no closed network or RFP procurement currently restricts new Personal Care Services providers.
• NPI Requirement: Agencies must obtain a National Provider Identifier (NPI) before initiating the SCDHHS application.

4. Licensure and Certification Requirements

Agencies must comply with DPH Regulation 61-122, Standards for Licensing In-Home Care Providers. This involves submitting an application, passing an initial survey, and renewing the license annually.

• Regulation: Regulation 61-122 (proposed to be renumbered R. 60-122 in 2025).
• Application Form: DPH Application for Licensure.
• Survey: DPH conducts initial and routine licensure inspections and complaint investigations.
• Renewal: Providers must renew their In-Home Care provider license annually to avoid Medicaid termination.

5. Medicaid Provider Enrollment

Enrollment is processed through the SCDHHS Provider Enrollment Web portal. Applicants receive a Reference ID# to track their in-process application, which must be completed within 30 days.

• Portal: SCDHHS Provider Enrollment Web [Become a Provider | SCDHHS](https://www.scdhhs.gov/providers/become-provider).
• Application Timeline: In-process applications are purged after 30 days if not submitted.
• Documentation: Supporting documents must be faxed to Provider Enrollment at 803-870-9022 with the Reference ID#.
• Agreements: Providers must electronically sign the participation agreement, Electronic Funds Transfer Agreement, W-9, and Trading Partner Agreement.

6. Staffing, Training and Background Checks

SCDHHS mandates strict background and competency checks for all direct care and administrative staff. Aides must be capable of following care plans and using the state's EVV system.

• Criminal Background: SLED check required prior to hire and every two years for all direct care and administrative staff.
• Registry Checks: CNA registry check and OIG report required for employee files.
• Aide Qualifications: Must be able to read, write, communicate effectively, and use the EVV system.
• Nurse Supervision: Provider must verify and maintain active nurse licensure for supervising nurses via the LLR website.

7. Documentation, Policies and Records

Providers must maintain comprehensive personnel and participant records. SCDHHS requires specific forms and validations to be kept on file for auditing purposes.

• Personnel Files: Must include application/resume, SLED checks, CNA registry check, OIG report, and SCDHHS competency evaluation.
• Medical Clearances: PPD testing documentation must be maintained as applicable.
• Driving Records: Valid driver's license and driving record required if the aide transports participants.
• Service Authorizations: Services provided without a current, valid authorization from the case manager are not reimbursable.

8. Billing, Rates and Claims

Reimbursement for Personal Care Services is tied to authorized units in the participant's Service Plan. Agencies must use the state-mandated EVV system to document service delivery.

• System Requirement: Agencies must utilize the automated systems mandated by SCDHHS (EVV) to document and bill for services.
• Unit Authorization: The number of units is dependent upon the individual participant's needs as set forth in the Service Plan/Authorization.
• Non-Reimbursable Time: The amount of authorized time does not include provider transportation time to and from the participant.
• Multiple Aides: If a participant requires more than one aide for lifting/transfers, it must be prior approved by SCDHHS.

9. Approval Sequence and Timeline

The process begins with business setup and DPH licensure, followed by Medicaid enrollment. The entire sequence can take several months from initial application to final Medicaid approval.

• Phase 1: Business setup and policy creation (approximately 1-2 months).
• Phase 2: DPH licensure process, including application and initial survey (approximately 3-5 months).
• Phase 3: SCDHHS Medicaid online enrollment application submission.
• Phase 4: Official notification of Medicaid enrollment and issuance of provider number.

10. Common Denials and Survey Findings

Applications and surveys frequently face issues due to incomplete background checks or failure to maintain active licensure. DPH and SCDHHS strictly enforce these baseline requirements.

• Background Check Gaps: Failure to complete SLED checks prior to hire or missing the two-year renewal requirement.
• Lapsed Licensure: Providers who do not maintain their annual DPH In-Home Care provider license face Medicaid termination.
• Incomplete Applications: SCDHHS web applications purged after 30 days of inactivity.
• Unapproved Training: Using training programs not on the SCDHHS prior approved list without submitting them 45 days in advance.

11. Key Contacts and Resources

Providers should utilize official state portals and contact numbers for licensure and enrollment inquiries.

• DPH Home Care Providers: [In-Home Care Providers | South Carolina Department of Public Health](https://dph.sc.gov/professionals/healthcare-quality/licensed-facilities-professionals/home-care-providers).
• SCDHHS Provider Enrollment: [Become a Provider | SCDHHS](https://www.scdhhs.gov/providers/become-provider) or call (888) 289-0709.
• SCDHHS Provider Enrollment Fax: 803-870-9022 for supporting documentation.
• SC Nurse Aide Registry: Email [email protected] or call (888) 549-0820 [Nurse Aide](https://www.scdhhs.gov/resources/programs-and-initiatives/long-term-living/nursing-facilities/nurse-aide).

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