Virginia - Homemaker Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

Virginia does not cover or license a standalone Homemaker Service under its Medicaid Home and Community-Based Services (HCBS) waivers; instead, general household support tasks like meal preparation, laundry, and light housekeeping are bundled into Personal Assistance Services under the Commonwealth Coordinated Care (CCC) Plus Waiver or In-Home Support Services under the Developmental Disabilities (DD) Waivers. Providers seeking to bill for these household support tasks must first obtain either a Home Care Organization (HCO) license from the Virginia Department of Health (VDH) or a Supportive In-Home Service license from the Department of Behavioral Health and Developmental Services (DBHDS) before submitting an enrollment application.

To deliver these bundled services, an applicant must secure the underlying VDH or DBHDS license, which requires a physical office location in Virginia and an approved human rights or policies and procedures manual, before the Department of Medical Assistance Services (DMAS) will accept a Medicaid enrollment application through the Provider Registration and Servicing System (PRSS).

1. Service Definition and Scope

Because Virginia does not utilize a distinct Homemaker Service category, household support tasks are authorized as components of Personal Assistance Services or In-Home Support Services. These services supplement the primary care provided by the individual, family, or other unpaid caregiver and are designed to ensure the health, safety, and welfare of the individual.

Under 12VAC30-122-410, In-Home Support Services include skill-building and the provision of supports that enable an individual to acquire, retain, or improve self-help, socialization, and adaptive skills required for successfully living in their community, which encompasses routine household maintenance.

• Covered Tasks: Meal preparation, laundry, shopping, and light housekeeping when the individual cannot perform them independently.
• Service Bundling: Homemaker tasks cannot be billed separately; they are integrated into the hourly rate for Personal Assistance or In-Home Support.
• Waiver Authority: Funded primarily through the CCC Plus Waiver and the Family and Individual Supports (FIS) and Community Living (CL) DD Waivers.
• Setting Limitations: Services must take place in the individual's own home, family home, or community settings.
• Exclusions: Cannot be provided simultaneously with respite services on the same dates and times for the same individual.

2. Regulatory and Oversight Agencies

Multiple state agencies share oversight of the services that encompass homemaker tasks. The Virginia Department of Health (VDH) and the Department of Behavioral Health and Developmental Services (DBHDS) handle provider licensure, depending on the target population.

The Department of Medical Assistance Services (DMAS) manages Medicaid enrollment, policy, and reimbursement, often operating through managed care organizations (MCOs) for the CCC Plus waiver.

• Virginia Department of Health (VDH): Licenses Home Care Organizations (HCO) providing personal care services (https://www.vdh.virginia.gov/licensure-and-certification/).
• Department of Behavioral Health and Developmental Services (DBHDS): Licenses Supportive In-Home Services for the DD population (https://dbhds.virginia.gov/quality-management/Office-of-Licensing/).
• Department of Medical Assistance Services (DMAS): Administers the Medicaid program and oversees waiver compliance (https://www.dmas.virginia.gov/).
• Medicaid Enterprise System (MES): The portal for provider enrollment via the Provider Registration and Servicing System (PRSS) (https://vamedicaid.dmas.virginia.gov/provider).
• Managed Care Organizations (MCOs): Contracted entities under CCC Plus that credential providers and authorize care (e.g., Anthem, Sentara Health Plans).

3. Gatekeeping Prerequisites: Who Can Even Apply

Virginia requires providers to hold an active state license before they can apply for Medicaid enrollment to provide personal assistance or in-home supports. There is no standalone Medicaid enrollment for homemaker services without this licensure.

Applicants must establish a physical business location and pass an initial licensing review, which includes policy approvals and background check clearances, before DMAS will process a PRSS application.

• Licensure Prerequisite: Must hold a VDH HCO license or a DBHDS Supportive In-Home Service license prior to Medicaid enrollment.
• Physical Location: DBHDS and VDH require a physical office location within the Commonwealth of Virginia to maintain records and host surveys.
• DBHDS Initial Application Phase: Requires submission of a comprehensive policy manual and approval of a Human Rights compliance verification before a conditional license is issued.
• MCO Network Access: For CCC Plus, providers must successfully credential and contract with regional MCOs after DMAS enrollment; MCOs may have closed networks in certain regions.

4. Licensure and Certification Requirements

Providers must navigate either the VDH or DBHDS licensure pathways. VDH licenses Home Care Organizations under 12VAC5-381, while DBHDS licenses providers of community services under 12VAC35-105.

Both pathways require extensive documentation, including organizational charts, financial projections, and customized policy manuals that align with Virginia administrative code.

• VDH HCO License: Requires submission of an initial application, a $500 fee, and a successful pre-occupancy survey.
• DBHDS Supportive In-Home License: Requires a multi-step process including a preliminary application, policy review, and an on-site inspection.
• Administrator Qualifications: VDH requires the HCO administrator to have at least one year of supervisory or management experience in healthcare.
• Financial Solvency: DBHDS requires a working capital business plan demonstrating the ability to operate for at least 90 days without revenue.
• Accreditation Alternative: VDH may grant deemed status to agencies accredited by CHAP, ACHC, or The Joint Commission.

5. Medicaid Provider Enrollment

Once licensed, providers must enroll with DMAS through the MES PRSS portal. Enrollment requires linking the state license to the specific Medicaid provider type and specialty codes.

Providers must also sign a participation agreement with DMAS, agreeing to comply with all waiver regulations and billing guidelines.

• Enrollment Portal: Applications must be submitted electronically through the MES PRSS portal.
• Provider Type: Typically enrolled as Provider Type 88 (Personal Care) or the specific DD waiver provider type for In-Home Supports.
• Application Fee: Subject to the CMS institutional provider application fee (currently $731 for 2024) unless waived by Medicare enrollment.
• Required Documents: Must upload the VDH or DBHDS license, W-9, and NPI verification during the PRSS application.
• Revalidation: Providers must revalidate their Medicaid enrollment every five years through the PRSS portal.

6. Staffing, Training and Background Checks

Direct support professionals (DSPs) and personal care aides (PCAs) performing household tasks must meet strict training and background check requirements. Virginia mandates screening against barrier crimes and federal exclusion lists.

Agencies must maintain documented proof of competency and ongoing training for all staff delivering in-home services.

• Criminal Background Checks: Required for barrier crimes in accordance with Sections 37.2-416, 37.2-506, and 37.2-607 of the Code of Virginia.
• Federal Exclusion Screening: Providers must screen all employees monthly against the HHS OIG List of Excluded Individuals and Entities (LEIE).
• PCA Qualifications: Must complete a 40-hour state-approved training program or hold a current CNA certification.
• DSP Training: DBHDS requires completion of the DSP Orientation Manual and passing the associated test within 30 days of hire.
• Supervisor Requirements: RNs or qualified developmental disability professionals (QDDPs) must conduct regular supervisory visits (typically every 30-90 days depending on the waiver).

7. Documentation, Policies and Records

Virginia regulations (12VAC30-120-930 and 12VAC30-122-120) require providers to maintain comprehensive business and professional records. Documentation must support all claims submitted for DMAS reimbursement.

Providers must use DMAS-designated forms for service documentation unless prior written approval is granted to use alternative electronic health record formats.

• Record Retention: Records must be retained for at least six years from the last date of service.
• Service Logs: Must maintain an attendance log indicating the date, type of service rendered, number of hours, and specific timeframes.
• Original Signatures: All documents must have original notes, dates, and signatures; copied or re-dated forms are prohibited.
• Plan for Supports: Must maintain a current, individualized plan for supports detailing the specific household tasks required.
• Incident Reporting: DBHDS-licensed providers must report serious incidents through the CHRIS system within 24 hours.

8. Billing, Rates and Claims

Because homemaker tasks are bundled, providers bill the standard Personal Assistance or In-Home Support procedure codes. Claims are submitted either directly to DMAS via MES or to the respective MCO.

Rates are established by the Virginia General Assembly and published in the DMAS fee schedules. Providers must accept the Medicaid rate as payment in full.

• Procedure Codes: Typically billed using T1019 for Personal Care or H2014 for In-Home Support Services.
• Unit Measurement: Services are generally billed in 15-minute increments or hourly units, depending on the specific waiver code.
• Electronic Visit Verification (EVV): Virginia requires EVV for all personal care and in-home support services to capture the start and end times of shifts.
• Claim Submission: Fee-for-service claims go through MES; managed care claims must be submitted to the specific MCO's clearinghouse.
• Usual and Customary Charges: Claims submitted to DMAS must not exceed the provider's usual and customary charges to the general public.

9. Approval Sequence and Timeline

The pathway to becoming a billing provider involves sequential approvals: entity formation, state licensure, Medicaid enrollment, and MCO credentialing. Skipping steps will result in application rejection.

The entire process from initial policy drafting to active MCO contracts typically takes 6 to 12 months, heavily dependent on state agency survey queues.

• Step 1: Entity formation and obtaining an NPI and EIN (1-2 weeks).
• Step 2: Submission of VDH or DBHDS licensure application and policy manuals (3-6 months for review and initial survey).
• Step 3: DMAS Medicaid Enrollment via PRSS (30-60 days after license issuance).
• Step 4: MCO Credentialing and Contracting for CCC Plus (90-120 days post-Medicaid enrollment).
• Step 5: EVV system integration and testing prior to billing the first claim.

10. Common Denials and Survey Findings

Applications and claims are frequently denied due to administrative errors, incomplete background checks, or failure to adhere to EVV mandates. State surveyors heavily scrutinize staff training records.

During licensure surveys, failure to demonstrate a working knowledge of Virginia's human rights regulations or HCBS settings rules often leads to corrective action plans.

• EVV Non-Compliance: Claims denied because the EVV system did not capture the required six data points (who, what, when, where, etc.).
• Background Check Gaps: Citations for allowing staff to provide care before barrier crime results are fully returned and cleared.
• Documentation Lapses: Recoupment of funds by DMAS due to missing signatures or overlapping service times (e.g., billing respite and in-home supports simultaneously).
• Policy Deficiencies: DBHDS application rejection due to generic policy manuals that do not specifically cite Virginia Administrative Code.
• LEIE Screening Failures: Citations for failing to conduct and document the required monthly OIG exclusion checks for all staff.

11. Key Contacts and Resources

Providers must utilize official state portals and resources for accurate, up-to-date information regarding licensure, enrollment, and billing guidelines.

Maintaining contact with the respective licensing specialists and MCO provider representatives is critical for ongoing compliance.

• Virginia Medicaid Enterprise System (MES): https://vamedicaid.dmas.virginia.gov/provider
• DBHDS Office of Licensing: https://dbhds.virginia.gov/quality-management/Office-of-Licensing/
• VDH Office of Licensure and Certification: https://www.vdh.virginia.gov/licensure-and-certification/
• Virginia Town Hall (Regulations): https://townhall.virginia.gov/
• DMAS Provider Manuals: Accessible via the MES portal for specific waiver guidelines and billing instructions.

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