KodaComplyHome care rules, state by state, in plain EnglishDocuments collected September 22, 2026

Pennsylvania home care rules

Pennsylvania's Department of Health licenses home care agencies and registries under 28 Pa. Code Chapter 611 and home health agencies under Chapter 601. Medicaid home care is paid by Community HealthChoices (CHC) health plans for CHC participants, and fee-for-service by the Department of Human Services' Office of Long-Term Living (OLTL) in the OBRA Waiver and Act 150 Program. Right now, DHS is flagging agencies whose EVV manual edits top 15% a quarter, and Medicaid providers the state classes as high-risk (for example, those under a fraud-related payment suspension or with an unpaid overpayment) must revalidate their enrollment by December 31, 2026.

180 official documents·collected September 22, 2026·checked against them September 22, 2026
License for non-medical home care?YesHome care agency or home care registry license from the Department of Health (28 Pa. Code Ch. 611) · $100 fee · a separate license for each physical location
License for home health?YesHome health care agency license (28 Pa. Code Ch. 601) · a regular license expires 1 year from issue. Medicaid home health also needs Medicare certification.
EVV85% rulePersonal assistance, respite (unlicensed settings) and home health visits. At least 85% of visits each quarter must have no manual edits; DHS flags providers over 15%.
Medicaid health plansCHC plansPlans whose documents we hold: AmeriHealth Caritas PA CHC, Keystone First CHC, PA Health & Wellness, UPMC Community HealthChoices

What changed, and what to do about it

Red means act now, amber means read it this month, grey is for the record.

Read this monthMA Bulletin 05-25-03, Aug. 29, 2025 · alerts since January 2026

EVV manual edits over 15% now trigger state alerts

DHS now sends alerts to fee-for-service providers whose EVV manual edits exceed 15% in a quarter, and sends CHC plans a list of their noncompliant providers. Two quarters in a row over 15% leads to a corrective action plan, and possibly sanctions. Some plans act sooner: PA Health & Wellness says a provider below 85% for any 3 months in a row faces a corrective action plan.

What to do: Run the EVV Compliance report in the DHS Aggregator each month. Coach the caregivers who miss clock-ins most often.
Read this monthMA Bulletin 99-26-06, Aug. 21, 2026

High-risk Medicaid providers must revalidate by December 31, 2026

At the federal government's request, DHS is revalidating Medicaid providers classed as high-risk, for example those under a payment suspension for a credible allegation of fraud, excluded by the federal Inspector General in the last 10 years, or with an unpaid overpayment over $1,500 that is more than 30 days old. DHS will email the providers who must revalidate. High-risk providers that miss their due date will have the service location closed in PROMISe.

What to do: Check your enrolled email and PROMISe for a 90-day or 30-day revalidation notice. If you have one, file before the date it gives.
Read this monthEffective July 1, 2026

CHC and OBRA waivers changed on July 1, 2026

The CHC Waiver amendment (PA.0386.R05.01) moved to the federal government's new application template, which puts teleservice rules in a section of their own; OLTL's summary of the OBRA Waiver renewal shows the same changes. Behavior therapy and benefits counseling were added to the services that may be delivered by teleservice; personal assistance is not on that list. The CHC Waiver also restates that State Police, FBI and child abuse certifications for workers in homes with children must be renewed every 60 months.

What to do: If any of your workers serve homes where children live, check that their certifications are less than 60 months old.
For the recordOLTL rate tables, Jan. 1 and July 1, 2026 · 56 Pa.B. 1226, Feb. 28, 2026

Agency PAS rates unchanged in the July 1 rate table

OLTL's July 1, 2026 fee schedule for the OBRA Waiver and Act 150 shows the same agency PAS (W1793) and agency respite (T1005) rates as January 1, 2026. Participant-directed PAS rates (W1792 and W1792 TU) were raised, retroactive to January 1, 2026, to fund a wage increase for workers, subject to federal approval of an OBRA Waiver amendment.

What to do: Nothing to change for agency billing. Our documents do not include CHC plan rates; check your plan contract.
For the recordAnnounced July 20, 2026

PA Health & Wellness direct care worker retention bonus

PA Health & Wellness (PHW) is paying a retention bonus to participating home care agencies. Agencies must pass 100% of the worker bonus funds to eligible workers serving PHW participants (less employee-related taxes), and PHW will audit this. The program period runs through 2026. The attestation deadline was July 31, 2026.

What to do: If you signed up, keep records showing each worker's payment.

Deadlines coming up

Dates taken from the rules and notices as we read them.

8days
October 1, 2026

PA Health & Wellness prior authorization changes

For CHC and CHIP. The table lists home visit code S9122 as "PA Required".

99days
December 31, 2026

High-risk Medicaid providers must revalidate

MA Bulletin 99-26-06. Missed deadlines close the service location in PROMISe.

99days
December 31, 2026

Current CHC Agreement term ends

DHS may extend it for two more six-month periods.