How to Start a Home Care Agency in Pennsylvania in 2026

Concepts Central Support
10 min read · Updated November 2026 · 10 sections

Planning a non-medical home care agency in Pennsylvania starts with two decisions: whether you are an agency, a registry or both, and how you will meet the Department of Health's (DOH) licensing requirements under 28 Pa. Code Chapter 611. You will also need procedures for caregiver files, client information, scheduling and after-hours calls from the first client.

If you plan to serve Medicaid participants, provider enrollment, EVV and managed care contracting are a separate part of your launch plan. This guide organizes those steps and links to the sources.

This article is general information. It is not legal or licensing advice. Requirements change; confirm the current rules with the Department of Health, the Department of Human Services and your attorney before you apply.

Agency or registry: decide first

Pennsylvania licenses two kinds of non-medical home care businesses under 28 Pa. Code Chapter 611. The definitions in § 611.5:

Home care agency: "An organization that supplies, arranges or schedules employees to provide home care services."
Home care registry: an organization that "supplies, arranges or refers independent contractors to provide home care services."

The difference is employees versus independent contractors. A business can be licensed as one or both. In the October 2026 DOH list, 3,455 licenses were agency only, 1,177 were combined agency/registry, and 49 were registry only. Most licenses include the agency model, with W-2 caregivers.

Context: how many agencies are new. DOH publishes a monthly list of every license held by its Division of Home Health. Comparing the March 2024 and October 2026 lists, about 1,550 of the 4,681 current home care licenses have facility IDs that did not appear in March 2024, roughly one in three. A change of ownership can also create a new ID, so this is not a count of brand-new businesses. It is our own comparison of the two lists, not a DOH statistic.

"Home care services" under Chapter 611 means personal care, help with instrumental activities of daily living, companionship, respite and specialized non-skilled care. Skilled nursing and therapy belong to home health agencies, which this guide does not cover.

The license: Chapter 611 basics

Section 611.2 sets the core rules:

No one may operate or "hold itself out as operating" a home care agency or registry without a DOH license.
Each physical location is licensed separately, with its own application and fee.
The fee is $100 per application, with no refunds.
DOH "will conduct an inspection prior to issuing an initial license or a license renewal."
Renewals must be submitted at least 60 days before the license expires.

Section 611.4 adds that you must keep a current copy of Chapter 611 at the agency.

Home care agencies must apply online

DOH's Division of Home Health moved home care applications to an online system. The DOH home care page states: "Mailed or emailed submissions will no longer be accepted effective March 31, 2026." Initial applications, renewals and change-of-ownership applications all go through the Initial Provider Application portal linked from that page. Questions go to the Division's resource accounts listed on the same page.

Caregiver files: what DOH expects to see

Most of Chapter 611 is about the direct care worker (DCW). Sections 611.51 to 611.56 require:

Requirement	Section	Key details
References	§ 611.51(a)(2)	At least two satisfactory, verifiable references from someone not related to the applicant
Interview	§ 611.51(a)(1)	The regulation calls for a face-to-face interview; Act 96 of 2024 changed part of this rule. Check current DOH guidance on permitted interview methods
Criminal history	§ 611.52	State Police record if a PA resident for the past 2 years; otherwise an FBI record and a Department of Aging letter of determination. Also required for office staff and owners
Child abuse clearance	§ 611.53	ChildLine verification if the agency serves anyone under 18
Provisional hiring	§ 611.54	Allowed while checks are pending, up to 30 days (PA residents of 2+ years) or 90 days (others), and not before competency is met
Competency	§ 611.55	Nurse license, a passed competency exam, or an approved training program, documented in the file
Health screening	§ 611.56	TB screening dated no more than 1 year before the start date, updated every 12 months

A competency examination or training program developed by the agency must cover ten subjects, including confidentiality, infection control, emergencies, documentation and recognizing abuse or neglect, plus six more for workers who provide personal care (§ 611.55(b)-(c)).

The annual competency review

Section 611.55(e) requires the agency to review each caregiver's competency "at least once per year after initial competency is established," through direct observation, testing, training, consumer feedback or another approved method. The review must be more frequent after discipline for a quality-of-care problem. Because each caregiver's due date is different, this is easy to fall behind on as the agency grows.

A clarification that often causes confusion: Chapter 611 does not set a schedule of "supervisory visits" for non-medical home care agencies. The 14-day and 60-day supervisory visit cycle comes from federal rules for Medicare-certified home health agencies (42 CFR 484.80(h)). Your agency, your MCO contracts or your own policy may set supervision practices, but the state licensing rule for home care is the annual competency review.

Consumer protections

Before services start, § 611.57(c) requires an information packet listing the services, caregiver, hours, fees, DOH contacts, the complaint hotline (1-866-826-3644), the local Ombudsman, caregiver requirements, and the worker's employee or contractor status. Section 611.57(a) also gives consumers the right to at least 10 calendar days' written notice before the agency ends services, with limited exceptions.

The annual DOH survey and Plan of Correction

DOH inspects licensed home care agencies and registries "every 12 months based on state regulations," and more often if an agency "has a history of serious problems, or if complaints are received." Surveyors review records, interview staff, consumers and caregivers, and may observe care with consent (§ 611.5, definition of "inspection").

If the survey finds problems, DOH issues a Statement of Deficiencies and the agency submits a Plan of Correction. DOH notes that "if the problems are very severe, the Department may revoke the HCA/HCR license."

For a new agency, the lesson is to prepare files to meet survey requirements from the first hire, not the week before the survey.

Medicaid enrollment and the managed care networks

Medicaid enrollment and CHC contracting are additional steps for agencies that plan to serve Medicaid participants. They are separate from DOH licensing and from other business requirements that may apply to your agency.

1. Enroll with DHS. Providers must enroll with the Department of Human Services before participating in Medical Assistance (DHS, PROMISe Provider Enrollment). The Community HealthChoices waiver lists the qualifications for a home care agency providing Personal Assistance Services, including the Chapter 611 license, compliance with 55 Pa. Code Chapters 52 and 1101, general liability, professional liability and workers' compensation insurance, and DCWs who are at least 18 and meet the § 611.55 competency rules.

2. Plan for annual staff training. 55 Pa. Code § 52.21 requires annual training for OLTL providers, covering topics such as abuse prevention, critical incidents, complaints and fraud, with attendance records kept.

3. Contract with the CHC MCOs. Community HealthChoices, Pennsylvania's Medicaid managed care program for long-term services and supports for adults, is run by three MCOs: Keystone First CHC, PA Health & Wellness and UPMC CHC. Getting a contract is not automatic. In April 2024 testimony, the Pennsylvania Homecare Association (PHA) told legislators that "New providers to the state of Pennsylvania have expressed frustration due to the closed provider networks at all three MCOs." Build your business plan so that it does not depend on MCO contracts arriving on a fixed date.

For how authorizations, start dates and recoupments work once you are in network, see our guide to Community HealthChoices for providers.

EVV from day one

If you bill Medicaid for personal care, every visit must be electronically verified. Federal law (Social Security Act § 1903(l)) requires EVV for personal care services, and Pennsylvania has denied CHC personal care encounters without a matching visit in the DHS EVV Aggregator since January 1, 2021 (OLTL Bulletin 07-20-04).

Pennsylvania uses an "open" model. Choose an EVV system for your payer mix:

The free DHS EVV system (Sandata), for fee-for-service visits. It does not capture visits for MCO submission. The DHS aggregator that receives EVV data is a separate function from the system used to capture visits.
An alternate EVV vendor certified by DHS. The list of certified vendors was updated March 1, 2026.
HHAeXchange, or a compatible alternate, for CHC. For CHC visits, use the MCO's EVV system or an alternate system that meets the plan's integration requirements. DHS says providers serving CHC participants "will have the option to use the MCO's EVV system, HHAeXchange." The three CHC MCOs use it as their provider portal for authorizations, visits and claims. PA Health & Wellness requires that PAS be billed only through HHAeXchange; a third-party EVV system is acceptable only if it interfaces with HHAeXchange, and PHW warns that "the integration process can take 6 weeks or more."

Two rules apply from the first visit:

85% without manual edits. Since January 1, 2025, at least 85% of your EVV records must be verified without manual edits, in each program (MA Bulletin 05-24-01). Changes made after the visit generally count as manual edits; check your plan's instructions for specific exceptions, such as PA Health & Wellness's guidance for qualifying midnight-shift corrections.
Alerts and corrective action. Starting January 2026, providers above 15% manual entries receive alerts from DHS (fee-for-service) or follow-up from their MCO (MA Bulletin 05-25-03). Two consecutive quarters above the threshold lead to a corrective action plan in fee-for-service, or corrective action by the MCO (MA Bulletin 05-25-03).

Train every caregiver on clock-in and clock-out before their first shift.

Your first authorizations

Under the 2026 CHC Agreement, new or increased PAS must "commence within seven (7) business days of the approval, unless the Participant requests a longer timeframe." For a new agency with a small caregiver pool, that is the first real operational test.

Before you accept your first CHC referrals:

Have caregivers screened, with caregiver files that hold the required documentation, before the referral arrives, not after.
Build each schedule from the service plan's type, scope, amount, duration and frequency. Payment follows the approved plan (55 Pa. Code § 52.42(d)), and units over the authorization are typically held or denied.
Track each authorization's end date from day one.

After-hours coverage from the first client

The first caregiver call-out on a Saturday night will come sooner than you expect. Keystone First CHC, in its August 2025 reminder about PAS start dates, suggested that providers "Confirm on-call availability of staff for immediate response" and "Maintain contingency plans for backup assistance in case of staff unavailability."

At minimum, decide before your first client:

Who answers the agency phone after hours, every night and weekend.
What that person can decide alone, and when they call the owner.
How a missed shift is covered, and who contacts the client.
How incidents are documented and reported. OLTL providers must follow the critical incident rules in 55 Pa. Code § 52.17.
How the next morning's team learns what happened overnight.

Many owners cover the phone themselves at first. Writing the rules down early makes it possible to hand it to someone else later.

A startup checklist

Before you apply - Choose agency, registry or both, and each physical location. - Read Chapter 611 in full and keep a copy at the office. - Prepare policies for hiring, competency, health screening and consumer information.

Before your first client - Submit the online DOH application and complete the pre-license inspection. - Build DCW files that meet §§ 611.51-611.56. - Prepare the § 611.57 consumer information packet. - Set up after-hours coverage and escalation rules.

Before Medicaid billing (if you plan to serve Medicaid participants) - Enroll with DHS and meet the CHC waiver qualifications. - Choose an EVV system for your payer mix: the free DHS system for fee-for-service visits, or an MCO-compatible system for CHC visits, and set up HHAeXchange access for CHC. - Apply to the MCO networks, knowing PHA has reported closed networks.

Every year - Competency reviews, TB screening updates and § 52.21 training for every caregiver. - License renewal at least 60 days before expiration, and readiness for the DOH survey.

How Concepts Central Support helps

Concepts Central Support provides remote operational support to Pennsylvania home care agencies, including new ones: after-hours and on-call coverage, scheduling, EVV monitoring, authorization utilization, DCW candidate screening and tracking of competency reviews and supervisory visits your agency schedules. Our team comes with 10 years of experience in home care operations. If you are setting up a new agency, contact us to talk about what support would fit.

Sources

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Related guides.

Community HealthChoices9 min readCommunity HealthChoices for Home Care ProvidersHow Community HealthChoices works for Pennsylvania home care providers: service plans, 7-business-day starts, authorization limits, EVV and repayment.Read the guide

Compliance9 min readSupervisory Visits in Pennsylvania: What Ch. 611 RequiresDoes Pennsylvania require supervisory visits for home care aides? What 28 Pa. Code Chapter 611 requires, what Medicare adds, and how to track it all.Read the guide

After-hours9 min readCaregiver Call-Offs at Night: An After-Hours PlaybookHow Pennsylvania home care agencies can handle caregiver call-offs after hours: escalation rules, backup lists, documentation and the morning summary.Read the guide

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