Supervisory Visits in Pennsylvania: What Ch. 611 Requires

Pennsylvania's Chapter 611 and the federal rules for Medicare-certified home health agencies cover different responsibilities. Chapter 611 requires documented competency reviews for direct care workers but does not set a recurring supervisory visit interval. For Medicare-certified agencies, 42 CFR 484.80(h) sets aide supervision intervals that depend on whether the patient receives skilled services. The 14-, 60- and 90-day numbers you hear come from these different rules, or from contracts and agency policy.

This guide helps you identify which rule applies to your agency, then covers how to track due dates and documentation ahead of your annual Department of Health survey.

Two kinds of agencies, two sets of rules

Pennsylvania licenses home care in more than one way, and the supervision rules follow the license and the payer.

• Home care agencies (non-medical personal care) are licensed by the Department of Health under 28 Pa. Code Chapter 611. Many of them provide personal assistance services (PAS) to Community HealthChoices participants.
• Home health agencies that are certified by Medicare must also meet the federal Conditions of Participation in 42 CFR Part 484, including the home health aide supervision standard.

If your agency is a Chapter 611 home care agency and not Medicare-certified, the federal 14- and 60-day schedule is not the rule you are measured against. If you are Medicare-certified, it is.

What Chapter 611 does not say

Chapter 611 is short. Its official table of contents lists twelve sections: general provisions (§§ 611.1 to 611.5) and "Governance and Management" (§§ 611.51 to 611.57). None of them sets a supervisory visit every set number of days for a direct care worker (DCW).

That is worth stating plainly because "supervisory visits every 60 days, as required by Pennsylvania" circulates as if it were a Chapter 611 rule. For a non-medical home care agency, it isn't one. That doesn't mean supervision is optional. It means the obligations are framed differently, and they are the ones the Department of Health checks.

What Chapter 611 does require

An annual competency review for every DCW

Under § 611.55, each direct care worker must establish competency through a nursing license, a competency examination or a recognized training program. The annual review is a separate, ongoing requirement under § 611.55(e): "The competency review must occur at least once per year after initial competency is established."

The regulation allows the review to be done by direct observation, testing, training, consumer feedback or another approved method. Documentation goes in the worker's file. In practice, an in-home observation of the worker is one common way agencies meet this, which is part of why "supervisory visit" and "competency review" are often used as if they were the same thing.

Complete worker files

Sections 611.51 to 611.56 describe what has to be in place for each DCW: verifiable references, criminal history checks (§ 611.52), child abuse clearance where it applies (§ 611.53), the rules for provisional hiring (§ 611.54), competency (§ 611.55) and health screening (§ 611.56). Keep the required documentation in each worker's file and track the relevant review dates.

A consumer information packet

Under § 611.57, before services begin the agency must give the consumer written information that includes the services to be provided and the assigned worker, the hours of service, the fees, the Department's contact information and complaint hot line, and the worker hiring and competency requirements. The agency must keep "documentation on file" that this was provided, "available for Department inspection." The same section requires written notice at least 10 days before the agency terminates services.

An inspection every 12 months

The Department of Health says it "conducts inspections of home care agencies (HCA)/home care registries (HCR) every 12 months based on state regulations," and that agencies with a history of serious problems, or with complaints, may be inspected more often. Problems found are written up in a Statement of Deficiencies, and the agency responds with a Plan of Correction.

The survey is where all of the above is checked: competency reviews, worker files and consumer packets.

If you serve CHC participants: Chapter 52 adds more

Agencies enrolled with the Office of Long-Term Living to provide waiver services, including PAS under Community HealthChoices, also follow 55 Pa. Code Chapter 52. Two parts are relevant here.

Annual staff training. Section 52.21 requires standard annual training for staff, covering topics that include prevention of abuse and exploitation of participants and reporting critical incidents, with records of attendance and content. The CHC waiver requires home care agencies providing PAS to "provide staff training pursuant to 55 PA Code Chapter 52, Section 52.21."

Service Coordinator verification. Under § 52.26(a)(10), the participant's Service Coordinator must "ensure and document at least on a quarterly basis that the participant's services are being delivered in the type, scope, amount, duration and frequency as required by the participant's service plan." This is the Service Coordinator's duty, not the agency's, but it means someone outside your agency is regularly checking whether the authorized hours are being delivered.

If you are Medicare-certified: the 14- and 60-day rules

For Medicare-certified home health agencies, 42 CFR 484.80(h) sets specific supervision intervals for home health aides:

• Patients receiving skilled services (nursing, physical or occupational therapy, or speech-language pathology): a registered nurse or other appropriate skilled professional must complete a supervisory assessment of the aide services "no less frequently than every 14 days." The aide does not need to be present. The assessment is onsite, or on the rare occasion by real-time two-way audio-video, "not to exceed 1 virtual supervisory assessment per patient in a 60-day episode."
• Patients not receiving skilled services: the registered nurse "must make an onsite, in person visit every 60 days." The aide does not need to be present.
• Observing each aide at work: an annual on-site visit to observe and assess each aide while performing care (skilled patients), or a semi-annual visit for aides providing non-skilled care.
• When there is a problem: if a deficiency is verified on an on-site visit, the agency must provide "retraining and a competency evaluation for the deficient and all related skills."

These are the numbers most people mean when they say "14 days" or "60 days." They apply to Medicare-certified home health agencies.

Other schedules: your MCO contract and your own policy

Beyond regulation, two other sources can set a supervisory visit schedule:

1. Your provider agreement. Managed care organizations can include supervision or quality requirements in their contracts or provider manuals. These are not always public, and they can differ between plans. Read your agreement and the plan's current provider manual, and keep a note of any schedule they set.
2. Your agency's own policies. Many agencies set their own supervisory visit schedule as part of quality management. Once it is written into your policies, surveyors and plans can reasonably expect you to follow it. A policy you don't follow can create more trouble than having no specific schedule.

The practical rule: know which schedule applies to each client, and why.

A summary table

Requirement	Who it applies to	How often	Source
Competency review of each DCW	Licensed home care agencies	At least once a year after initial competency	28 Pa. Code § 611.55(e)
Worker file: references, background checks, competency, health screening	Licensed home care agencies	Before work begins, kept current	28 Pa. Code §§ 611.51-611.56
Consumer information packet	Licensed home care agencies	Before services begin	28 Pa. Code § 611.57
Department of Health inspection	Licensed home care agencies	Every 12 months, more often if needed	PA Department of Health
Annual staff training	OLTL waiver providers, including CHC PAS	Every year	55 Pa. Code § 52.21
Service Coordinator verification of services	CHC participants (done by the SC)	At least quarterly	55 Pa. Code § 52.26(a)(10)
Aide supervisory assessment, skilled patients	Medicare-certified home health agencies	At least every 14 days	42 CFR 484.80(h)(1)
Aide supervisory visit, non-skilled patients	Medicare-certified home health agencies	Every 60 days	42 CFR 484.80(h)(2)
Supervisory visits under contract or policy	Depends on your MCO agreement or agency policy	As written there	Your provider agreement or policies

How to track it without a scramble

The requirements are not complicated on their own. What causes deficiencies is usually the number of dates: one competency date per worker, several document dates per file, one packet per client, plus whatever schedule your contracts or policies add. A few habits help.

Keep one calendar per requirement, not per person's memory. For each DCW, record the date initial competency was established and the date the next annual review is due. For each client, record the supervisory visit schedule that applies and the source of it (policy, contract, or 42 CFR 484.80 if certified).

Track three states, not two. "Done" and "not done" isn't enough. Track "due soon" as well, with a reminder far enough ahead for a supervisor to schedule the visit.

Record completion with the evidence. A visit isn't complete in your records until the note or form is in the file. Record who did it, the date and where the documentation is.

Close follow-up items. If a review finds that a worker needs retraining, or a client's needs have changed, track that item until it is resolved and documented.

Review files before the survey, not during it. Pick a sample of worker files and client files every quarter and check them against the list above. Whatever is missing in March is easier to fix than whatever is missing on survey day.

Check your contracts once a year. Provider manuals change. Note the date you last reviewed each plan's requirements.

This article is general information for Pennsylvania home care agencies, not legal advice. Regulations, bulletins and MCO requirements change; check the current text and your provider agreement, and consult your own counsel for decisions about your agency.

Sources

• 28 Pa. Code Chapter 611, table of contents
• 28 Pa. Code § 611.51, Hiring or rostering of direct care workers
• 28 Pa. Code § 611.55, Competency requirements
• 28 Pa. Code § 611.57, Consumer protections
• Pennsylvania Department of Health, "Home Care Agency/Home Care Registry Survey: Understanding Survey Results"
• 55 Pa. Code § 52.21, Staff training
• 55 Pa. Code § 52.26, Service coordination services
• Pennsylvania Department of Human Services, Community HealthChoices 1915(c) Waiver PA.0386.R05.01 (July 1, 2026)
• 42 CFR 484.80, Condition of participation: Home health aide services (eCFR)

How Concepts Central Support helps

Our Supervisory Visit Monitoring service keeps the calendar for you: visit due dates based on your agency's schedule, reminders to your supervisors, completion and follow-up items tracked, and annual competency review dates alongside. Our DCW Candidate Screening helps new worker files start organized, using your agency's criteria. Your supervisors and clinicians do the visits and make every decision; we keep the record in order.