These videos give an overview of the various Home and Community-Based Services (HCBS) available in Pennsylvania for providers who want to learn how to start or operate an HCBS agency in the state. Each video explains the purpose of the service, provider requirements, licensing process, and how the program functions. Use these videos to better understand the responsibilities, standards, and steps involved in becoming or working with approved HCBS providers in Pennsylvania. Explore each section to find the service that best matches your goals or area of interest.
Respite Care
RESPITE CARE SERVICES PROVIDER IN PENNSYLVANIA
OFFERING TEMPORARY RELIEF FOR CAREGIVERS WHILE ENSURING SAFE, COMPASSIONATE SUPPORT FOR INDIVIDUALS WITH DISABILITIES AND CHRONIC CONDITIONS
Respite Care Services in Pennsylvania are Medicaid-funded supports that provide short-term, temporary care for individuals with disabilities or complex health needs so their primary caregivers can rest, attend to personal matters, or prevent burnout. Respite may occur in the individual’s home, a provider-operated facility, or a community-based setting. These services are covered under the state’s Home and Community-Based Services (HCBS) waivers through the Office of Developmental Programs (ODP) and the Office of Long-Term Living (OLTL).
1. GOVERNING AGENCIES
Agency: Pennsylvania Department of Human Services (DHS) – Office of Developmental Programs (ODP)
Role: Manages respite services under the Consolidated, Community Living, and P/FDS waivers for individuals with intellectual/developmental disabilities (IDD).
Agency: DHS – Office of Long-Term Living (OLTL)
Role: Oversees respite care for older adults and individuals with physical disabilities via Aging and Independence Waivers.
Agency: Community HealthChoices (CHC) Managed Care Organizations (MCOs)
Role: Authorize and reimburse respite services for CHC participants.
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal regulation and funding oversight under 1915(c) waiver authority.
Agency: Pennsylvania Department of State
Role: Registers provider businesses operating in Pennsylvania.
2. RESPITE CARE SERVICES OVERVIEW
Respite care offers temporary coverage for primary caregivers and is tailored to the individual’s care plan and safety needs.
Approved providers may deliver:
Planned Respite: Scheduled short-term care based on caregiver needs (e.g., weekly breaks).
Emergency Respite: Unplanned or urgent coverage due to caregiver illness, crisis, or absence.
In-Home Respite: Delivered at the individual’s home with trained staff or aides.
Out-of-Home Respite: Provided at a licensed community residence, camp, or host home.
Overnight, Hourly, or Day-Based Models: Based on the individual's ISP or service plan.
Documentation: Daily logs, shift reports, and Medicaid billing records.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your business with the Pennsylvania Department of State.
Obtain an EIN from the IRS and a Type 2 NPI.
Enroll in the PROMISe™ system as a Medicaid respite provider.
If operating a facility, obtain Residential Habilitation or Respite Licensure (via ODP or DOH).
Contract with MCOs (if serving CHC participants) and get approved through your Administrative Entity (AE) or County MH/ID program.
Develop a Respite Care Services Policy & Procedure Manual per ODP/OLTL standards.
4. PENNSYLVANIA PROVIDER ENROLLMENT PROCESS
Step 1: Register your entity, secure EIN/NPI, and insurance policies.
Step 2: Apply for provider qualification through HCSIS (ODP) or MCO contract (OLTL/CHC).
Step 3: Complete PROMISe™ Medicaid enrollment.
Step 4: Submit your policy manual, staff credentials, and background checks.
Step 5: Receive approval and begin coordinating with SCs or MCOs for referrals.
5. REQUIRED DOCUMENTATION
Business registration and Articles of Incorporation
EIN and NPI confirmations
Licensure (if providing out-of-home care)
Insurance certificates (liability, workers’ comp)
Respite Services Policy & Procedure Manual including:
Intake and caregiver coordination forms
Supervision and safety protocols
Staffing ratios and training policies
HIPAA compliance and client rights
Incident reporting and risk mitigation
Service documentation templates
Medicaid billing and encounter logs
6. STAFFING REQUIREMENTS
Role: Respite Aide / Direct Support Professional (DSP)
Requirements: Background check, CPR/First Aid, state-mandated training for the specific waiver population.
Role: Program Supervisor
Requirements: Oversees care quality, client documentation, and scheduling; may require supervisory training.
Role: Nurse / Behavioral Support (optional)
Requirements: Required only for high-acuity clients; must be licensed in PA.
All staff must complete:
Mandatory reporter and abuse prevention training
HIPAA and person-centered care modules
Emergency procedures and behavior support training
Annual skills review and service documentation training
7. MEDICAID WAIVER PROGRAMS
Respite Care is funded through:
ODP Waivers:
Consolidated Waiver – Includes 24/7 out-of-home and in-home respite
Community Living Waiver – For individuals living with family
P/FDS Waiver – Subject to individual spending limits
OLTL Waivers:
Aging Waiver – For seniors requiring intermittent caregiver relief
Independence & OBRA Waivers – For adults with physical disabilities
Community HealthChoices (CHC):
Managed respite authorizations for Medicaid/Medicare dual-eligibles
8. TIMELINE TO LAUNCH
Phase: Business Registration & Policy Manual Creation
Timeline: 1–2 months
Phase: Medicaid Enrollment & MCO/ODP Qualification
Timeline: 2–3 months
Phase: Staff Hiring, Credentialing & Training
Timeline: 30–60 days
Phase: Referral Activation & Service Launch
Timeline: Begins once service authorization and documentation system are in place
9. CONTACT INFORMATION
PA DHS – Office of Developmental Programs (ODP)
Website: https://www.myodp.org
PA DHS – Office of Long-Term Living (OLTL)
Website: https://www.dhs.pa.gov
PROMISe™ Medicaid Provider Portal
Website: https://promise.dpw.state.pa.us
Community HealthChoices MCOs:
UPMC CHC – https://www.upmchealthplan.com
PA Health & Wellness – https://www.pahealthwellness.com
Keystone First CHC – https://www.keystonefirstchc.com
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — PENNSYLVANIA RESPITE CARE PROVIDER
WCG supports new Respite Care providers in Pennsylvania with tools and training to offer safe, reliable services that support both families and individuals.
Scope of Work:
Business formation, Medicaid enrollment, and waiver alignment
Respite Care Policy Manual and caregiver coordination tools
Staff hiring templates, training logs, and credential checklists
Service documentation forms and billing templates
Risk management plans and incident tracking tools
Referral network development with case managers and MCOs
Licensing (if applicable) and inspection readiness
Residential Care
RESIDENTIAL SUPPORT SERVICES PROVIDER IN PENNSYLVANIA
PROVIDING PERSON-CENTERED HOUSING SUPPORTS TO PROMOTE INDEPENDENCE, STABILITY, AND COMMUNITY INCLUSION
Residential Support Services in Pennsylvania are Medicaid-funded programs that offer 24/7 or intermittent supervision and assistance for individuals with intellectual or developmental disabilities (IDD). These services help individuals live safely in community-based settings while receiving the daily supports they need to develop life skills, maintain health, and participate meaningfully in society. Residential supports are funded under the Consolidated and Community Living Waivers through the Office of Developmental Programs (ODP).
1. GOVERNING AGENCIES
Agency: Pennsylvania Department of Human Services (DHS) – Office of Developmental Programs (ODP)
Role: Certifies, funds, and monitors residential service providers for individuals with IDD.
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal regulation and oversight of Medicaid waiver services, including residential options.
Agency: Administrative Entities (AEs) / County MH/ID Offices
Role: Coordinate local provider qualification, service authorizations, and quality monitoring.
Agency: Pennsylvania Department of State
Role: Handles legal business registration for residential service providers.
2. RESIDENTIAL SUPPORT SERVICES OVERVIEW
Residential support includes individualized services delivered in certified homes to help people live with dignity, autonomy, and access to community life.
Approved providers may deliver:
Community Homes (licensed): 24/7 support in small group homes for 1–4 individuals.
Life Sharing (unlicensed): Individuals live with host families and receive supports in a shared environment.
Supported Living (unlicensed): Support for individuals living in their own apartment or home.
Daily Living Support: Assistance with cooking, hygiene, laundry, medication, and household management.
Community Participation Support: Outings, recreational activities, and social engagement.
Health and Safety Monitoring: Oversight to ensure medical, behavioral, and nutritional needs are met.
Documentation: Shift notes, ISP tracking, medication logs, and Medicaid billing records.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your business with the Pennsylvania Department of State.
Obtain an EIN and Type 2 NPI.
Qualify as a provider through the ODP’s Home and Community Services Information System (HCSIS).
Obtain Chapter 6400 licensure from ODP (for licensed community homes).
Meet Life Sharing or Supported Living guidelines (for unlicensed options).
Maintain liability and workers’ compensation insurance.
Develop a Residential Services Policy & Procedure Manual based on ODP and CMS standards.
4. PENNSYLVANIA PROVIDER ENROLLMENT PROCESS
Step 1: Register your business and acquire EIN, NPI, and insurance.
Step 2: Apply for provider qualification through HCSIS and complete all required documents.
Step 3: If offering licensed homes, complete the Chapter 6400 facility licensing application.
Step 4: Complete fire safety, environmental inspection, and staff clearances.
Step 5: Receive approval and begin receiving referrals through County MH/ID and Supports Coordinators.
5. REQUIRED DOCUMENTATION
Articles of Incorporation and business registration
EIN and NPI confirmations
Chapter 6400 license (if operating a licensed community home)
Insurance certificates
Residential Support Services Policy & Procedure Manual including:
Individual Support Plan (ISP) implementation procedures
Medication administration and incident reporting
Staff supervision and ratio standards
Participant rights, grievances, and confidentiality safeguards
Safety drills and emergency preparedness protocols
Daily documentation templates and shift notes
Billing forms and audit readiness tools
6. STAFFING REQUIREMENTS
Role: Direct Support Professional (DSP)
Requirements: Background checks, orientation training, First Aid/CPR, and ODP-mandated competencies.
Role: Residential Program Supervisor
Requirements: Oversees compliance, staff scheduling, documentation, and resident well-being.
Role: Medication Administrator (optional)
Requirements: Completed Medication Administration Training (ODP-certified).
All staff must complete:
ODP-approved orientation and annual refresher training
Person-centered planning and ISP implementation
Abuse prevention and incident management
HIPAA and documentation compliance training
Emergency response and behavior support (if applicable)
7. MEDICAID WAIVER PROGRAMS
Residential support is funded through:
Consolidated Waiver (ODP):
Community Homes (licensed)
Life Sharing
Supported Living
Community Living Waiver (ODP):
Supports individuals in shared or individual residences without 24-hour residential services
Note: The Person/Family Directed Support (P/FDS) Waiver does not cover residential services.
8. TIMELINE TO LAUNCH
Phase: Business Registration & Policy Manual Creation
Timeline: 1–2 months
Phase: ODP Qualification & Licensure (if required)
Timeline: 3–4 months
Phase: Staff Hiring, Credentialing & Training
Timeline: 30–60 days
Phase: Referral Coordination & Home Activation
Timeline: Begins once licensing is approved and ISP authorizations are received
9. CONTACT INFORMATION
PA DHS – Office of Developmental Programs (ODP)
Website: https://www.myodp.org
PA HCSIS Provider Portal
Website: https://www.hcsis.state.pa.us
Chapter 6400 Licensing & Guidance
Website: https://www.dhs.pa.gov/providers
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
PA Department of State – Business Services
Website: https://www.dos.pa.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — PENNSYLVANIA RESIDENTIAL SUPPORT PROVIDER
WCG supports providers with everything needed to launch successful, compliant residential programs that prioritize person-centered living in Pennsylvania.
Scope of Work:
Business formation, Medicaid enrollment, and ODP provider qualification
Chapter 6400 licensing application and site readiness
Policy & Procedure Manual development
Staff onboarding materials and credentialing trackers
ISP implementation tools and documentation templates
Emergency protocols and incident management logs
Referral development and AE relationship-building strategies
Supported Employment
SUPPORTED EMPLOYMENT SERVICES PROVIDER IN PENNSYLVANIA
EMPOWERING INDIVIDUALS WITH DISABILITIES TO ACCESS MEANINGFUL WORK AND INTEGRATE INTO THE WORKFORCE THROUGH PERSON-CENTERED SUPPORTS
Supported Employment Services in Pennsylvania are Medicaid-funded and state-supported services that assist individuals with intellectual disabilities, autism, and other disabilities in preparing for, obtaining, and maintaining competitive integrated employment. These services are delivered through the Office of Developmental Programs (ODP) and authorized under Pennsylvania’s HCBS Waivers, including the Consolidated, Person/Family Directed Support (P/FDS), and Community Living Waivers. Additional coordination may occur with the Pennsylvania Office of Vocational Rehabilitation (OVR).
1. GOVERNING AGENCIES
Agency: Pennsylvania Department of Human Services (DHS) – Office of Developmental Programs (ODP)
Role: Administers the state’s Medicaid waivers and oversees provider enrollment, training, and compliance.
Agency: Office of Vocational Rehabilitation (OVR)
Role: Funds and coordinates short-term employment supports and transitions to long-term waiver-funded services.
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight for HCBS waivers, including Supported Employment services.
Agency: Pennsylvania Secretary of State – Department of State (DOS)
Role: Registers legal business entities providing employment services in Pennsylvania.
2. SUPPORTED EMPLOYMENT SERVICES OVERVIEW
Supported Employment includes individualized services to help people find and maintain competitive employment in integrated community settings.
Approved providers may deliver:
Career Assessment & Discovery: Identifying skills, preferences, and support needs.
Job Development & Placement: Resume building, interview coaching, job matching, and placement assistance.
Job Coaching & Training: On-site support to ensure job retention and skill mastery.
Follow-Along Supports: Periodic monitoring, coaching, and intervention as needed to sustain employment.
Self-Employment Support: Assistance with starting and managing a small business.
Benefits Counseling (optional): Helping individuals understand how employment impacts their benefits.
Documentation: Service logs, progress notes, time studies, and billing records for waiver and OVR compliance.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your business with the Pennsylvania Department of State.
Obtain an EIN from the IRS and a Type 2 NPI.
Enroll as a qualified provider through ODP’s HCSIS system and PROMISe™ (Medicaid provider portal).
Complete ODP-required trainings, including ISP development and person-centered thinking.
Maintain liability and workers’ compensation insurance.
Develop a Supported Employment Services Policy & Procedure Manual based on ODP’s standards and CMS guidance.
4. PENNSYLVANIA PROVIDER ENROLLMENT PROCESS
Step 1: Register your business and obtain EIN and NPI.
Step 2: Complete provider qualification process in HCSIS (Home and Community Services Information System).
Step 3: Submit your PROMISe™ Medicaid provider application.
Step 4: Upload policies, proof of insurance, and staff credentials to HCSIS.
Step 5: Once qualified, enter into contracts with Supports Coordination Organizations (SCOs) and begin receiving referrals.
5. REQUIRED DOCUMENTATION
Articles of Incorporation or business registration
EIN and NPI confirmations
Insurance certificates (liability and workers’ comp)
ODP qualification approval
Supported Employment Policy & Procedure Manual including:
Employment planning and job matching processes
Coaching and follow-along protocols
Emergency procedures and client safety plans
Client rights and complaint resolution processes
Documentation, data tracking, and Medicaid billing standards
HIPAA compliance and confidentiality safeguards
Staff training policies and supervision guidelines
6. STAFFING REQUIREMENTS
Role: Employment Specialist / Job Coach
Requirements: Background check; high school diploma or higher; experience in employment services or disability supports; completion of ODP-approved training.
Role: Program Supervisor
Requirements: Manages caseloads, quality assurance, and compliance; must complete additional supervisory training modules.
Optional Role: Benefits Counselor
Requirements: Certification through a Social Security Administration-approved program (e.g., CWIC).
All staff must complete:
ODP-required training modules
Person-centered thinking and planning
Incident management and abuse reporting
HIPAA and documentation best practices
Annual refresher and professional development training
7. MEDICAID WAIVER PROGRAMS
Supported Employment Services are available under:
Consolidated Waiver – Full array of employment and residential supports
Person/Family Directed Support (P/FDS) Waiver – For individuals living with families or independently
Community Living Waiver – For individuals not receiving 24-hour residential services
OVR Short-Term Employment Services – Provided before transitioning to waiver-funded long-term supports
8. TIMELINE TO LAUNCH
Phase: Business Formation & Policy Manual Development
Timeline: 1–2 months
Phase: ODP Qualification & PROMISe™ Enrollment
Timeline: 2–3 months
Phase: Staff Hiring, Training & Credentialing
Timeline: 30–60 days
Phase: Referral Network Building & Service Launch
Timeline: Begins once contracts are in place with SCOs and OVR (if applicable)
9. CONTACT INFORMATION
Office of Developmental Programs (ODP)
Website: https://www.myodp.org
PA PROMISe™ Medicaid Provider Portal
Website: https://promise.dpw.state.pa.us
Office of Vocational Rehabilitation (OVR)
Website: https://www.dli.pa.gov/Individuals/Disability-Services/ovr
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
PA Department of State – Business Registration
Website: https://www.dos.pa.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — PENNSYLVANIA SUPPORTED EMPLOYMENT PROVIDER
WCG guides providers in Pennsylvania to launch successful Supported Employment programs aligned with state and federal expectations.
Scope of Work:
Business registration and Medicaid enrollment
ODP qualification and HCSIS application support
Policy & Procedure Manual tailored to PA employment standards
Staff training plan development and documentation logs
Service tracking templates, coaching forms, and billing tools
Referral strategies and contract guidance with SCOs and OVR
Audit preparedness and ongoing compliance consulting
Personal Care
PERSONAL CARE SERVICES PROVIDER IN PENNSYLVANIA
DELIVERING ESSENTIAL DAILY SUPPORT TO HELP INDIVIDUALS LIVE SAFELY AND INDEPENDENTLY IN THEIR HOMES AND COMMUNITIES
Personal Care Services in Pennsylvania are Medicaid-funded supports that help individuals with disabilities, chronic conditions, or age-related limitations perform activities of daily living (ADLs). These services are designed to promote independence, reduce institutionalization, and support safe, stable living arrangements in the community. Personal care is authorized through Pennsylvania’s HCBS Waivers under the Office of Long-Term Living (OLTL) and the Office of Developmental Programs (ODP), as well as the Community HealthChoices (CHC) managed care program.
1. GOVERNING AGENCIES
Agency: Pennsylvania Department of Human Services (DHS) – Office of Long-Term Living (OLTL)
Role: Administers personal assistance services for individuals with physical disabilities or age-related needs.
Agency: DHS – Office of Developmental Programs (ODP)
Role: Oversees personal care supports for individuals with intellectual or developmental disabilities.
Agency: Community HealthChoices (CHC) Managed Care Organizations (MCOs)
Role: Authorize and coordinate services under Pennsylvania’s mandatory managed long-term services and supports (MLTSS) program.
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight of Medicaid-funded personal care services.
Agency: Pennsylvania Department of State
Role: Registers provider businesses and oversees healthcare-related licensing.
2. PERSONAL CARE SERVICES OVERVIEW
These services support individuals who require hands-on assistance with daily living tasks. Providers help clients maintain their health, hygiene, and safety within their home environments.
Approved providers may deliver:
Activities of Daily Living (ADL) Support: Bathing, dressing, grooming, toileting, eating, and mobility assistance.
Instrumental Activities of Daily Living (IADL): Light housekeeping, laundry, shopping, meal preparation, and medication reminders.
Companionship & Monitoring: Ensuring client safety, providing supervision, and preventing isolation.
Transfer Assistance: Helping individuals safely move between beds, chairs, or mobility devices.
Documentation: Daily service logs, care plans, attendance sheets, and EVV (Electronic Visit Verification) records.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your business with the Pennsylvania Department of State.
Obtain an EIN from the IRS and a Type 2 NPI.
Enroll as a Medicaid provider via PROMISe™.
If operating a home care agency, obtain a Home Care Agency License from the PA Department of Health (DOH).
Carry liability insurance, workers’ compensation, and bonding (if applicable).
Develop a Personal Care Services Policy & Procedure Manual aligned with OLTL, ODP, and CHC standards.
4. PENNSYLVANIA PROVIDER ENROLLMENT PROCESS
Step 1: Register your legal entity, acquire EIN, NPI, and appropriate insurances.
Step 2: Apply for a Home Care Agency License through the Pennsylvania DOH (if applicable).
Step 3: Enroll in the PROMISe™ system as a Medicaid provider.
Step 4: Contract with CHC Managed Care Organizations (e.g., UPMC, Keystone First, PA Health & Wellness).
Step 5: Upload policies, staff credentials, and documentation tools for compliance review.
Step 6: Begin accepting service authorizations and managing EVV.
5. REQUIRED DOCUMENTATION
Articles of Incorporation and business registration
EIN and NPI documentation
Home Care Agency License (if providing hands-on care)
Insurance certificates (liability, workers’ comp, bonding if applicable)
Personal Care Services Policy & Procedure Manual including:
ADL/IADL service delivery protocols
Staff supervision and delegation policies
HIPAA and client rights materials
Incident reporting and emergency procedures
Service tracking templates and shift logs
EVV compliance workflows
Quality assurance systems and audit readiness tools
6. STAFFING REQUIREMENTS
Role: Personal Care Aide / Direct Care Worker
Requirements: Background check, TB testing, CPR/First Aid certification, and completion of state-mandated training.
Role: Agency Administrator / Program Coordinator
Requirements: Oversees scheduling, compliance, and staff supervision; must complete designated training modules.
Role: RN Supervisor (optional/required depending on client needs and license type)
Requirements: Active PA nursing license; responsible for client assessments and oversight of non-medical care.
All staff must complete:
Orientation on abuse prevention, HIPAA, and safety protocols
EVV system training
Competency assessments and annual refresher courses
Documentation and timekeeping compliance
7. MEDICAID WAIVER PROGRAMS
Personal Care Services are available through:
Community HealthChoices (CHC): Managed long-term services for older adults and people with physical disabilities.
OBRA Waiver (OLTL): For adults with physical disabilities who began services before age 60.
Aging Waiver (OLTL): For individuals age 60+ requiring long-term services.
Consolidated & P/FDS Waivers (ODP): Personal care supports for individuals with intellectual/developmental disabilities.
Act 150 Program (non-Medicaid): State-funded alternative to waivers for individuals not financially eligible for MA.
8. TIMELINE TO LAUNCH
Phase: Business Formation & Licensing Application
Timeline: 1–2 months
Phase: Medicaid Enrollment & MCO Contracting
Timeline: 2–3 months
Phase: Staff Hiring, Credentialing & Training
Timeline: 30–60 days
Phase: Referral Coordination & EVV Implementation
Timeline: Begins once authorization agreements and systems are approved
9. CONTACT INFORMATION
PA Department of Human Services – OLTL
Website: https://www.dhs.pa.gov
PA Department of Health – Home Care Licensing
Website: https://www.health.pa.gov
PROMISe™ Provider Portal
Website: https://promise.dpw.state.pa.us
Community HealthChoices MCO Contacts:
UPMC Community HealthChoices – https://www.upmchealthplan.com
PA Health & Wellness – https://www.pahealthwellness.com
Keystone First CHC – https://www.keystonefirstchc.com
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — PENNSYLVANIA PERSONAL CARE PROVIDER
WCG helps providers in Pennsylvania launch compliant and compassionate personal care service agencies that support dignity, safety, and independence at home.
Scope of Work:
Business registration, Medicaid enrollment, and Home Care licensing support
Policy & Procedure Manual development and compliance checklist
EVV system onboarding and training tools
Staff hiring templates, training trackers, and credentialing logs
MCO contracting support and documentation review
Referral-building strategies and quality assurance systems
Specialized Medical Equipment
SPECIALIZED MEDICAL EQUIPMENT SERVICES PROVIDER IN PENNSYLVANIA
SUPPORTING INDEPENDENT LIVING THROUGH MEDICAID-FUNDED EQUIPMENT THAT ENHANCES SAFETY, MOBILITY, AND FUNCTIONALITY IN THE HOME
Specialized Medical Equipment (SME) Services in Pennsylvania are Medicaid-funded supports that provide individuals with disabilities or chronic health conditions the assistive devices and equipment needed to live safely and independently in their homes or community settings. These services are delivered through the state’s HCBS Waivers — including the Consolidated, Community Living, and P/FDS Waivers — and are authorized under the Office of Developmental Programs (ODP) and the Office of Long-Term Living (OLTL), depending on the population served.
1. GOVERNING AGENCIES
Agency: Pennsylvania Department of Human Services (DHS) – Office of Developmental Programs (ODP) / Office of Long-Term Living (OLTL)
Role: Oversees waiver services including SME for individuals with intellectual disabilities, physical disabilities, or aging-related needs.
Agency: Pennsylvania Medical Assistance Program (via PROMISe™)
Role: Enrolls Medicaid providers and administers payments for SME.
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Ensures federal compliance for Medicaid-funded medical equipment services under 1915(c) HCBS waivers.
Agency: Pennsylvania Department of State
Role: Registers legal business entities and manages durable medical equipment (DME) licensure (if applicable).
2. SPECIALIZED MEDICAL EQUIPMENT SERVICES OVERVIEW
These services provide devices and technologies not typically covered under standard Medicaid benefits but that are necessary to improve or maintain an individual’s ability to function independently in the home or community.
Approved providers may deliver:
Mobility Equipment: Walkers, wheelchairs (manual or powered), gait trainers, and transfer lifts.
Environmental Adaptations: Specialized controls for doors, lighting, thermostats, or safety alarms.
Communication Aids: Augmentative and alternative communication (AAC) devices and accessories.
Daily Living Supports: Adaptive utensils, feeding equipment, bathing chairs, and toileting systems.
Maintenance & Repair: Routine servicing, troubleshooting, and repair of covered equipment.
Installation & Customization: Setup and configuration of complex equipment to individual specifications.
Documentation: Evaluations, delivery confirmations, repair logs, and Medicaid billing records.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your business with the PA Department of State.
Obtain an EIN and Type 2 NPI.
Enroll as a Medicaid provider through PROMISe™.
If supplying DME (durable medical equipment), obtain appropriate licensure or accreditation (e.g., CHAP, ACHC, or The Compliance Team).
Carry general liability and workers’ compensation insurance.
Develop a Specialized Medical Equipment Policy & Procedure Manual in line with CMS, ODP, and OLTL standards.
4. PENNSYLVANIA PROVIDER ENROLLMENT PROCESS
Step 1: Form your legal entity and obtain EIN, NPI, and necessary insurances.
Step 2: Enroll in PROMISe™ as a DME or SME provider.
Step 3: Upload licensure, accreditation, and policy documentation to DHS.
Step 4: Get approved by ODP or OLTL for SME vendor status.
Step 5: Start receiving service authorizations and process equipment requests.
5. REQUIRED DOCUMENTATION
Business registration and Articles of Incorporation
EIN and NPI confirmations
Accreditation or DME licensure (if applicable)
Liability and workers’ compensation insurance
SME Services Policy & Procedure Manual including:
Intake and assessment procedures
Equipment sourcing, tracking, and delivery processes
Client training and caregiver instruction policies
Maintenance, repairs, and return protocols
Incident tracking and reporting procedures
Medicaid billing, authorization, and documentation standards
Privacy and HIPAA compliance statements
6. STAFFING REQUIREMENTS
Role: Equipment Technician / Delivery Specialist
Requirements: Trained in equipment setup, mobility safety, and customer service; background checks required.
Role: Program Coordinator
Requirements: Oversees orders, authorizations, service coordination, and Medicaid documentation.
Role: Licensed Clinician (optional)
Requirements: OT, PT, or SLP to perform assessments for customized or high-tech equipment.
All staff must complete:
HIPAA and confidentiality training
Medicaid billing and documentation education
Infection control and equipment safety protocols
Annual compliance training and credential updates
7. MEDICAID WAIVER PROGRAMS
Specialized Medical Equipment Services are reimbursed through:
Consolidated Waiver (ODP) – Includes SME for individuals with intellectual disabilities.
Community Living Waiver (ODP) – Covers equipment to support community-based living.
Person/Family Directed Support (P/FDS) Waiver (ODP) – SME within individual spending limits.
Aging and Independence Waivers (OLTL) – For older adults and individuals with physical disabilities.
State Plan DME Benefit (via PROMISe™) – May overlap with standard Medicaid durable medical equipment.
8. TIMELINE TO LAUNCH
Phase: Business Formation & Policy Manual Creation
Timeline: 1–2 months
Phase: Medicaid Enrollment & DME Accreditation
Timeline: 2–4 months (depends on licensure)
Phase: Equipment Vendor Setup & Staff Training
Timeline: 30–60 days
Phase: Authorization Coordination & Service Launch
Timeline: Begins once contracts are in place with ODP/OLTL and client referrals are received
9. CONTACT INFORMATION
PA PROMISe™ Provider Enrollment
Website: https://promise.dpw.state.pa.us
Office of Developmental Programs (ODP)
Website: https://www.myodp.org
Office of Long-Term Living (OLTL)
Website: https://www.dhs.pa.gov
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
PA Department of State – Business Registration
Website: https://www.dos.pa.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — PENNSYLVANIA SME PROVIDER
WCG supports SME providers in Pennsylvania with end-to-end launch support and compliance solutions tailored to meet Medicaid requirements.
Scope of Work:
Business registration, Medicaid enrollment, and vendor onboarding
SME Policy Manual development and accreditation guidance
Equipment tracking templates and installation checklists
Maintenance logs and repair forms
Staff training trackers and onboarding materials
Medicaid billing documentation and claim readiness tools
Referral and contract support with ODP/OLTL and support coordinators
Skilled Nursing
SKILLED NURSING SERVICES PROVIDER IN PENNSYLVANIA
DELIVERING MEDICALLY NECESSARY CARE AT HOME TO PROMOTE HEALTH, RECOVERY, AND INDEPENDENCE
Skilled Nursing Services in Pennsylvania are Medicaid-funded, medically necessary services delivered by licensed nurses to individuals with complex health needs. These services are designed to prevent or delay institutionalization by providing clinical interventions in the individual’s home or community setting. Skilled nursing is covered under the Pennsylvania Medicaid State Plan, Home and Community-Based Services (HCBS) waivers, and Community HealthChoices (CHC) Managed Care Organizations (MCOs).
1. GOVERNING AGENCIES
Agency: Pennsylvania Department of Health (DOH) – Division of Home Health
Role: Licenses home health agencies that deliver skilled nursing care.
Agency: Pennsylvania Department of Human Services (DHS) – Office of Long-Term Living (OLTL)
Role: Oversees HCBS waiver programs that fund skilled nursing for aging and physically disabled populations.
Agency: Community HealthChoices (CHC) MCOs
Role: Authorize and reimburse for skilled nursing under managed Medicaid.
Agency: Centers for Medicare & Medicaid Services (CMS)**
Role: Provides federal guidance and oversight for Medicaid and Medicare-funded skilled services.
Agency: Pennsylvania Department of State
Role: Registers healthcare entities and ensures nurse licensure compliance.
2. SKILLED NURSING SERVICES OVERVIEW
Skilled Nursing Services are prescribed by a physician and delivered by a Registered Nurse (RN) or Licensed Practical Nurse (LPN) under physician oversight.
Approved providers may deliver:
Medication Administration: Injections, IV therapy, and oral medication management.
Wound Care: Dressing changes, pressure sore management, and surgical site care.
Chronic Condition Monitoring: Diabetes, cardiac, respiratory, or neurological support.
Post-Acute Care: Follow-up after hospital discharge or surgery.
Care Plan Development: RN-supervised care planning in coordination with the primary physician.
Training for Family/Caregivers: Teaching medication administration, monitoring signs/symptoms.
Documentation: Skilled nursing notes, medication logs, care plan updates, and billing forms.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your business with the Pennsylvania Department of State.
Obtain an EIN and Type 2 NPI.
Apply for a Home Health Agency License through the PA Department of Health (if operating a home health model).
Enroll with PROMISe™ as a Medicaid skilled nursing provider.
Contract with CHC MCOs for waiver-eligible populations.
Maintain malpractice, liability, and workers’ compensation insurance.
Develop a Skilled Nursing Services Policy & Procedure Manual in alignment with DOH and CMS guidelines.
4. PENNSYLVANIA PROVIDER ENROLLMENT PROCESS
Step 1: Form legal entity and obtain EIN, NPI, and required insurance.
Step 2: Apply for a Home Health Agency License via DOH (if applicable).
Step 3: Enroll with PROMISe™ under provider type for skilled nursing.
Step 4: Contract with CHC MCOs (UPMC, Keystone First, PA Health & Wellness).
Step 5: Submit staff credentials, licensure, and policy documentation.
Step 6: Begin receiving authorizations and referrals upon approval.
5. REQUIRED DOCUMENTATION
Business registration and Articles of Incorporation
EIN and NPI confirmation
Home Health License (if applicable)
Nursing staff licensure and credentials
Insurance certificates (malpractice, general liability, workers’ comp)
Skilled Nursing Policy & Procedure Manual including:
Plan of care development and clinical supervision
Medication administration and documentation protocols
Infection control and emergency response plans
HIPAA compliance and patient rights
RN and LPN supervisory requirements
Visit note templates and electronic documentation standards
Medicaid billing and chart audit readiness materials
6. STAFFING REQUIREMENTS
Role: Registered Nurse (RN)
Requirements: Active PA license; responsible for assessments, care planning, direct care, and LPN supervision.
Role: Licensed Practical Nurse (LPN)
Requirements: Active PA license; provides care under RN supervision.
Role: Clinical Supervisor / Director of Nursing
Requirements: Oversees nursing compliance, staff evaluations, and quality assurance.
All nursing staff must complete:
CPR/First Aid certification
HIPAA and abuse prevention training
Infection control and medication administration refreshers
Continuing education per PA Board of Nursing requirements
Electronic documentation and charting training
7. MEDICAID WAIVER PROGRAMS
Skilled Nursing Services are reimbursable through:
Medicaid State Plan Home Health Benefit – Physician-ordered nursing under medical necessity.
CHC Waiver (OLTL):
Skilled nursing included in service plan authorized by CHC MCOs
Aging, Independence, and OBRA Waivers (OLTL):
Nursing care to maintain or improve health at home
Children’s Waivers (if pediatric):
For medically complex children (via PH-95 or MA eligibility)
8. TIMELINE TO LAUNCH
Phase: Business Registration & Policy Manual Development
Timeline: 1–2 months
Phase: DOH Licensing & PROMISe™ Enrollment
Timeline: 2–4 months
Phase: MCO Contracting & Staff Credentialing
Timeline: 1–2 months
Phase: Referral Development & Service Launch
Timeline: Begins upon approval and readiness certification
9. CONTACT INFORMATION
PA Department of Health – Home Health Licensing
Website: https://www.health.pa.gov
PA DHS – Office of Long-Term Living (OLTL)
Website: https://www.dhs.pa.gov
PROMISe™ Provider Portal
Website: https://promise.dpw.state.pa.us
Community HealthChoices MCOs:
UPMC CHC – https://www.upmchealthplan.com
PA Health & Wellness – https://www.pahealthwellness.com
Keystone First CHC – https://www.keystonefirstchc.com
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — PENNSYLVANIA SKILLED NURSING PROVIDER
WCG supports healthcare agencies with launching, staffing, and maintaining high-quality skilled nursing operations in full compliance with PA Medicaid and licensing requirements.
Scope of Work:
Business registration, DOH licensing, and PROMISe™ enrollment
Policy & Procedure Manual development (aligned with clinical standards)
Nurse credentialing logs and supervision protocols
Visit note templates, medication tracking tools, and billing forms
MCO contracting guidance and referral development
Compliance tracking and audit readiness support
Habilitation Services
HABILITATION SERVICES PROVIDER IN PENNSYLVANIA
EMPOWERING INDIVIDUALS WITH DISABILITIES TO BUILD SKILLS FOR INDEPENDENT LIVING, COMMUNITY ENGAGEMENT, AND PERSONAL GROWTH
Habilitation Services in Pennsylvania are Medicaid-funded supports that help individuals with intellectual or developmental disabilities (IDD) acquire, retain, or improve self-help, social, and adaptive skills needed for daily living. These services are delivered under Pennsylvania’s Home and Community-Based Services (HCBS) Waivers through the Office of Developmental Programs (ODP). Habilitation may occur in homes, day programs, or community settings, and is tailored to meet the individual’s goals as outlined in their Individual Support Plan (ISP).
1. GOVERNING AGENCIES
Agency: Pennsylvania Department of Human Services (DHS) – Office of Developmental Programs (ODP)
Role: Oversees all habilitation service models under the Consolidated, Community Living, and P/FDS waivers.
Agency: Administrative Entities (AEs) / County MH/ID Offices
Role: Review provider qualifications, authorize services, and monitor quality and compliance.
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Ensures habilitation services comply with federal 1915(c) HCBS waiver regulations.
Agency: Pennsylvania Department of State
Role: Handles business registration for habilitation providers operating in Pennsylvania.
2. HABILITATION SERVICES OVERVIEW
Habilitation Services are person-centered supports that promote skill-building and independence through structured instruction and coaching.
Approved providers may deliver:
In-Home & Community Habilitation: Teaching ADLs, communication, problem-solving, and socialization in home or community settings.
Companion Services (non-skilled): Social support and supervision during community activities.
Behavioral Skill Development: Implementing strategies outlined in behavioral support plans (with proper training).
Life Skills Coaching: Supporting financial management, transportation training, cooking, and other IADLs.
Community Participation Support (CPS): Structured, group-based learning and social engagement in day program environments.
Documentation: Daily logs, ISP progress tracking, time sheets, and Medicaid billing forms.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your business with the PA Department of State.
Obtain an EIN from the IRS and a Type 2 NPI.
Enroll through the ODP’s provider qualification process via HCSIS.
Complete waiver-specific service descriptions (e.g., In-Home and Community, CPS, Companion).
Maintain liability, workers’ comp, and vehicle insurance (if transporting individuals).
Develop a Habilitation Services Policy & Procedure Manual aligned with ODP and CMS standards.
4. PENNSYLVANIA PROVIDER ENROLLMENT PROCESS
Step 1: Register your legal entity and obtain EIN, NPI, and required insurance.
Step 2: Complete the provider qualification packet and upload to HCSIS.
Step 3: Undergo Administrative Entity (AE) or County MH/ID review and site visit (if applicable).
Step 4: Submit resumes, training documentation, and clearances for key staff.
Step 5: Once qualified, begin receiving service authorizations and coordinating with Supports Coordinators.
5. REQUIRED DOCUMENTATION
Articles of Incorporation and business registration
EIN and NPI confirmation
Insurance certificates
Habilitation Policy & Procedure Manual including:
ISP implementation and skill-building protocols
Service delivery models (1:1, group, in-home, CPS)
Risk mitigation and incident reporting procedures
Participant rights and communication support
Staff supervision and training guidelines
Service log templates and shift note formats
HIPAA and documentation compliance standards
6. STAFFING REQUIREMENTS
Role: Direct Support Professional (DSP)
Requirements: Background check, CPR/First Aid, ODP-required training in ISP implementation, abuse prevention, and documentation.
Role: Program Coordinator / Supervisor
Requirements: Manages staff training, ISP delivery, and ensures compliance with service guidelines.
Role: Behavior Support Aide (if implementing BSP)
Requirements: Additional behavioral training or guidance from a Behavior Specialist Consultant.
All staff must complete:
ODP Orientation and Refresher Training
Person-centered practices and goal tracking
Incident management and emergency protocols
Documentation and Medicaid billing training
Annual performance evaluations and training renewals
7. MEDICAID WAIVER PROGRAMS
Habilitation services are funded under:
Consolidated Waiver (ODP):
In-Home & Community Habilitation
Community Participation Support
Companion Services
Behavioral Support
Community Living Waiver (ODP):
Same habilitation services as the Consolidated Waiver without residential funding
Person/Family Directed Support (P/FDS) Waiver:
Offers habilitation services within individual spending limits
8. TIMELINE TO LAUNCH
Phase: Business Registration & Manual Development
Timeline: 1–2 months
Phase: ODP Qualification & County AE Review
Timeline: 2–3 months
Phase: Staff Hiring, Credentialing & Training
Timeline: 30–60 days
Phase: Referral Network Development & Service Launch
Timeline: Begins upon approval and ISP authorization
9. CONTACT INFORMATION
PA DHS – Office of Developmental Programs (ODP)
Website: https://www.myodp.org
HCSIS Provider Portal
Website: https://www.hcsis.state.pa.us
Administrative Entity Contact List
Available via your county MH/ID office or AE directory
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
PA Department of State – Business Registration
Website: https://www.dos.pa.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — PENNSYLVANIA HABILITATION PROVIDER
WCG helps new Habilitation providers in Pennsylvania build robust, person-centered programs that empower clients and meet all compliance requirements.
Scope of Work:
Business registration and ODP provider qualification
Policy & Procedure Manual development tailored to habilitation
Staff onboarding materials and ODP training tracking
ISP implementation logs and skill progression charts
Medicaid documentation templates and billing tools
AE relationship-building and referral network development
Incident reporting systems and quality assurance support
Adult Health
ADULT HEALTH SERVICES PROVIDER IN PENNSYLVANIA
SUPPORTING THE HEALTH, WELLNESS, AND INDEPENDENCE OF ADULTS THROUGH MEDICALLY NECESSARY AND PERSON-CENTERED CARE
Adult Health Services in Pennsylvania are Medicaid-funded supports that help individuals with disabilities, chronic illnesses, and aging-related needs maintain their health, function, and independence at home or in the community. These services are delivered through the Pennsylvania Department of Human Services (DHS), primarily under the Office of Long-Term Living (OLTL), Office of Developmental Programs (ODP), and Community HealthChoices (CHC) Managed Care Organizations (MCOs). Services range from medical oversight and monitoring to personal care and therapeutic supports.
1. GOVERNING AGENCIES
Agency: Pennsylvania Department of Human Services (DHS) – Office of Long-Term Living (OLTL)
Role: Manages Medicaid waivers and coordinates services for older adults and adults with physical disabilities.
Agency: DHS – Office of Developmental Programs (ODP)
Role: Administers adult health supports for individuals with intellectual and developmental disabilities.
Agency: Community HealthChoices (CHC) Managed Care Organizations (MCOs)
Role: Authorize and reimburse services for Medicaid-eligible adults enrolled in CHC.
Agency: Centers for Medicare & Medicaid Services (CMS)**
Role: Provides federal guidance and oversight for adult health services delivered through Medicaid HCBS waivers.
Agency: Pennsylvania Department of State
Role: Registers legal business entities and ensures licensure for healthcare professionals and facilities.
2. ADULT HEALTH SERVICES OVERVIEW
Adult Health Services address a range of medical and supportive needs to ensure safe, dignified, and independent living.
Approved providers may deliver:
Skilled Nursing Care: Medication administration, chronic disease management, and wound care (by licensed RNs or LPNs).
Home Health Aide Support: Assistance with bathing, hygiene, dressing, and mobility under RN supervision.
Personal Assistance Services (PAS): Non-medical support with ADLs/IADLs such as meal prep, housekeeping, and errands.
Nutrition & Meal Services: Dietary planning, feeding support, or home-delivered meals based on medical needs.
Adult Day Services (optional): Structured activities, medical oversight, and meals in a licensed facility.
Health Monitoring & Coordination: Wellness checks, symptom reporting, and communication with healthcare teams.
Documentation: Daily notes, plan of care updates, incident reports, and Medicaid billing records.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your business with the Pennsylvania Department of State.
Obtain an EIN and Type 2 NPI.
Apply for a Home Care or Home Health Agency License (as applicable) through the PA Department of Health.
Enroll in the PROMISe™ system as a Medicaid provider.
Contract with CHC MCOs and/or receive qualification through ODP or OLTL.
Maintain liability, workers’ compensation, and malpractice insurance.
Develop an Adult Health Services Policy & Procedure Manual aligned with DHS and CMS standards.
4. PENNSYLVANIA PROVIDER ENROLLMENT PROCESS
Step 1: Register your entity and obtain EIN, NPI, and required insurance.
Step 2: Apply for licensure with the PA Department of Health (if providing skilled services).
Step 3: Enroll in PROMISe™ as a home health, PAS, or waiver service provider.
Step 4: Contract with MCOs or qualify through your AE (for ODP services).
Step 5: Submit required staff credentials, policies, and compliance documentation.
Step 6: Begin receiving service authorizations and referrals upon approval.
5. REQUIRED DOCUMENTATION
Articles of Incorporation and business registration
EIN and NPI confirmations
Home Care/Home Health license (if applicable)
Insurance certificates (liability, workers’ comp, malpractice if skilled)
Adult Health Policy & Procedure Manual including:
Plan of care development and service authorization protocols
ADL/IADL support procedures and staff supervision
Medication administration and health monitoring
Emergency response, infection control, and participant safety
Staff credentialing and training guidelines
HIPAA, client rights, and abuse prevention policies
Medicaid billing forms, EVV (if applicable), and shift note templates
6. STAFFING REQUIREMENTS
Role: Registered Nurse (RN) / Clinical Supervisor
Requirements: Active PA license; responsible for clinical oversight, care planning, and supervision of direct care staff.
Role: Home Health Aide / Personal Care Aide
Requirements: CPR/First Aid certification, background check, completion of approved training (Home Health Aide or PAS curriculum).
Role: Program Coordinator
Requirements: Oversees service delivery, schedules, documentation compliance, and staff coordination.
Optional Roles: Licensed Therapists, Dietitians, or Social Workers (depending on scope of services)
All staff must complete:
Orientation and annual training in HIPAA, safety, and abuse prevention
EVV documentation training (if applicable)
Role-specific continuing education and skill competency checks
7. MEDICAID WAIVER PROGRAMS
Adult Health Services are supported through:
Community HealthChoices (CHC): For dual-eligible individuals age 21+ needing long-term services.
Aging Waiver (OLTL): For individuals 60+ requiring health and personal care supports.
Independence Waiver (OLTL): For adults with physical disabilities who need assistance at home.
OBRA Waiver (OLTL): For adults with developmental physical disabilities who began services before age 60.
Consolidated and Community Living Waivers (ODP): Includes medical and personal health supports for individuals with IDD.
Medicaid State Plan Services: Includes personal care, skilled nursing, and home health benefits (physician-ordered).
8. TIMELINE TO LAUNCH
Phase: Business Registration & Manual Development
Timeline: 1–2 months
Phase: Licensing & Medicaid Enrollment
Timeline: 2–3 months
Phase: Staff Hiring, Credentialing & Training
Timeline: 30–60 days
Phase: Referral Activation & Service Launch
Timeline: Begins upon contracting approval and care plan authorization
9. CONTACT INFORMATION
PA Department of Human Services – OLTL
Website: https://www.dhs.pa.gov
PA Department of Health – Licensing Division
Website: https://www.health.pa.gov
PA DHS – Office of Developmental Programs (ODP)
Website: https://www.myodp.org
PROMISe™ Medicaid Provider Portal
Website: https://promise.dpw.state.pa.us
CHC MCO Contacts:
UPMC CHC – https://www.upmchealthplan.com
Keystone First CHC – https://www.keystonefirstchc.com
PA Health & Wellness – https://www.pahealthwellness.com
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — PENNSYLVANIA ADULT HEALTH SERVICES PROVIDER
WCG helps new and expanding Adult Health Services providers in Pennsylvania launch with confidence and full regulatory compliance.
Scope of Work:
Business formation, licensing, and Medicaid enrollment
Policy & Procedure Manual tailored to ADL, PAS, and nursing support models
Staff onboarding guides and credentialing trackers
Service documentation templates and care coordination forms
EVV implementation and Medicaid billing workflows
MCO referral partnerships and contract navigation
Compliance review and audit prep support
Assistive Technology
ASSISTIVE TECHNOLOGY SERVICES PROVIDER IN PENNSYLVANIA
ENHANCING INDEPENDENCE THROUGH TECHNOLOGY THAT CONNECTS INDIVIDUALS TO THEIR ENVIRONMENTS, COMMUNITIES, AND GOALS
Assistive Technology (AT) Services in Pennsylvania are Medicaid-funded supports that provide individuals with disabilities the tools, devices, and training necessary to increase, maintain, or improve their functional abilities at home and in the community. These services are authorized under Pennsylvania’s Home and Community-Based Services (HCBS) waivers through the Office of Developmental Programs (ODP), Office of Long-Term Living (OLTL), and Community HealthChoices (CHC) managed care organizations (MCOs).
1. GOVERNING AGENCIES
Agency: Pennsylvania Department of Human Services (DHS) – Office of Developmental Programs (ODP)
Role: Administers AT services under the Consolidated, Community Living, and P/FDS waivers.
Agency: DHS – Office of Long-Term Living (OLTL)
Role: Oversees AT for adults with physical disabilities and aging-related needs through HCBS waivers.
Agency: Community HealthChoices (CHC) MCOs
Role: Authorizes AT assessments, purchases, and training for CHC-eligible individuals.
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal guidance and oversight of Medicaid-funded assistive technology.
Agency: Pennsylvania Department of State
Role: Handles business registration and licensure (if required for certain devices or services).
2. ASSISTIVE TECHNOLOGY SERVICES OVERVIEW
AT includes equipment and training that helps individuals perform tasks they would otherwise be unable to do or could only do with difficulty. Services may range from simple devices to complex, customized systems.
Approved providers may deliver:
AT Needs Assessments: Evaluations conducted to determine the most appropriate equipment.
Device Procurement: Ordering, purchasing, and delivering approved AT devices.
Customization & Installation: Fitting, configuring, or adjusting devices for personal use.
Training & Education: Teaching individuals and caregivers how to properly use the equipment.
Maintenance & Repairs: Troubleshooting, updating, and fixing approved equipment.
Documentation: Evaluation reports, device logs, training notes, and Medicaid billing forms.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your business with the PA Department of State.
Obtain an EIN and Type 2 NPI.
Enroll in PROMISe™ as a Medicaid provider.
Contract with ODP, OLTL, or CHC MCOs depending on your target population.
Obtain any required professional certifications (e.g., Assistive Technology Professional [ATP] from RESNA) if providing clinical assessments.
Maintain liability, workers’ compensation, and equipment insurance (if applicable).
Develop an Assistive Technology Services Policy & Procedure Manual per DHS and CMS guidelines.
4. PENNSYLVANIA PROVIDER ENROLLMENT PROCESS
Step 1: Register your business and obtain EIN, NPI, and insurance.
Step 2: Enroll in PROMISe™ under applicable AT-related provider type.
Step 3: Contract with CHC MCOs or apply for ODP/OLTL provider qualification.
Step 4: Upload documentation, licensure (if required), and service procedures.
Step 5: Begin receiving referrals from support coordinators or service coordinators.
5. REQUIRED DOCUMENTATION
Business registration and Articles of Incorporation
EIN and NPI confirmations
Proof of ATP certification (if applicable)
Insurance certificates
Assistive Technology Policy & Procedure Manual including:
Evaluation and intake processes
Equipment sourcing, customization, and delivery workflows
User training and education procedures
Safety and maintenance guidelines
Incident reporting and troubleshooting protocols
Medicaid documentation and billing procedures
HIPAA and participant rights safeguards
6. STAFFING REQUIREMENTS
Role: Assistive Technology Specialist
Requirements: Experience in AT delivery; ATP certification (optional but preferred); background check and training in HCBS documentation.
Role: Program Coordinator
Requirements: Oversees referrals, authorizations, and equipment records.
Role: Licensed Clinician (optional)
Requirements: OT, PT, or SLP with expertise in AT evaluations and medical justifications.
All staff must complete:
HIPAA and confidentiality training
Safety and device handling training
Medicaid documentation and billing protocols
Annual compliance reviews and continuing education (as needed)
7. MEDICAID WAIVER PROGRAMS
Assistive Technology is covered through:
ODP Waivers:
Consolidated Waiver – Full range of AT supports
Community Living Waiver – Moderate AT needs for individuals in shared or family living
P/FDS Waiver – AT services within the individual’s annual budget
OLTL Waivers:
Aging Waiver – AT for seniors living independently
Independence & OBRA Waivers – For physically disabled adults requiring devices to function at home
Community HealthChoices (CHC):
MCO-authorized AT assessments, purchases, and follow-up training
8. TIMELINE TO LAUNCH
Phase: Business Registration & Policy Manual Development
Timeline: 1–2 months
Phase: PROMISe™ Enrollment & Provider Approval
Timeline: 2–3 months
Phase: Staff Hiring, Credentialing & Equipment Sourcing
Timeline: 30–60 days
Phase: Referral Coordination & Service Delivery
Timeline: Begins once contracts are in place and authorizations received
9. CONTACT INFORMATION
PA DHS – Office of Developmental Programs (ODP)
Website: https://www.myodp.org
PA DHS – Office of Long-Term Living (OLTL)
Website: https://www.dhs.pa.gov
PROMISe™ Medicaid Provider Portal
Website: https://promise.dpw.state.pa.us
Community HealthChoices MCOs:
UPMC CHC – https://www.upmchealthplan.com
Keystone First CHC – https://www.keystonefirstchc.com
PA Health & Wellness – https://www.pahealthwellness.com
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — PENNSYLVANIA AT PROVIDER
WCG helps providers launch effective, compliant Assistive Technology programs to empower individuals through technology and skill-building.
Scope of Work:
Business registration, Medicaid enrollment, and MCO onboarding
Assistive Technology Policy & Procedure Manual
Intake forms, assessment templates, and equipment checklists
Service logs, repair forms, and training documentation
ATP credentialing support and clinician onboarding (if applicable)
Medicaid billing guidance and documentation tools
Referral-building strategies and program marketing support
Behavioral Health
BEHAVIORAL HEALTH SERVICES PROVIDER IN PENNSYLVANIA
DELIVERING EVIDENCE-BASED MENTAL AND BEHAVIORAL HEALTH SUPPORT TO PROMOTE WELLNESS, FUNCTIONALITY, AND COMMUNITY PARTICIPATION
Behavioral Health Services in Pennsylvania are Medicaid-funded supports designed to help individuals with mental illness, emotional disturbances, autism spectrum disorders (ASD), or co-occurring behavioral challenges achieve stability, manage symptoms, and improve quality of life. Services range from individual therapy to community-based behavioral support and are delivered under the oversight of the Office of Mental Health and Substance Abuse Services (OMHSAS), managed care organizations (BH-MCOs), and the Office of Developmental Programs (ODP) for individuals with IDD.
1. GOVERNING AGENCIES
Agency: Pennsylvania Department of Human Services (DHS) – Office of Mental Health and Substance Abuse Services (OMHSAS)
Role: Oversees Medicaid-funded behavioral and mental health services across all counties.
Agency: Behavioral Health-Managed Care Organizations (BH-MCOs)
Role: Coordinate and authorize behavioral health services for individuals enrolled in HealthChoices.
Agency: DHS – Office of Developmental Programs (ODP)
Role: Oversees behavioral supports for individuals with intellectual or developmental disabilities under waiver programs.
Agency: Centers for Medicare & Medicaid Services (CMS)**
Role: Ensures federal compliance for Medicaid behavioral health programs.
Agency: Pennsylvania Department of State & Department of Health (DOH)
Role: Handles provider licensing, business registration, and facility regulation.
2. BEHAVIORAL HEALTH SERVICES OVERVIEW
Behavioral Health Services address mental illness, behavioral challenges, and emotional disturbances using therapeutic, clinical, and rehabilitative interventions.
Approved providers may deliver:
Individual & Group Therapy: CBT, DBT, trauma-informed therapy, and more.
Mobile Therapy / Behavioral Health Rehabilitation Services (BHRS): In-home and community-based treatment for children and youth.
Functional Behavioral Assessments (FBA): Development of behavior support plans (BSP).
Applied Behavior Analysis (ABA): Evidence-based therapy for individuals with autism or developmental delays.
Behavior Specialist Consultant (BSC): Designs and oversees behavioral interventions.
Crisis Intervention & De-escalation: On-call support to address psychiatric or behavioral emergencies.
Psychiatric Evaluations & Medication Management: Conducted by licensed psychiatrists or psychiatric nurse practitioners.
Documentation: Service notes, treatment plans, encounter forms, and Medicaid billing logs.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your business with the PA Department of State.
Obtain an EIN and Type 2 NPI.
Apply for a mental health agency or outpatient psychiatric clinic license through the Department of Health (DOH), if applicable.
Enroll as a Medicaid behavioral health provider via PROMISe™.
Contract with relevant BH-MCOs by region (e.g., Community Care Behavioral Health, Magellan, PerformCare).
Ensure clinical staff hold proper PA licensure (LCSW, LPC, LMFT, BCBA, psychiatrist, etc.).
Develop a Behavioral Health Services Policy & Procedure Manual aligned with OMHSAS and CMS guidelines.
4. PENNSYLVANIA PROVIDER ENROLLMENT PROCESS
Step 1: Form your business entity and secure EIN, NPI, and necessary insurances.
Step 2: Apply for licensure with DOH (if operating as a clinic or facility).
Step 3: Enroll in PROMISe™ as a behavioral health service provider.
Step 4: Contract with your regional BH-MCO(s) based on county coverage area.
Step 5: Submit clinical staff credentials, supervision plans, and policy manuals for approval.
Step 6: Begin accepting authorizations and coordinating with Managed Care referral sources.
5. REQUIRED DOCUMENTATION
Articles of Incorporation and business registration
EIN and NPI confirmation
DOH license (if applicable)
Proof of credentialing for licensed clinicians and supervisors
Insurance certificates (liability, malpractice, workers’ comp)
Behavioral Health Policy & Procedure Manual including:
Treatment plan development and review timelines
Clinical documentation and progress note standards
Confidentiality and HIPAA compliance
Client intake, risk screening, and safety planning
Emergency/crisis response procedures
Staff training and credentialing policies
Billing templates and audit readiness tools
6. STAFFING REQUIREMENTS
Role: Licensed Therapist (LCSW, LPC, LMFT, Psychologist)
Requirements: Active PA license; trained in trauma-informed care and evidence-based practices.
Role: Behavior Specialist Consultant (BSC)
Requirements: PA BSC license or autism endorsement for ASD cases; clinical supervision as needed.
Role: Mobile Therapist / Therapeutic Support Staff (TSS)
Requirements: BA/MA-level professionals with behavioral health training.
Role: Psychiatrist / Psychiatric Nurse Practitioner (optional)
Requirements: Licensed and credentialed for medication evaluation and management.
All staff must complete:
FBI/Child Abuse/PA State Police background checks
HIPAA, trauma-informed care, and abuse prevention training
Annual continuing education and credential renewals
Supervision documentation and clinical quality review
7. MEDICAID WAIVER PROGRAMS & COVERAGE
Behavioral Health Services are funded under:
HealthChoices (BH-MCOs):
Covers outpatient therapy, mobile therapy, ABA, and psychiatric services
ODP Waivers:
Behavioral Support Services (BSS) and behavior plan implementation for individuals with IDD
Children’s Waiver Services:
Behavioral Health Rehabilitation Services (BHRS) or Intensive Behavioral Health Services (IBHS)
Medicaid Fee-for-Service (FFS):
For individuals not enrolled in an MCO (rare cases)
8. TIMELINE TO LAUNCH
Phase: Business Formation & Licensing Application
Timeline: 1–2 months
Phase: Medicaid Enrollment & BH-MCO Contracting
Timeline: 2–3 months
Phase: Staff Hiring, Credentialing & Supervision Setup
Timeline: 30–60 days
Phase: Referral Development & Service Launch
Timeline: Begins once contracts are in place and billing system is activated
9. CONTACT INFORMATION
PA DHS – Office of Mental Health and Substance Abuse Services (OMHSAS)
Website: https://www.dhs.pa.gov/providers/OMHSAS
PA Department of Health – Facility Licensing
Website: https://www.health.pa.gov
PROMISe™ Provider Enrollment
Website: https://promise.dpw.state.pa.us
BH-MCO Contacts:
Community Care Behavioral Health – https://www.ccbh.com
Magellan Behavioral Health of PA – https://www.magellanofpa.com
PerformCare PA – https://pa.performcare.org
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — PENNSYLVANIA BEHAVIORAL HEALTH PROVIDER
WCG supports the launch of high-quality, compliance-ready behavioral health practices across Pennsylvania for mental health and IDD-focused providers.
Scope of Work:
Business registration, licensing, and Medicaid enrollment
BH-MCO contracting and regional referral mapping
Behavioral Health Policy & Procedure Manual development
Clinical staff onboarding and supervision logs
Medicaid documentation templates and audit prep tools
HIPAA, client rights, and trauma-informed care training toolkits
Compliance consulting and quality assurance planning
Home Modification
HOME MODIFICATION SERVICES PROVIDER IN PENNSYLVANIA
IMPROVING ACCESSIBILITY, FUNCTIONAL SAFETY, AND INDEPENDENCE FOR INDIVIDUALS WITH DISABILITIES THROUGH STRUCTURAL HOME ADAPTATIONS
Home Modification Services in Pennsylvania are Medicaid-funded supports that allow individuals with disabilities, chronic health conditions, or age-related limitations to remain safely in their homes by modifying their physical living environment. These services are available through the state’s Home and Community-Based Services (HCBS) waivers under the Office of Long-Term Living (OLTL), the Office of Developmental Programs (ODP), and Community HealthChoices (CHC) Managed Care Organizations (MCOs).
1. GOVERNING AGENCIES
Agency: Pennsylvania Department of Human Services (DHS) – OLTL & ODP
Role: Authorizes home modifications through HCBS waivers and coordinates approvals through Service Coordinators and Administrative Entities.
Agency: Community HealthChoices (CHC) MCOs
Role: Authorize funding for eligible members and coordinate installation vendors for home modifications.
Agency: Centers for Medicare & Medicaid Services (CMS)**
Role: Ensures compliance of Medicaid-funded environmental adaptation services under federal 1915(c) waiver standards.
Agency: Pennsylvania Department of State
Role: Registers provider entities and ensures compliance with business regulations.
Agency: Pennsylvania Department of Labor & Industry – Contractor Registration
Role: Requires home modification vendors to register as home improvement contractors (HIC) under PA law.
2. HOME MODIFICATION SERVICES OVERVIEW
These services involve changes to the individual’s residence that enable greater independence and reduce the risk of institutionalization.
Approved providers may deliver:
Accessibility Modifications: Wheelchair ramps, widened doorways, roll-in showers, stair lifts, grab bars.
Bathroom & Kitchen Adaptations: Lowered countertops, accessible sinks, raised toilets, lever-handle faucets.
Safety Enhancements: Non-slip flooring, transfer systems, visual alarms, and environmental controls.
Environmental Control Units (ECUs): Smart home or adaptive devices to improve independent living.
Project Management: Site evaluations, scope of work documentation, contractor coordination, and post-install inspection.
Documentation: Cost estimates, before/after photos, receipts, and Medicaid billing paperwork.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your business with the Pennsylvania Department of State.
Obtain an EIN from the IRS and a Type 2 NPI.
Register with the PA Home Improvement Contractor Program (HIC) under the Department of Labor & Industry.
Enroll in PROMISe™ as a Medicaid provider for Home Modifications.
Contract with CHC MCOs, and coordinate with ODP/OLTL Service Coordinators or Support Coordinators.
Maintain general liability and workers’ compensation insurance.
Develop a Home Modification Services Policy & Procedure Manual that includes project workflows, safety protocols, and Medicaid documentation standards.
4. PENNSYLVANIA PROVIDER ENROLLMENT PROCESS
Step 1: Form a legal entity, register with the Department of State, and secure EIN/NPI.
Step 2: Register as a PA Home Improvement Contractor (if applicable).
Step 3: Enroll in PROMISe™ under the appropriate provider type/specialty.
Step 4: Submit qualifications to CHC MCOs and/or ODP/OLTL administrative entities.
Step 5: Upload policy documents, cost estimate templates, and staff/vendor credentials.
Step 6: Begin accepting authorized work orders and service authorizations.
5. REQUIRED DOCUMENTATION
Business registration and Articles of Incorporation
EIN and NPI confirmations
PA HIC Registration Certificate
Liability and workers’ comp insurance
Home Modification Policy & Procedure Manual including:
Client intake and pre-authorization protocols
Scope of work development and contractor vetting
Equipment and material safety standards
Installation oversight and post-completion inspection process
Service tracking logs and project notes
Billing templates, estimate forms, and completion verification
HIPAA compliance, grievance procedures, and incident reporting
6. STAFFING REQUIREMENTS
Role: Project Manager / Home Modification Specialist
Requirements: Experience in ADA-compliant design and coordination of accessible construction projects.
Role: Licensed Contractor / Installer
Requirements: PA HIC registration, contractor liability insurance, and experience with Medicaid-approved modifications.
Role: Administrative Coordinator
Requirements: Manages project timelines, cost estimates, billing, and coordination with case managers.
All staff and subcontractors must complete:
HIPAA and participant privacy training
Safety and OSHA-compliant worksite practices
Medicaid billing compliance training (as applicable)
Annual credential and license renewals
7. MEDICAID WAIVER PROGRAMS
Home Modifications are funded through:
Community HealthChoices (CHC): For adults with physical disabilities or aging-related needs
Independence, OBRA, and Aging Waivers (OLTL): Environmental adaptations to support safe living
ODP Waivers (Consolidated, Community Living, P/FDS):
Support for individuals with intellectual/developmental disabilities requiring accessibility-related changes in their homes
State Plan (limited): Basic DME-related adjustments when authorized
8. TIMELINE TO LAUNCH
Phase: Business Formation & Manual Development
Timeline: 1–2 months
Phase: HIC Registration & Medicaid Enrollment
Timeline: 2–3 months
Phase: Staff/Contractor Vetting & System Setup
Timeline: 30–60 days
Phase: Referral & Project Coordination
Timeline: Begins upon MCO/waiver contract approval and service authorizations
9. CONTACT INFORMATION
PA Department of Human Services – OLTL
Website: https://www.dhs.pa.gov
PA DHS – Office of Developmental Programs (ODP)
Website: https://www.myodp.org
PA Home Improvement Contractor Registration
Website: https://www.attorneygeneral.gov
PROMISe™ Medicaid Provider Portal
Website: https://promise.dpw.state.pa.us
CHC MCO Contacts:
UPMC CHC – https://www.upmchealthplan.com
PA Health & Wellness – https://www.pahealthwellness.com
Keystone First CHC – https://www.keystonefirstchc.com
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — PENNSYLVANIA HOME MODIFICATION PROVIDER
WCG supports contractors and accessibility service providers in Pennsylvania with the full setup and launch of Medicaid-approved home modification operations.
Scope of Work:
Business registration and Medicaid enrollment
HIC registration and insurance compliance guidance
Policy & Procedure Manual development and compliance review
Scope of work templates, cost estimate forms, and tracking tools
Billing documentation and post-installation verification materials
Referral-building strategies and relationship development with MCOs, SCs, and AEs
Compliance consulting for safety standards, ADA guidelines, and Medicaid audits
Nursing Facility Transition
NURSING FACILITY TRANSITION SERVICES PROVIDER IN PENNSYLVANIA
HELPING INDIVIDUALS SAFELY RETURN TO COMMUNITY LIVING WITH DIGNITY, SUPPORT, AND PERSON-CENTERED PLANNING
Nursing Facility Transition (NFT) Services in Pennsylvania are Medicaid-funded supports that assist individuals in moving from nursing facilities back into their homes or community-based settings. These services are designed to reduce unnecessary institutionalization and are coordinated through Pennsylvania’s Community HealthChoices (CHC) program, the Office of Long-Term Living (OLTL), and local Managed Care Organizations (MCOs). They include service planning, housing search, home setup, and linkage to Home and Community-Based Services (HCBS).
1. GOVERNING AGENCIES
Agency: Pennsylvania Department of Human Services (DHS) – Office of Long-Term Living (OLTL)
Role: Oversees Nursing Facility Transition services under Medicaid HCBS waivers.
Agency: Community HealthChoices (CHC) Managed Care Organizations (MCOs)
Role: Coordinate transitions, authorize funding, and contract with NFT providers.
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Ensures compliance with federal Medicaid requirements and Money Follows the Person (MFP) initiatives.
Agency: Pennsylvania Department of State
Role: Registers legal business entities operating as NFT service providers.
2. NURSING FACILITY TRANSITION SERVICES OVERVIEW
NFT Services support individuals in developing a transition plan, securing housing, obtaining furnishings, and arranging for HCBS supports after discharge.
Approved providers may deliver:
Transition Planning: Person-centered discharge planning and coordination with facility staff.
Housing Search & Coordination: Locating affordable housing, submitting applications, and arranging utilities.
One-Time Transition Expenses: Purchasing furniture, appliances, linens, and household items needed to set up a safe home.
Caregiver Training & Support: Educating informal caregivers about care needs and resources.
Community Support Connection: Linking individuals to personal assistance, meal programs, and health services.
Follow-Up Monitoring: Post-discharge check-ins to ensure service access and stability.
Documentation: Transition plans, purchase logs, follow-up notes, and Medicaid billing records.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your business with the Pennsylvania Department of State.
Obtain an EIN from the IRS and a Type 2 NPI.
Enroll in PROMISe™ as a Medicaid provider.
Contract with CHC Managed Care Organizations (MCOs) as a transition service provider.
Maintain liability and workers’ compensation insurance.
Develop a Nursing Facility Transition Policy & Procedure Manual that meets OLTL and CHC program requirements.
4. PENNSYLVANIA PROVIDER ENROLLMENT PROCESS
Step 1: Register business and secure EIN, NPI, and insurances.
Step 2: Apply for PROMISe™ enrollment as a transition support or waiver service provider.
Step 3: Submit applications to contract with CHC MCOs (UPMC, PA Health & Wellness, Keystone First).
Step 4: Upload policy documents, training plans, and staff background checks.
Step 5: Once approved, begin receiving transition referrals from MCO Service Coordinators.
5. REQUIRED DOCUMENTATION
Articles of Incorporation and business registration
EIN and NPI confirmations
Insurance certificates
CHC MCO contract confirmation
NFT Services Policy & Procedure Manual including:
Housing search and coordination protocols
Authorization and funding request workflows
Safety checklists for move-in setup
Emergency planning and backup supports
Participant consent and rights materials
Service tracking logs and expense reports
Medicaid billing and transition completion forms
6. STAFFING REQUIREMENTS
Role: Transition Coordinator
Requirements: Experience in care coordination, Medicaid waivers, and housing support; background check required.
Role: Program Supervisor
Requirements: Oversees quality control, service tracking, and compliance with CHC contracts.
Role: Housing Liaison (optional)
Requirements: Connects clients to landlords and housing authorities; familiar with local housing programs.
All staff must complete:
HIPAA and participant rights training
Person-centered planning and motivational interviewing
Housing readiness and safety assessment training
Medicaid documentation and compliance courses
Annual performance reviews and policy refreshers
7. MEDICAID WAIVER PROGRAMS
NFT Services are covered through:
Community HealthChoices (CHC): Coordinated by MCOs for Medicaid-eligible individuals transitioning from nursing homes.
Aging Waiver & Independence Waiver (OLTL): For individuals requiring HCBS post-discharge.
Money Follows the Person (MFP): May provide additional funding for transition expenses.
OBRA Waiver: For adults with physical disabilities under 60 requiring home-based supports.
8. TIMELINE TO LAUNCH
Phase: Business Registration & Policy Manual Development
Timeline: 1–2 months
Phase: Medicaid Enrollment & MCO Contracting
Timeline: 2–3 months
Phase: Staff Hiring & Credentialing
Timeline: 30–60 days
Phase: Referral Activation & Transition Coordination
Timeline: Begins once authorization agreements and MCO onboarding are complete
9. CONTACT INFORMATION
PA Department of Human Services – OLTL
Website: https://www.dhs.pa.gov
PROMISe™ Medicaid Provider Portal
Website: https://promise.dpw.state.pa.us
CHC MCO Contacts:
UPMC CHC – https://www.upmchealthplan.com
PA Health & Wellness – https://www.pahealthwellness.com
Keystone First CHC – https://www.keystonefirstchc.com
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — PENNSYLVANIA NFT PROVIDER
WCG helps providers build person-centered, fully compliant NFT programs that ease the transition from institutional to community living.
Scope of Work:
Business formation, Medicaid enrollment, and MCO contract support
Custom NFT Policy & Procedure Manual and housing tools
Transition tracking logs, safety checklists, and expense documentation templates
Staff onboarding plans, training logs, and credentialing checklists
Medicaid billing and audit preparation tools
Community Integration
COMMUNITY INTEGRATION SERVICES PROVIDER IN PENNSYLVANIA
FACILITATING SOCIAL CONNECTION, INCLUSION, AND SKILL-BUILDING FOR INDIVIDUALS WITH DISABILITIES THROUGH COMMUNITY-BASED SUPPORTS
Community Integration Services in Pennsylvania are Medicaid-funded supports designed to help individuals with intellectual and developmental disabilities (IDD) access and engage with their communities. These services promote inclusion, build natural supports, and empower individuals to participate in meaningful social, recreational, educational, and civic activities. Community Integration is authorized under Pennsylvania’s HCBS waivers through the Office of Developmental Programs (ODP).
1. GOVERNING AGENCIES
Agency: Pennsylvania Department of Human Services (DHS) – Office of Developmental Programs (ODP)
Role: Oversees waiver-funded Community Participation Support (CPS) and in-home community habilitation programs.
Agency: Administrative Entities (AEs) / County MH/ID Offices
Role: Coordinate provider qualification, service authorization, and ongoing compliance monitoring.
Agency: Centers for Medicare & Medicaid Services (CMS)**
Role: Provides federal regulation for HCBS-funded community integration services.
Agency: Pennsylvania Department of State
Role: Handles legal registration of business entities providing waiver-funded community services.
2. COMMUNITY INTEGRATION SERVICES OVERVIEW
These services assist individuals with disabilities in engaging with the broader community through meaningful and individualized experiences outside the home.
Approved providers may deliver:
In-Home and Community Habilitation: One-on-one or small group support to develop social and functional skills in real-world settings.
Community Participation Support (CPS): Facility-based or community-based services designed to increase access to and involvement in community activities.
Social Integration & Life Skills Training: Building relationships, navigating public spaces, and accessing transportation.
Civic & Volunteer Engagement: Support for participating in volunteerism, religious events, and community leadership.
Cultural, Recreational & Educational Access: Accompanying individuals to libraries, parks, fitness centers, museums, and community classes.
Documentation: Activity logs, service delivery notes, goal tracking, and billing records.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your business with the Pennsylvania Department of State.
Obtain an EIN and Type 2 NPI.
Complete the provider qualification process through ODP via HCSIS.
Develop and submit a Community Integration service description (e.g., for In-Home & Community Habilitation or CPS).
Maintain general liability and workers’ compensation insurance.
Develop a Community Integration Services Policy & Procedure Manual aligned with ODP expectations.
4. PENNSYLVANIA PROVIDER ENROLLMENT PROCESS
Step 1: Form your business entity and obtain EIN, NPI, and insurance.
Step 2: Apply for provider qualification via HCSIS and submit required documentation.
Step 3: Work with your local Administrative Entity (AE) or County MH/ID office for approval.
Step 4: Finalize policy manuals, staff credentials, and service models.
Step 5: Begin receiving referrals from Supports Coordinators once authorized.
5. REQUIRED DOCUMENTATION
Articles of Incorporation and business registration
EIN and NPI confirmation
Insurance certificates (liability and workers’ comp)
Community Integration Policy & Procedure Manual including:
Participant intake and goal-setting procedures
Community activity planning and safety protocols
ISP implementation tracking and documentation
Transportation safety and risk assessment policies
HIPAA and participant rights materials
Emergency and incident response procedures
Daily activity logs and Medicaid billing forms
6. STAFFING REQUIREMENTS
Role: Community Integration Specialist / Direct Support Professional (DSP)
Requirements: High school diploma (minimum), background clearance, training in person-centered support and community-based services.
Role: Program Coordinator
Requirements: Manages schedules, documentation review, and ensures ISP alignment with community goals.
Optional Role: Behavior Support Aide
Requirements: May assist individuals with behavioral challenges during community activities.
All staff must complete:
ODP orientation and annual refresher training
HIPAA and abuse prevention certification
Emergency response and safety planning
Activity documentation and Medicaid billing procedures
7. MEDICAID WAIVER PROGRAMS
Community Integration Services are authorized through:
Consolidated Waiver (ODP):
In-Home & Community Habilitation
Community Participation Support
Companion Services
Community Living Waiver (ODP):
Similar services as above for individuals not living in licensed residential settings
Person/Family Directed Support (P/FDS) Waiver:
Community integration services within the individual’s budget cap
8. TIMELINE TO LAUNCH
Phase: Business Registration & Policy Development
Timeline: 1–2 months
Phase: HCSIS Qualification & AE Review
Timeline: 2–3 months
Phase: Staff Hiring, Credentialing & Training
Timeline: 30–60 days
Phase: ISP Coordination & Service Activation
Timeline: Begins once AE approval and referrals are received
9. CONTACT INFORMATION
PA DHS – Office of Developmental Programs (ODP)
Website: https://www.myodp.org
HCSIS Provider Portal
Website: https://www.hcsis.state.pa.us
Administrative Entity Contact List
Available via your County MH/ID Office
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
PA Department of State – Business Registration
Website: https://www.dos.pa.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — PENNSYLVANIA COMMUNITY INTEGRATION PROVIDER
WCG helps providers create inclusive, compliant, and person-centered Community Integration programs across Pennsylvania.
Scope of Work:
Business registration and HCSIS qualification
Policy & Procedure Manual development
Community activity planning tools and safety checklists
Staff training logs, orientation packets, and credentialing templates
Service tracking and ISP progress forms
AE partnership support and SC referral development
Documentation and billing templates for compliance audits
Homemaker
HOMEMAKER SERVICES PROVIDER IN PENNSYLVANIA
PROMOTING INDEPENDENCE AND SAFETY THROUGH NON-MEDICAL SUPPORTS THAT HELP INDIVIDUALS MAINTAIN THEIR HOMES AND DAILY ROUTINES
Homemaker Services in Pennsylvania are Medicaid-funded supports that assist individuals with disabilities, chronic conditions, or aging-related limitations in maintaining a clean, safe, and functional home environment. These non-medical services are provided under Pennsylvania’s Home and Community-Based Services (HCBS) waivers through the Office of Long-Term Living (OLTL) and coordinated by Community HealthChoices (CHC) Managed Care Organizations (MCOs).
1. GOVERNING AGENCIES
Agency: Pennsylvania Department of Human Services (DHS) – Office of Long-Term Living (OLTL)
Role: Oversees waiver services that fund homemaker supports for eligible individuals.
Agency: Community HealthChoices (CHC) Managed Care Organizations (MCOs)
Role: Authorize homemaker services and coordinate care plans and reimbursement.
Agency: Centers for Medicare & Medicaid Services (CMS)**
Role: Provides federal oversight of Medicaid-funded HCBS services, including homemaker support.
Agency: Pennsylvania Department of State
Role: Registers provider businesses offering homemaker or personal assistance services.
2. HOMEMAKER SERVICES OVERVIEW
Homemaker Services offer in-home assistance with household tasks and instrumental activities of daily living (IADLs) to help individuals remain safely in their own homes.
Approved providers may deliver:
Light Housekeeping: Dusting, sweeping, vacuuming, mopping, and general room cleaning.
Laundry Support: Washing, drying, folding, and putting away clothes and linens.
Meal Preparation: Cooking basic meals in line with dietary instructions or cultural preferences.
Errands & Grocery Shopping: Running household errands or assisting clients with shopping needs.
Organization: Tidying living areas, rotating seasonal clothing, organizing medications (non-clinical), etc.
Companionship (non-medical): Social interaction and light supervision.
Documentation: Task logs, visit notes, and billing records.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your business with the PA Department of State.
Obtain an EIN from the IRS and a Type 2 NPI.
Enroll as a Medicaid provider in the PROMISe™ system.
Contract with CHC MCOs as a provider of homemaker or personal assistance services.
Maintain liability and workers’ compensation insurance.
Develop a Homemaker Services Policy & Procedure Manual compliant with OLTL and MCO requirements.
Note: A separate Home Care Agency license is not required if your services are strictly non-medical and do not involve ADLs.
4. PENNSYLVANIA PROVIDER ENROLLMENT PROCESS
Step 1: Form a legal business entity and secure EIN, NPI, and insurance.
Step 2: Enroll in PROMISe™ as a provider of non-medical waiver services.
Step 3: Contract with CHC MCOs serving your region (e.g., UPMC, PA Health & Wellness, Keystone First).
Step 4: Submit staff background checks, service descriptions, and policy documentation.
Step 5: Begin receiving referrals and authorizations for homemaker services.
5. REQUIRED DOCUMENTATION
Articles of Incorporation and business registration
EIN and NPI confirmations
Insurance certificates (liability and workers’ comp)
MCO provider contract confirmation
Homemaker Services Policy & Procedure Manual including:
Client intake and task scheduling procedures
Service documentation and visit note templates
Grievance, incident reporting, and emergency protocols
Staff supervision, training, and conduct expectations
Cultural sensitivity and confidentiality guidelines
Billing templates and service verification forms
EVV (Electronic Visit Verification) process (if required)
6. STAFFING REQUIREMENTS
Role: Homemaker / Housekeeping Aide
Requirements: Background check, CPR/First Aid (recommended), and training in IADL task delivery.
Role: Program Coordinator / Scheduler
Requirements: Oversees service assignments, client communication, and staff documentation compliance.
All staff must complete:
HIPAA and participant privacy training
Abuse prevention and safety protocols
Documentation standards and timekeeping procedures
Cultural competency and disability awareness (recommended)
Annual performance reviews and refresher training
7. MEDICAID WAIVER PROGRAMS
Homemaker Services are funded through:
Community HealthChoices (CHC): For adults 21+ who are dually eligible for Medicaid and Medicare.
Independence Waiver (OLTL): For adults with physical disabilities requiring household support.
OBRA and Aging Waivers (OLTL): For individuals needing long-term services to prevent institutionalization.
8. TIMELINE TO LAUNCH
Phase: Business Registration & Policy Manual Development
Timeline: 1–2 months
Phase: Medicaid Enrollment & MCO Contracting
Timeline: 2–3 months
Phase: Staff Hiring, Training & Background Checks
Timeline: 30–60 days
Phase: Referral Activation & Service Launch
Timeline: Begins once service authorizations are approved by CHC MCOs
9. CONTACT INFORMATION
PA Department of Human Services – OLTL
Website: https://www.dhs.pa.gov
PROMISe™ Medicaid Provider Portal
Website: https://promise.dpw.state.pa.us
CHC MCO Contacts:
UPMC CHC – https://www.upmchealthplan.com
PA Health & Wellness – https://www.pahealthwellness.com
Keystone First CHC – https://www.keystonefirstchc.com
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
PA Department of State – Business Services
Website: https://www.dos.pa.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — PENNSYLVANIA HOMEMAKER PROVIDER
WCG helps Homemaker Service providers in Pennsylvania launch compliant, efficient programs that support dignity, autonomy, and community-based living.
Scope of Work:
Business registration, Medicaid enrollment, and MCO onboarding
Homemaker Policy & Procedure Manual development
Client intake forms and service scheduling tools
Task documentation logs and visit note templates
Staff onboarding materials and training checklists
Referral strategies with case managers and MCOs
EVV system guidance and billing compliance tools
Case Management
CASE MANAGEMENT SERVICES PROVIDER IN PENNSYLVANIA
COORDINATING CARE, SERVICES, AND SUPPORTS TO HELP INDIVIDUALS NAVIGATE MEDICAID SYSTEMS AND LIVE SAFELY IN THEIR COMMUNITIES
Case Management Services in Pennsylvania are Medicaid-funded supports that assist individuals with disabilities, chronic illnesses, or aging-related needs in accessing and coordinating the full range of Home and Community-Based Services (HCBS). Case managers (also known as Service Coordinators or Supports Coordinators) develop service plans, monitor care delivery, and connect individuals with waiver services to improve quality of life and prevent institutionalization. These services are delivered under the Office of Long-Term Living (OLTL), Office of Developmental Programs (ODP), and Community HealthChoices (CHC) Managed Care Organizations (MCOs).
1. GOVERNING AGENCIES
Agency: Pennsylvania Department of Human Services (DHS) – OLTL & ODP
Role: Establishes standards, monitors performance, and funds case management services under HCBS waivers.
Agency: Community HealthChoices (CHC) Managed Care Organizations (MCOs)
Role: Contract with Service Coordination Entities (SCEs) to manage long-term supports for CHC members.
Agency: Centers for Medicare & Medicaid Services (CMS)**
Role: Oversees federal requirements for HCBS care coordination under 1915(c) and MLTSS programs.
Agency: Pennsylvania Department of State
Role: Handles business registration for provider entities delivering case management.
2. CASE MANAGEMENT SERVICES OVERVIEW
Case Management (also referred to as Supports Coordination or Service Coordination) includes comprehensive planning, facilitation, and oversight of all waiver services for eligible individuals.
Approved providers may deliver:
Comprehensive Assessments: Evaluating functional needs, strengths, risks, and preferences.
Service Planning: Developing, revising, and implementing Individual Support Plans (ISP) or Person-Centered Service Plans (PCSP).
Coordination & Referrals: Connecting individuals with housing, medical, behavioral, transportation, and social services.
Monitoring & Follow-Up: Ensuring timely service delivery, health and safety oversight, and plan compliance.
Crisis Intervention: Addressing emergent issues and coordinating supports during hospitalization or service interruption.
Documentation: Case notes, contact logs, ISP updates, critical incident reports, and Medicaid billing records.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your entity with the Pennsylvania Department of State.
Obtain an EIN and a Type 2 NPI.
Enroll with PROMISe™ as a Service Coordination Entity (SCE) or Supports Coordination Organization (SCO).
Contract with CHC MCOs (UPMC, PA Health & Wellness, Keystone First), ODP Administrative Entities, or OLTL waiver programs.
Maintain general liability, professional liability, and workers’ compensation insurance.
Develop a Case Management Services Policy & Procedure Manual consistent with DHS and CMS care coordination standards.
4. PENNSYLVANIA PROVIDER ENROLLMENT PROCESS
Step 1: Register your business and obtain EIN, NPI, and insurances.
Step 2: Submit provider qualification application through the HCSIS portal (ODP) or via CHC/OLTL pathways.
Step 3: Upload staffing plan, credentials, supervision protocols, and policies.
Step 4: Complete contracting and onboarding with MCOs or Administrative Entities.
Step 5: Begin receiving referrals and authorizations to conduct assessments and coordinate services.
5. REQUIRED DOCUMENTATION
Business registration and Articles of Incorporation
EIN and NPI confirmation
Insurance certificates (liability, professional, workers’ comp)
Case Management Policy & Procedure Manual including:
Intake, eligibility screening, and risk assessment procedures
Plan development and service authorization processes
Monitoring and follow-up protocols
Critical incident management and escalation procedures
Participant rights and informed choice guidelines
Documentation standards and visit note templates
Compliance logs and Medicaid billing formats
Staff training, supervision, and performance review policies
6. STAFFING REQUIREMENTS
Role: Supports/Service Coordinator
Requirements: Bachelor’s degree in social work, human services, or related field; knowledge of HCBS services; strong documentation and advocacy skills.
Role: Supervisor / Program Manager
Requirements: At least 2 years of relevant experience plus supervisory training; oversees caseloads and quality control.
Role: Intake Specialist (optional)
Requirements: Manages referrals, screening, and eligibility documentation.
All staff must complete:
Mandatory Reporter and abuse prevention training
HIPAA and participant rights modules
ISP/PCSP development and documentation training
Crisis response and incident management protocols
Annual refresher courses and performance evaluations
7. MEDICAID WAIVER PROGRAMS
Case Management Services are available through:
Community HealthChoices (CHC):
Managed care model for adults 21+ needing long-term services
Independence, OBRA, and Aging Waivers (OLTL):
OLTL authorizes case management for Medicaid-eligible adults with functional impairments
ODP Waivers (Consolidated, Community Living, P/FDS):
Supports Coordination provided by ODP-approved agencies
Act 150 Program (non-Medicaid):
State-funded case management for adults not yet MA-eligible
8. TIMELINE TO LAUNCH
Phase: Business Registration & Manual Development
Timeline: 1–2 months
Phase: Provider Enrollment & Contracting
Timeline: 2–3 months
Phase: Staff Hiring, Credentialing & Training
Timeline: 30–60 days
Phase: Referral Activation & Caseload Assignment
Timeline: Begins upon approval and onboarding with AE or CHC MCO
9. CONTACT INFORMATION
PA DHS – Office of Long-Term Living (OLTL)
Website: https://www.dhs.pa.gov
PA DHS – Office of Developmental Programs (ODP)
Website: https://www.myodp.org
HCSIS Provider Portal (ODP)
Website: https://www.hcsis.state.pa.us
PROMISe™ Medicaid Provider Portal
Website: https://promise.dpw.state.pa.us
Community HealthChoices MCOs:
UPMC CHC – https://www.upmchealthplan.com
Keystone First CHC – https://www.keystonefirstchc.com
PA Health & Wellness – https://www.pahealthwellness.com
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — PENNSYLVANIA CASE MANAGEMENT PROVIDER
WCG supports new Service Coordination and Supports Coordination agencies in Pennsylvania by equipping them with tools to deliver compliant, person-centered case management services.
Scope of Work:
Business registration, Medicaid enrollment, and provider qualification
Policy & Procedure Manual development
Staff onboarding materials and credentialing checklists
ISP/PCSP templates, documentation logs, and incident tracking
AE and MCO contract guidance
Quality assurance planning and audit preparation tools
Transportation
TRANSPORTATION SERVICES PROVIDER IN PENNSYLVANIA
HELPING INDIVIDUALS ACCESS HEALTH CARE, COMMUNITY ACTIVITIES, AND ESSENTIAL SERVICES THROUGH RELIABLE, MEDICAID-FUNDED TRANSPORTATION
Transportation Services in Pennsylvania are Medicaid-funded supports that assist individuals with disabilities, chronic health conditions, and aging-related needs in traveling to medical appointments, waiver services, employment, and community activities. These services promote independence, prevent isolation, and ensure access to vital resources. Transportation is authorized through the Department of Human Services (DHS), the Office of Long-Term Living (OLTL), the Office of Developmental Programs (ODP), and Community HealthChoices (CHC) Managed Care Organizations (MCOs).
1. GOVERNING AGENCIES
Agency: Pennsylvania Department of Human Services (DHS) – OLTL & ODP
Role: Funds transportation under HCBS waivers and ensures coordination with service plans.
Agency: Community HealthChoices (CHC) Managed Care Organizations (MCOs)
Role: Authorize and reimburse transportation for CHC members.
Agency: Medical Assistance Transportation Program (MATP) – County-Based
Role: Offers non-emergency transportation for Medicaid members not enrolled in CHC.
Agency: Centers for Medicare & Medicaid Services (CMS)**
Role: Oversees federal compliance for Medicaid-funded transportation services.
Agency: Pennsylvania Department of State
Role: Handles business registration for transportation providers.
Agency: Pennsylvania Public Utility Commission (PUC)
Role: Regulates non-emergency medical transportation (NEMT) providers operating for-hire vehicles.
2. TRANSPORTATION SERVICES OVERVIEW
These services ensure individuals can travel safely to approved Medicaid-covered appointments and community-based services as outlined in their care plans.
Approved providers may deliver:
Non-Emergency Medical Transportation (NEMT): Travel to doctors, therapy sessions, day programs, and other Medicaid-covered services.
Community Participation Transportation: Travel to recreational, social, or volunteer activities authorized through HCBS waivers.
Job & Employment Access: Transporting individuals to and from supported employment or vocational training sites.
Escort Support (optional): Staff accompaniment when individuals require supervision or assistance during travel.
Wheelchair-Accessible Transport: Specialized vehicles to support individuals with mobility needs.
Documentation: Trip logs, driver records, incident reports, and Medicaid billing logs.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your transportation company with the PA Department of State.
Obtain an EIN and a Type 2 NPI.
Apply for a PUC Operating Authority (if transporting for compensation).
Enroll with PROMISe™ as a Medicaid Transportation Provider.
Contract with CHC MCOs and coordinate with ODP/OLTL Service Coordinators.
Maintain general liability, vehicle, and workers’ compensation insurance.
Develop a Transportation Services Policy & Procedure Manual covering routing, safety, and billing protocols.
4. PENNSYLVANIA PROVIDER ENROLLMENT PROCESS
Step 1: Form a legal business entity and obtain EIN, NPI, and commercial insurance.
Step 2: Register as a transportation business with the PUC (Class B, C, or D depending on services).
Step 3: Enroll in PROMISe™ as a transportation service provider.
Step 4: Contract with MCOs (CHC), ODP AEs, or MATP vendors.
Step 5: Submit staff and driver credentials, policy documentation, and fleet info.
Step 6: Begin providing services upon contract execution and authorization.
5. REQUIRED DOCUMENTATION
Business registration and Articles of Incorporation
EIN and NPI confirmation
PUC certificate and driver clearances
Commercial auto and liability insurance
Vehicle inspection certificates
Transportation Services Policy & Procedure Manual including:
Trip authorization, pickup, and drop-off protocols
Vehicle safety, maintenance, and inspection guidelines
HIPAA and participant confidentiality safeguards
Emergency procedures and incident reporting
Driver background checks, training logs, and driving records
Trip logs, mileage tracking, and Medicaid billing forms
6. STAFFING REQUIREMENTS
Role: Transportation Driver
Requirements: Valid PA driver’s license; clean driving record; CPR/First Aid (recommended); background check; wheelchair securement and passenger safety training.
Role: Transportation Coordinator / Dispatcher
Requirements: Oversees scheduling, fleet management, routing, and client communication.
Role: Escort / Travel Aide (optional)
Requirements: Supports riders with behavioral, mobility, or cognitive needs.
All staff must complete:
HIPAA and abuse prevention training
Defensive driving and wheelchair securement (if applicable)
Incident reporting and client communication training
Annual DMV record checks and performance reviews
7. MEDICAID WAIVER PROGRAMS
Transportation services are funded through:
Community HealthChoices (CHC): Travel to waiver-authorized services and appointments
Independence, OBRA, and Aging Waivers (OLTL): For individuals needing accessible or escorted transport
Consolidated, Community Living, and P/FDS Waivers (ODP): Transport to day programs, employment, and community participation
Medical Assistance Transportation Program (MATP): Non-emergency transport for Medicaid beneficiaries not under CHC
8. TIMELINE TO LAUNCH
Phase: Business Formation & Manual Development
Timeline: 1–2 months
Phase: PUC Certification & Medicaid Enrollment
Timeline: 2–3 months
Phase: Driver Hiring, Credentialing & Vehicle Prep
Timeline: 30–60 days
Phase: Contracting & Service Launch
Timeline: Begins once provider is onboarded by CHC MCO or AE and authorized for trip coordination
9. CONTACT INFORMATION
PA DHS – Office of Long-Term Living (OLTL)
Website: https://www.dhs.pa.gov
PA DHS – Office of Developmental Programs (ODP)
Website: https://www.myodp.org
PA Public Utility Commission (PUC)
Website: https://www.puc.pa.gov
PROMISe™ Medicaid Provider Portal
Website: https://promise.dpw.state.pa.us
Community HealthChoices MCOs:
UPMC CHC – https://www.upmchealthplan.com
Keystone First CHC – https://www.keystonefirstchc.com
PA Health & Wellness – https://www.pahealthwellness.com
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — PENNSYLVANIA TRANSPORTATION PROVIDER
WCG helps Transportation providers in Pennsylvania become Medicaid-authorized, compliance-ready vendors serving individuals across waiver and MCO programs.
Scope of Work:
Business registration, PUC certification, and Medicaid enrollment
Policy & Procedure Manual development
Fleet readiness checklist and maintenance logs
Trip authorization and billing documentation templates
Driver onboarding toolkit with credentialing and training logs
Contracting support with CHC MCOs, AEs, and MATP administrators
Compliance readiness and audit preparation
Home Health
HOME HEALTH CARE SERVICES PROVIDER IN PENNSYLVANIA
DELIVERING CLINICAL CARE AT HOME TO SUPPORT RECOVERY, CHRONIC CONDITION MANAGEMENT, AND INDEPENDENT LIVING
Home Health Care Services in Pennsylvania are Medicaid-funded clinical services provided in an individual’s home for the purpose of treating illness, managing chronic health conditions, or aiding recovery after surgery or hospitalization. These services must be medically necessary, ordered by a physician, and delivered by licensed professionals. Home Health Care is authorized through the Pennsylvania Medical Assistance Program (via PROMISe™), the Office of Long-Term Living (OLTL), Community HealthChoices (CHC) Managed Care Organizations (MCOs), and in some cases, via private insurance or Medicare.
1. GOVERNING AGENCIES
Agency: Pennsylvania Department of Health (DOH) – Division of Home Health
Role: Licenses Home Health Agencies (HHAs) and ensures compliance with state and federal regulations.
Agency: Pennsylvania Department of Human Services (DHS) – Office of Long-Term Living (OLTL)
Role: Coordinates Medicaid-funded home health services and authorizations through waiver programs and CHC.
Agency: Community HealthChoices (CHC) Managed Care Organizations (MCOs)
Role: Authorize and reimburse for home health services for individuals in CHC.
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal regulation and oversight for home health care reimbursement through Medicaid and Medicare.
Agency: Pennsylvania Department of State
Role: Handles legal registration of provider businesses.
2. HOME HEALTH CARE SERVICES OVERVIEW
Home Health Care includes intermittent, short-term, or ongoing skilled care provided in a residential setting, under a physician's order.
Approved providers may deliver:
Skilled Nursing: Wound care, medication administration, IV therapy, chronic disease monitoring.
Home Health Aide Services: Assistance with ADLs under the supervision of a nurse.
Physical Therapy (PT): Post-operative rehabilitation, mobility improvement.
Occupational Therapy (OT): ADL skill-building and adaptive strategies.
Speech Therapy (ST): Communication and swallowing therapy.
Medical Social Services: Counseling and coordination of care and services.
Documentation & Care Coordination: Plan of care development, visit notes, electronic charting, and billing.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your business with the Pennsylvania Department of State.
Obtain an EIN and a Type 2 NPI.
Apply for a Home Health Agency License from the PA Department of Health.
Enroll as a Medicaid provider via PROMISe™ and contract with CHC MCOs.
Obtain accreditation (e.g., CHAP, ACHC, Joint Commission – recommended but not required).
Maintain general liability, workers’ compensation, and malpractice insurance.
Develop a Home Health Care Services Policy & Procedure Manual in accordance with Pennsylvania DOH and CMS standards.
4. PENNSYLVANIA PROVIDER ENROLLMENT PROCESS
Step 1: Register your business entity and obtain EIN, NPI, and insurances.
Step 2: Apply for a Home Health Agency License through the DOH.
Step 3: Enroll in PROMISe™ as a home health provider.
Step 4: Contract with Community HealthChoices MCOs (UPMC, Keystone First, PA Health & Wellness).
Step 5: Complete credentialing and readiness reviews to begin receiving referrals.
5. REQUIRED DOCUMENTATION
Articles of Incorporation and business registration
Home Health Agency License (PA DOH)
Accreditation certificate (if applicable)
EIN and NPI confirmation
Insurance certificates (general liability, malpractice, workers’ comp)
Home Health Policy & Procedure Manual including:
Admission and discharge criteria
Physician order tracking and plan of care development
Medication administration and nursing protocols
Infection control, emergency preparedness, and patient safety
HIPAA compliance and documentation standards
Visit note templates and electronic charting formats
Billing processes and audit readiness tools
6. STAFFING REQUIREMENTS
Role: Registered Nurse (RN) / Clinical Supervisor
Requirements: Active PA license; develops care plans, supervises aides, delivers skilled care.
Role: Home Health Aide (HHA)
Requirements: Completion of state-approved training program; background check and CPR certification.
Role: Therapists (PT, OT, ST)
Requirements: Active PA licensure; provides therapy as prescribed by a physician.
Role: Medical Social Worker
Requirements: MSW; supports psychosocial aspects of care.
All staff must complete:
HIPAA and patient rights training
Infection control and universal precautions
Documentation and billing compliance education
Annual continuing education and performance evaluations
7. MEDICAID WAIVER PROGRAMS
Home Health Care Services are covered under:
State Plan Medicaid Home Health Benefit: Physician-ordered, medically necessary services.
Community HealthChoices (CHC): Skilled care services authorized through MCOs.
Aging Waiver (OLTL): For seniors requiring skilled care to remain at home.
OBRA and Independence Waivers (OLTL): Home health for younger adults with physical disabilities.
Act 150 Program (non-Medicaid): Similar to waivers, but state-funded.
8. TIMELINE TO LAUNCH
Phase: Business Registration & Manual Development
Timeline: 1–2 months
Phase: DOH Licensing & Medicaid Enrollment
Timeline: 3–4 months (depending on inspection schedules)
Phase: MCO Contracting & Staff Credentialing
Timeline: 1–2 months
Phase: Referral Activation & Service Start
Timeline: Begins once contracts and readiness reviews are completed
9. CONTACT INFORMATION
PA Department of Health – Home Health Licensing
Website: https://www.health.pa.gov
PA Department of Human Services – OLTL
Website: https://www.dhs.pa.gov
PROMISe™ Medicaid Provider Enrollment
Website: https://promise.dpw.state.pa.us
Community HealthChoices MCO Contacts:
UPMC Community HealthChoices – https://www.upmchealthplan.com
Keystone First CHC – https://www.keystonefirstchc.com
PA Health & Wellness – https://www.pahealthwellness.com
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — PENNSYLVANIA HOME HEALTH CARE PROVIDER
WCG provides comprehensive guidance to help launch and scale compliant Home Health Agencies across Pennsylvania.
Scope of Work:
Business formation and Home Health licensing support
Medicaid enrollment and MCO contract navigation
Home Health Policy Manual development and documentation templates
RN and aide credentialing logs and supervision checklists
EMR/EHR implementation readiness
Audit preparation tools and compliance walkthroughs
Referral-building strategies and care coordination workflows
Meal & Nutrition
MEAL & NUTRITION SERVICES PROVIDER IN PENNSYLVANIA
SUPPORTING WELLNESS AND INDEPENDENT LIVING THROUGH MEAL PREPARATION, DELIVERY, AND NUTRITIONAL SUPPORT SERVICES
Meal & Nutrition Services in Pennsylvania are Medicaid-funded supports that ensure individuals with disabilities, chronic conditions, or aging-related limitations receive regular access to balanced, nutritious meals. These services are essential for preventing malnutrition, promoting health, and helping individuals live safely and independently in their homes. Meal services are authorized through Pennsylvania’s Home and Community-Based Services (HCBS) waivers via the Office of Long-Term Living (OLTL), Office of Developmental Programs (ODP), and Community HealthChoices (CHC) Managed Care Organizations (MCOs).
1. GOVERNING AGENCIES
Agency: Pennsylvania Department of Human Services (DHS) – OLTL & ODP
Role: Administers HCBS waivers that authorize nutrition support and meal preparation/delivery.
Agency: Community HealthChoices (CHC) MCOs
Role: Authorize and reimburse meal services for waiver-eligible individuals.
Agency: Centers for Medicare & Medicaid Services (CMS)**
Role: Provides federal regulatory oversight of meal services under HCBS waivers.
Agency: Pennsylvania Department of State
Role: Handles business registration for meal service providers.
Agency: Pennsylvania Department of Agriculture or Local Health Department
Role: Regulates food handling, kitchen certification, and food safety compliance (when applicable).
2. MEAL & NUTRITION SERVICES OVERVIEW
These services provide in-home meal preparation or home-delivered meals for individuals unable to consistently shop or cook due to functional limitations.
Approved providers may deliver:
In-Home Meal Preparation: Cooking meals in the client’s home according to dietary needs.
Home-Delivered Meals: Providing hot, cold, or frozen meals on a scheduled basis.
Menu Planning: Creating balanced meal plans in collaboration with caregivers or clinicians.
Feeding Assistance (non-clinical): Assisting with safe meal consumption in alignment with the care plan.
Nutrition Education (optional): Teaching individuals or caregivers how to maintain a healthy diet.
Dietary Support (with RD credentials): Services provided by Registered Dietitians for individuals with complex health conditions.
Documentation: Delivery logs, meal plans, dietary restrictions, and billing forms.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register your business with the PA Department of State.
Obtain an EIN and Type 2 NPI.
Enroll in PROMISe™ as a Medicaid provider under waiver-authorized service codes.
Contract with CHC MCOs or ODP Administrative Entities.
Secure a food handler’s license or kitchen certification (if preparing food off-site).
Maintain liability and workers’ compensation insurance.
Develop a Meal & Nutrition Services Policy & Procedure Manual that includes food safety, menu design, and client-specific customization.
4. PENNSYLVANIA PROVIDER ENROLLMENT PROCESS
Step 1: Register your business, obtain EIN/NPI, and purchase insurance coverage.
Step 2: If applicable, register your kitchen and meal production site with the PA Department of Agriculture or local health department.
Step 3: Enroll in PROMISe™ as a waiver meal services provider.
Step 4: Contract with CHC MCOs and/or qualify with your local Administrative Entity (ODP waivers).
Step 5: Upload all required documents and prepare for readiness review or pre-authorization process.
5. REQUIRED DOCUMENTATION
Articles of Incorporation and business registration
EIN and NPI confirmation
Insurance certificates (liability, workers’ comp)
Food safety inspection certificate (if applicable)
Meal & Nutrition Services Policy & Procedure Manual including:
Meal planning and dietary restriction tracking
Delivery routing and storage procedures
Infection control and food handling guidelines
Client rights, consent, and intake forms
Missed delivery and backup food protocols
Service documentation templates and billing formats
HIPAA compliance and nutrition education materials
6. STAFFING REQUIREMENTS
Role: Meal Delivery Driver / In-Home Cook
Requirements: Food handler’s permit, background check, and basic safety training.
Role: Registered Dietitian (optional)
Requirements: PA-licensed RD for nutrition education or therapeutic diet consultation.
Role: Program Coordinator / Scheduler
Requirements: Manages client intake, delivery scheduling, and care plan coordination.
All staff must complete:
HIPAA and abuse prevention training
Safe food handling and sanitation training
Emergency protocols and customer interaction procedures
Cultural sensitivity and dietary preference awareness
7. MEDICAID WAIVER PROGRAMS
Meal & Nutrition Services are reimbursed under:
Community HealthChoices (CHC): For older adults and individuals with disabilities
Independence, OBRA, and Aging Waivers (OLTL): For individuals at risk of institutional placement
ODP Waivers (Consolidated, Community Living, P/FDS):
Covers in-home meal preparation and nutrition-related training
8. TIMELINE TO LAUNCH
Phase: Business Formation & Manual Development
Timeline: 1–2 months
Phase: Kitchen/Food License & Medicaid Enrollment
Timeline: 2–3 months
Phase: Staff Hiring, Training & Routing Setup
Timeline: 30–60 days
Phase: Referral Activation & Meal Delivery
Timeline: Begins once MCO contracts and waiver authorizations are received
9. CONTACT INFORMATION
PA Department of Human Services – OLTL & ODP
Website: https://www.dhs.pa.gov
PROMISe™ Medicaid Provider Enrollment
Website: https://promise.dpw.state.pa.us
Community HealthChoices MCOs:
UPMC CHC – https://www.upmchealthplan.com
PA Health & Wellness – https://www.pahealthwellness.com
Keystone First CHC – https://www.keystonefirstchc.com
PA Department of Agriculture – Food Safety Division
Website: https://www.agriculture.pa.gov
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — PENNSYLVANIA MEAL & NUTRITION PROVIDER
WCG helps providers across Pennsylvania establish safe, compliant, and person-centered meal services for waiver recipients.
Scope of Work:
Business registration, Medicaid enrollment, and kitchen licensing guidance
Policy & Procedure Manual tailored to meal delivery and in-home prep
Delivery route planning tools and client intake forms
Nutrition log templates and dietary tracking sheets
Staff training modules on food safety and cultural preferences
Contract support with CHC MCOs and AE referral development
Medicaid billing preparation and compliance audit tools
Our Client Portal offers a wealth of resources that you can explore related to various programs and state requirements.