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

Last reviewed: 2026-08-16

In South Carolina, Personal Assistance Services—providing hands-on help with activities of daily living (ADLs) such as bathing, dressing, and transferring—are primarily delivered through the state's Medicaid Home and Community-Based Services (HCBS) waivers, most notably the Community Choices Waiver. These services are regulated as non-medical home care and require providers to meet strict state licensing and Medicaid enrollment standards to operate and bill for services.

The single biggest structural barrier to entry for a new provider in South Carolina is the sequential licensure prerequisite: an applicant cannot even begin the South Carolina Department of Health and Human Services (SCDHHS) Medicaid enrollment process until they have fully secured an In-Home Care Provider License from the South Carolina Department of Public Health (SC DPH). While South Carolina favorably does not require a Certificate of Need (CON) for this service, the initial DPH licensure process requires a comprehensive operational readiness review, including the submission and approval of extensive policy and procedure manuals.

1. Service Definition and Scope

Personal Assistance Services in South Carolina are defined as in-home care services that assist Medicaid waiver participants with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). These services are designed to help seniors and adults with disabilities who meet a nursing facility level of care remain safely in their own homes or community settings.

Under the Community Choices Waiver administered by Community Long Term Care (CLTC), these services are strictly non-medical. Providers are authorized to offer hands-on personal care, but they are prohibited from performing skilled nursing tasks unless they are separately licensed as a Home Health Agency.

• Service Name: Personal Care Services / Attendant Care Services
• Primary Waiver: Community Choices Waiver (1915(c) HCBS Waiver)
• Target Population: Seniors and adults with physical disabilities requiring nursing facility level of care
• Covered ADL Tasks: Hands-on assistance with bathing, dressing, transferring, toileting, and ambulation
• Covered IADL Tasks: Light housekeeping, meal preparation, and essential errands when incidental to personal care
• Service Setting: The participant's private residence or approved community setting
• Exclusions: Skilled nursing tasks, medication administration (beyond basic reminders), and sterile wound care

2. Regulatory and Oversight Agencies

The oversight of Personal Assistance Services in South Carolina is divided between the state's public health department, which handles facility and agency licensing, and the state's Medicaid agency, which handles provider enrollment, waiver administration, and claims.

Providers must maintain compliance with both entities simultaneously, as well as any Managed Care Organizations (MCOs) they contract with under the Healthy Connections Medicaid program.

• Licensing Agency: South Carolina Department of Public Health (SC DPH) Bureau of Health Facilities Licensing (https://dph.sc.gov)
• Medicaid Authority: South Carolina Department of Health and Human Services (SCDHHS) (https://www.scdhhs.gov)
• Waiver Administrator: SCDHHS Community Long Term Care (CLTC) (https://www.scdhhs.gov)
• Medicaid Enrollment Portal: SCDHHS Provider Enrollment Web Portal (https://providerservices.scdhhs.gov)
• Background Check Authority: South Carolina State Law Enforcement Division (SLED) (https://www.sled.sc.gov)

3. Gatekeeping Prerequisites: Who Can Even Apply

South Carolina operates an open-market system for non-medical In-Home Care Providers, meaning there are no closed networks, moratoria, or competitive Request for Proposal (RFP) procurements required to become a basic Medicaid provider. Furthermore, South Carolina explicitly does not require a Certificate of Need (CON) for In-Home Care Providers.

However, a strict sequential prerequisite exists: SCDHHS will not accept or process a Medicaid provider enrollment application until the agency has already been fully licensed by SC DPH. Additionally, to serve the majority of Medicaid beneficiaries, providers must secure credentialing and contracts with Healthy Connections managed care plans after state enrollment.

• Certificate of Need (CON): Not required in South Carolina for non-medical In-Home Care Providers
• Licensure Prerequisite: Must possess an active In-Home Care Provider License from SC DPH before SCDHHS Medicaid enrollment can begin
• Network Status: Open enrollment at the state level; no RFP or closed network moratorium blocks initial application
• Managed Care Contracting: Required to serve members enrolled in Healthy Connections Prime or Medicaid MCOs; requires separate credentialing approval
• Business Registration: Must be registered and in good standing with the South Carolina Secretary of State prior to DPH licensure

4. Licensure and Certification Requirements

To legally provide hands-on personal care in South Carolina, an agency must obtain an In-Home Care Provider License from the SC DPH Bureau of Health Facilities Licensing. This process is governed by S.C. Code Regs. 61-122 (formerly 60-122).

The licensure process requires the submission of a detailed application, a licensing fee, and a comprehensive review of the agency's operational policies, procedures, and administrative structure to ensure compliance with state health and safety standards.

• Regulatory Citation: S.C. Code Regs. 61-122 (Standards for Licensing In-Home Care Providers)
• Application Form: SC DPH Application for Licensure as an In-Home Care Provider
• Policy Manual Requirement: Must submit comprehensive policies covering client rights, infection control, emergency preparedness, and caregiver supervision
• Administrator Requirement: Must designate a qualified administrator responsible for day-to-day operations and regulatory compliance
• Insurance Requirements: Must maintain general liability, professional malpractice, and workers' compensation insurance
• Physical Office: Must maintain a physical business office in South Carolina where records are securely stored

5. Medicaid Provider Enrollment

Once the SC DPH license is secured, the agency must enroll as a Medicaid provider through the SCDHHS Provider Enrollment Web Portal. This process links the agency's National Provider Identifier (NPI) and state license to the state's Medicaid Management Information System (MMIS).

Providers must select the exact enrollment type and taxonomy code that matches their HCBS waiver services. Incorrect selections at this stage are the most common cause of application denial and require the provider to restart the process.

• Enrollment System: SCDHHS Provider Enrollment Web Portal (https://providerservices.scdhhs.gov)
• Required Identifiers: Type 2 (Organizational) National Provider Identifier (NPI) and Federal Employer Identification Number (EIN)
• Taxonomy Code: Must select the appropriate non-medical home care/personal care taxonomy code during CAQH and SCDHHS setup
• Screening Risk Level: Subject to categorical risk screening, which may include site visits and ownership disclosures
• Application Fee: Subject to the federal ACA institutional provider application fee unless a waiver or exemption applies
• Credentialing System: Must maintain an updated CAQH ProView profile for subsequent MCO credentialing

6. Staffing, Training and Background Checks

South Carolina requires all direct care staff (Personal Care Aides/In-Home Care Aides) to undergo strict background screening and competency evaluations before providing hands-on care. Unlike Medicare-certified Home Health Aides, non-medical aides do not have a strict 75-hour federal training mandate, but they must meet the competency standards outlined in SC DPH Reg. 61-122.

Agencies are responsible for verifying that caregivers can safely perform ADL tasks, understand infection control, and know how to report abuse or neglect.

• Criminal Background Checks: State Law Enforcement Division (SLED) criminal record checks required for all owners, administrators, and direct care staff
• Health Screening: Tuberculosis (TB) screening required for all staff providing direct in-home care prior to client contact
• Caregiver Competency: Must pass a documented competency evaluation covering ADL assistance, safe transfers, and client rights
• Orientation Training: Mandatory training on HIPAA, emergency procedures, and infection control before first assignment
• Supervision: Routine supervisory visits by a qualified supervisor to assess caregiver performance and client satisfaction
• Registry Checks: Must verify staff against the South Carolina Direct Care Caregiver Registry and federal OIG exclusion lists

7. Documentation, Policies and Records

Both SC DPH and SCDHHS require meticulous record-keeping to justify billed services and ensure client safety. Agencies must maintain distinct files for personnel, clients, and administrative operations.

Service logs must clearly document the specific tasks performed, the date, the start and end times of the visit, and the signatures of both the caregiver and the client (or their representative).

• Service Plan: An individualized plan of care detailing required ADL tasks, frequency, and duration, aligned with the CLTC authorization
• Service Logs: Daily documentation of time in/out, specific tasks completed, and caregiver/client signatures
• Personnel Files: Must contain SLED background checks, TB test results, competency checklists, and annual performance reviews
• Incident Reporting: Documented policies for reporting critical incidents, abuse, neglect, or exploitation to SCDHHS and SC DPH
• Record Retention: Client and billing records must be securely retained for a minimum of five years post-discharge
• HIPAA Compliance: Secure physical and electronic storage protocols to protect Protected Health Information (PHI)

8. Billing, Rates and Claims

Personal Assistance Services are billed either directly to SCDHHS for fee-for-service waiver participants or to the respective Healthy Connections MCO for managed care members. All services must be prior-authorized by a CLTC case manager.

Providers bill using standard HCPCS codes in 15-minute increments. Claims lacking a matching prior authorization in the MMIS or MCO portal will be automatically denied.

• Billing System (FFS): SCDHHS Web Tool / MMIS for traditional fee-for-service Medicaid claims
• Billing System (MCO): Respective clearinghouses or portals for Healthy Connections managed care plans
• Prior Authorization: Mandatory; services must be explicitly authorized on the participant's CLTC service plan before delivery
• Unit of Service: Typically billed in 15-minute increments using specific HCBS HCPCS codes (e.g., T1019)
• Electronic Visit Verification (EVV): Required for personal care services to electronically capture visit start/end times and location
• Claim Timeliness: Claims must generally be submitted within 365 days of the date of service to avoid timely filing denials

9. Approval Sequence and Timeline

Becoming a fully operational and billing Medicaid Personal Assistance provider in South Carolina is a multi-phase process that typically takes 6 to 9 months from business formation to MCO credentialing.

Because the steps are strictly sequential, delays in the SC DPH licensure phase will push back the entire Medicaid enrollment and MCO contracting timeline.

• Phase 1: Business entity formation, EIN, NPI, and Secretary of State registration (1-2 weeks)
• Phase 2: SC DPH In-Home Care Provider licensure application, policy review, and approval (1-3 months)
• Phase 3: SCDHHS Medicaid provider enrollment via the web portal (30-60 days)
• Phase 4: CAQH ProView setup and primary source verification (2-4 weeks)
• Phase 5: Healthy Connections MCO credentialing and network contracting (60-120 days)

10. Common Denials and Survey Findings

Applications and routine surveys frequently fail due to administrative oversights rather than clinical deficiencies. SC DPH surveyors heavily scrutinize personnel files for missing background checks and health screenings.

On the Medicaid enrollment side, selecting the wrong provider type or failing to respond to SCDHHS requests for additional information within the allotted timeframe will result in an automatic application denial.

• Enrollment Denial: Selecting an incorrect provider type or taxonomy code in the SCDHHS portal
• Licensure Delay: Submitting generic, non-state-specific policy manuals to SC DPH that fail to cite Reg. 61-122
• Survey Deficiency: Missing, incomplete, or expired SLED background checks in caregiver personnel files
• Survey Deficiency: Failure to document mandatory TB screenings prior to a caregiver's first client contact
• Claim Denial: Billing for services without an active CLTC prior authorization on file
• Claim Denial: Failure to properly utilize the state-mandated Electronic Visit Verification (EVV) system

11. Key Contacts and Resources

Prospective providers should rely on the official state portals for the most current regulations, fee schedules, and application materials. The SC DPH and SCDHHS websites are the primary hubs for compliance.

Providers should also familiarize themselves with the specific credentialing portals for the Healthy Connections MCOs operating in their target counties.

• SC DPH Bureau of Health Facilities Licensing: https://dph.sc.gov
• SCDHHS Provider Enrollment Portal: https://providerservices.scdhhs.gov
• SCDHHS Main Website: https://www.scdhhs.gov
• South Carolina Secretary of State: https://sos.sc.gov
• South Carolina State Law Enforcement Division (SLED): https://www.sled.sc.gov
• CAQH ProView (for MCO Credentialing): https://proview.caqh.org

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