Pennsylvania home care agency and home care registry license

Agency, registry, or both

Pennsylvania licenses two business models under one chapter, and the decision between them comes before almost anything else. Chapter 611 defines them by how the caregiver is engaged:

• Home care agency: an organization that “supplies, arranges or schedules employees” to provide home care services in the consumer’s home or other independent living environment, for a fee ⁠³.
• Home care registry: an organization, or part of one, that “supplies, arranges or refers independent contractors” to provide the same services, for a fee ⁠³.

You name the model on your application, and the license states whether you are licensed as an agency, a registry, or both ⁠¹. The chapter applies to for-profit and nonprofit operators alike ⁠².

The choice matters most in what you have to tell clients. Before services begin, every client signs the Department of Health’s “Consumer Notice of Direct Care Worker Status,” which is included in the application as Exhibit L (Question 12 of the Licensure Survey Questions) ⁠⁵⁠¹⁶. The client initials only the statement that fits your model:

Chapter 611 itself does not require liability insurance. It requires a disclosure of the tax and insurance obligations that follow from the worker’s status ⁠¹³, and the Department’s form asks you to state whether you carry liability insurance ⁠¹⁶. Medicaid waiver enrollment does require insurance, covered below.

What the license allows, and where home health takes over

Pennsylvania’s definition of home care services is broad. It covers five activities: personal care, help with instrumental activities of daily living, companionship, respite care and specialized care ⁠³. The Department of Health groups them all as “non-skilled services” ⁠⁴.

• Personal care includes help with self-administered medications, feeding, oral, skin and mouth care, shaving, ambulation, bathing, hair care and grooming, dressing, toileting and transfers ⁠³. There is no separate companion-only license tier: the same license covers this hands-on work.
• Instrumental activities of daily living are defined in the Health Care Facilities Act as meal preparation, shopping and errands, telephone use, light housework, laundry and transportation ⁠¹⁴.
• Companionship services means socialization, support and help with IADLs ⁠³.
• Respite care is personal care and IADL help given for a short time while the usual caregivers are away or need relief ⁠³.
• Specialized care is “nonskilled services unique to the consumer’s care needs” ⁠³.

The limit is skilled care. The Act defines a home health care agency as one “staffed and equipped to provide nursing and at least one therapeutic service,” and its definition of a home care agency excludes home health care agencies ⁠¹⁴. Chapter 611 does not apply to a home health agency ⁠². A licensed nurse can qualify as a direct care worker under a home care license ⁠¹¹, but the services must still be non-skilled ⁠⁴. If you plan to offer nursing visits or therapy, read the Pennsylvania home health agency license guide.

If you plan to house clients rather than visit them, the license is different again. Housing and giving personal care to four or more adults who are not relatives of the operator, for more than 24 hours, falls under the personal care home license ⁠²⁵, and a day program is an older adult daily living center.

Who is outside Chapter 611

Section 611.3 lists four exclusions ⁠²:

• home health care agencies;
• durable medical equipment providers;
• volunteer providers;
• entities designated under section 3504 of the Internal Revenue Code that provide financial management services or supports coordination to people in Medicaid waiver or other publicly funded home and community-based programs.

The last exclusion covers the fiscal agents behind participant-directed Medicaid care. In Community HealthChoices, the OBRA waiver and the Act 150 program, a participant who directs their own services uses a Vendor Fiscal/Employer Agent, which handles payroll and taxes on the participant’s behalf ⁠²¹. That is a different business from a licensed agency or registry, which arranges the workers itself.

There is no exemption for small operators. The definitions turn on supplying, arranging or referring workers for a fee, not on how many clients or workers you have ⁠³.

A physical office for every location

The Division of Home Health’s FAQ answers two questions founders often ask:

• Virtual office: not allowed. “You must have a physical location,” because the address goes on the license, and the license has to be posted at the agency ⁠⁵. The statute requires the license to be posted “in a conspicuous place on the provider’s premises” ⁠¹⁴.
• Home office: allowed, but the Division warns that its “unannounced, on-site inspections” will then take place in your home ⁠⁵.

Pennsylvania home care has no branch offices. “Each physical location must be separately licensed,” and each needs its own initial application and $100 fee ⁠¹⁠⁵. Your service area is set by county, and to add counties you send the Division a letter. If a new county does not adjoin the county where your office is, the letter must include your plan for staffing, staff supervision and training there ⁠⁵.

Business names on the application must be approved through the Department of State, and using a fictitious name is optional ⁠⁵.

You must also keep a current copy of Chapter 611 at the office and follow Chapter 51, the Department’s general rules for all licensed health care facilities ⁠⁶⁠¹⁹. Chapter 51 adds a civil rights requirement. Before receiving an initial license, you sign a statement that you will comply with the federal Civil Rights Act and the Pennsylvania Human Relations Act. You keep a nondiscrimination policy, post it, and publicize it in the community at least every 3 years ⁠¹⁹.

Applying online through the Division of Home Health

The Division of Home Health now takes applications through its online Initial Provider Application system ⁠⁴⁠²⁴. Mailed or emailed submissions “will no longer be accepted effective March 31, 2026.” The change applies to initial applications, renewals and change-of-ownership applications ⁠⁴. The revised application form cites the regulation behind each section ⁠⁴.

1. Read Chapter 611 and the Health Care Facilities Act

   The Division’s FAQ tells applicants to start there ⁠⁵. The Department posts the Act, Chapter 51 and Chapter 611 together on its regulations page ⁠⁶.

2. Settle your model, name and office

   Decide whether you are applying as an agency, a registry or both ⁠¹. Clear your business name with the Department of State ⁠⁵. Secure a physical address ⁠⁵.

3. Line up owner and office-staff clearances

   Before licensing, the Department must determine that owners and office staff, as well as workers, have criminal history reports on file ⁠¹⁴. ChildLine clearances are also required if you will serve anyone under 18 ⁠⁹⁠¹⁴.

4. Complete every form in the packet

   The forms include “Information Requested of Healthcare Providers Applying for a License to Operate a Healthcare Facility,” a Civil Rights Survey (Chart 2 must list at least you as owner/administrator, even with zero employees), a Password Agreement, and the Licensure Survey Questions with their exhibits ⁠⁵. Anyone over 18 can witness the Password Agreement, and it does not need a notary ⁠⁵.

5. Submit only what is asked for

   The FAQ says the Division discards material it did not request, such as an entire policy manual, a business plan or policies written for other state programs ⁠⁵. A packet missing a form or supporting document is returned in full as “Incomplete” ⁠⁵.

6. Pass the initial inspection

   The Department inspects before it issues an initial license ⁠¹. Applying counts as your consent for Department staff to enter the premises during business hours for inspections ⁠¹⁴.

The FAQ was written for the paper process. It says the fee must be paid by check or money order payable to the Commonwealth of Pennsylvania ⁠⁵. The Division’s FAQ still describes paying the $100 fee by check or money order, which predates the online-only rule, so confirm how to pay when you submit. Send questions about the online process to [email protected] and general licensing questions to [email protected] ⁠⁴.

The Department publishes no processing time for initial applications.

The worker file DOH checks at inspection

Most Chapter 611 requirements apply to hiring. Before you hire (agency) or roster (registry) a direct care worker, you must have ⁠⁷:

• An interview. The rule says “face-to-face.” Act 96 of 2024, effective October 16, 2024, provides that the requirement “may be fulfilled through the use of two-way video remote technology.” It abrogates § 611.51(a)(1) to the extent of any inconsistency, as the Pennsylvania Code’s editor’s note records ⁠⁷⁠¹⁵.
• Two satisfactory references. Each must be a positive, verifiable reference from a former employer or another unrelated person, confirming that the person can provide home care ⁠⁷.
• A criminal history report, plus a ChildLine verification if you serve minors ⁠⁷.

The file must record the interview date and the references, alongside the documents described below ⁠⁷.

Criminal history under the Older Adults Protective Services Act

The criminal history report must be obtained at the time of application or within the year before it. The requirement also covers office staff and owners ⁠⁸.

• Pennsylvania residents for the past 2 years: a Pennsylvania State Police criminal history record ⁠⁸. The Department of Health accepts only checks requested for “employment” purposes, not “volunteer” or “other” ⁠⁶.
• Everyone else: a federal (FBI) criminal history record and a letter of determination from the Department of Aging ⁠⁸. The Department of Aging says the FBI fingerprint fee rose to $26.20 effective June 15, 2024. Fingerprinting is run by IDEMIA through PA SafeCheck ⁠¹⁸.

Section 611.52 bars hiring anyone with a conviction listed in 6 Pa. Code § 15.143 ⁠⁸. That list includes felony drug convictions, homicide, aggravated assault, rape and other sexual offenses, arson, burglary, robbery, a felony theft or two or more theft misdemeanors, and several offenses against children ⁠¹⁷. However, the Commonwealth Court held in Peake v. Commonwealth (December 30, 2015) that the lifetime employment ban in section 503(a) of the Older Adults Protective Services Act is unenforceable. The Commonwealth did not appeal ⁠¹⁸. The Department of Aging now recommends an individualized, case-by-case assessment. The factors include the nature of the crime, the time since conviction, evidence of rehabilitation and the requirements of the job. It also recommends consulting an attorney before deciding ⁠¹⁸. Checks are still required ⁠¹⁸.

If you turn someone down based on their record, you must tell them how to appeal to the source of the record ⁠⁸. Records are confidential and may be used only for the hiring decision ⁠⁸.

ChildLine clearance

ChildLine applies only if you serve people under 18. In that case, every worker and office-staff applicant must request a ChildLine verification, and you cannot employ or roster anyone named as the perpetrator of a founded or indicated report ⁠⁹.

Provisional hiring

You may hire provisionally while results are pending, under these conditions ⁠¹⁰:

• The applicant has applied for the checks and given you copies of the request forms.
• You have no knowledge that would disqualify them under the records-tampering statute (18 Pa.C.S. § 4911) cited in the rule.
• They swear in writing that they are not disqualified.
• They have already met the competency requirement. A provisional hire cannot be assigned until they have.
• You monitor them through random direct observation and client feedback, and document it.
• For clients under 18, you directly supervise the worker or send another worker with them until the ChildLine result arrives.

Provisional status ends after 30 days for people who have lived in Pennsylvania for 2 years or more, and after 90 days for everyone else. Anyone who turns out to be disqualified, or who does not produce the results in time, must be terminated or removed from the roster immediately ⁠¹⁰.

TB screening

Workers, and any office staff or contractors with direct client contact, must document before contact that they have been screened and are free from active tuberculosis. The screening follows CDC health care guidelines, must be dated no more than 1 year before the start date, and is renewed at least every 12 months ⁠¹².

Competency: four ways a worker can qualify

Before you assign or refer a worker, § 611.55 requires one of the following ⁠¹¹:

1. A valid Pennsylvania nurse’s license.
2. A passing score on a competency exam you developed.
3. Completion of a training program you or another entity developed.
4. Completion of an existing program: a home health aide course meeting 42 CFR 484.36, the Department of Education’s nurse aide program, the training a Medicaid waiver program requires of its providers, or another program the Department publishes.

A competency exam or training program you write yourself must cover ten subjects. They are confidentiality, consumer control and the independent living philosophy, IADLs, recognizing changes in the consumer, basic infection control, universal precautions, emergencies, documentation, recognizing and reporting abuse or neglect, and difficult behaviors ⁠¹¹. Workers who will give personal care need six more: bathing, shaving, grooming and dressing; hair, skin and mouth care; ambulation and transfers; meal preparation and feeding; toileting; and help with self-administered medications ⁠¹¹.

Chapter 611 sets no minimum number of training hours. It sets these subject lists and an ongoing review. You must review each worker’s competency at least once a year by observation, testing, training or client feedback. The review must happen sooner after any discipline for a quality-of-care problem, even a verbal warning ⁠¹¹. A worker’s completed competency carries over to another licensed agency or registry if their break in work is no longer than 12 months ⁠¹¹. The Health Care Facilities Act separately requires agencies to supervise employees on an ongoing basis, and registries to keep ongoing referral documentation ⁠¹⁴.

What every client receives before the first visit

Section 611.57 requires an information packet before services begin ⁠¹³. It must include:

• the services to be provided and the identity of the worker;
• the hours;
• fees and total costs on an hourly or weekly basis;
• who to contact at the Department about licensing and compliance;
• the Department’s complaint hotline (1-866-826-3644) and the number of the local Area Agency on Aging ombudsman;
• your hiring and competency requirements;
• the employee or contractor status disclosure ⁠¹³.

Clients have the right to take part in service planning. They are entitled to at least 10 calendar days’ written notice before you end services. You may give shorter notice only if the client is more than 14 days behind on payment despite notice, or if the worker’s health and welfare is at risk ⁠¹³. No one affiliated with your business may become a client’s power of attorney or guardian, and you may not require a client to sign checks over to you ⁠¹³. Keep documentation of all of this for inspection ⁠¹³.

Fee, license term, inspections and renewal

As published on 2026-10-12, the application and renewal fee is $100. Section 807 of the Health Care Facilities Act sets the same $100 for “home care agency or home care registry” ⁠¹⁠¹⁴. The fee is not refunded, prorated or rebated ⁠¹. Licenses for facilities other than hospitals are issued for one year ⁠¹⁴.

• Renewal: file at least 60 days before the license expires ⁠¹. Enter zero for “Requested Capacity” on the renewal form ⁠⁵. The Department inspects before each renewal ⁠¹.
• Inspections: an inspection may be scheduled or unscheduled. It can include record review, interviews with office staff, clients and workers, and observation of care for clients who agree in advance ⁠³. The Division describes its post-licensure inspections as unannounced ⁠⁵.
• Plans of correction: if inspectors find violations, you receive a written report and must submit a plan of correction with a timetable ⁠¹⁴.
• Sanctions: grounds for revocation or nonrenewal include a serious violation, failure to submit a correction plan, and a cyclical pattern of deficiencies over two or more years ⁠¹⁴. Chapter 51 also allows a provisional license and civil penalties of up to $500 per day ⁠¹⁹.

If a rule in Chapter 611 does not fit an innovative model, Chapter 51 lets you request an exception in writing. The Department publishes the request in the Pennsylvania Bulletin for public comment before deciding ⁠¹⁹. The Division posts an exception request form for this ⁠⁴.

Changes after you are licensed

• Ownership: any change of 5% or more requires Step 1 of the change-of-ownership application first, and the change “cannot occur until approval has been granted” ⁠⁵. Chapter 51 also requires 30 days’ written notice before a transfer of 5% or more of the stock or equity ⁠¹⁹. A license is not transferable without prior written approval ⁠¹⁴.
• Administrator: send a letter, a signed Password Agreement, the new administrator’s resume, and a criminal background check no more than 1 year old ⁠⁵.
• Address and other details: email a letter with your license number, the effective date and the new contact details to [email protected] ⁠⁴⁠⁵.
• Serious events: Chapter 51 requires immediate written notice of events that seriously compromise patient safety. Examples include complaints of abuse (confirmed or not), hospital transfers caused by injuries or accidents, and significant service disruptions caused by a disaster such as a fire, storm or flood ⁠¹⁹.

Workers who have already met Chapter 611 requirements do not need new criminal history reports after a change of ownership, or when they move to another location owned by the same entity ⁠⁸.

Getting paid by Medicaid: OLTL waivers and Community HealthChoices

The license does not make you a Medicaid provider. According to the Division’s FAQ, after licensure you apply to the Department of Human Services’ Office of Long-Term Living (OLTL). You can reach its enrollment and certification unit at 1-800-932-0939, option 1, or [email protected] ⁠⁵. The FAQ adds that “enrollment in state Medicaid does not guarantee enrollment in individual MCO networks,” and that some managed care networks may be closed ⁠⁵.

Community HealthChoices (CHC) is the managed care program for Medicaid long-term services and supports. It covers people 21 and older who receive both Medicare and Medicaid or who receive Medicaid long-term services and supports. Each of the five CHC zones is covered by all three CHC managed care organizations ⁠²³. The FAQ tells new providers to contact each MCO directly about its network needs ⁠⁵.

OLTL’s provider rules in 55 Pa. Code Chapter 52 add requirements beyond Chapter 611 ⁠²⁰:

• Enrollment file: an MA application and provider agreement with waiver addenda; proof of fiscal solvency (your latest tax return, a monthly balance sheet or a business plan with projected revenue and costs, and formation documents); and commercial general liability and workers’ compensation insurance ⁠²⁰.
• Policies: twelve written policies, including criminal history screening, Social Security number verification, exclusion screening against the LEIE, EPLS and Medicheck lists, HIPAA, ADA, critical incident management, and language access ⁠²⁰.
• After enrollment: attend OLTL new-provider training within 180 days, resubmit your qualifications at least every 2 years, give staff annual training on six topics including abuse prevention and fraud prevention, and expect OLTL monitoring at least once every 2 years ⁠²⁰. Incomplete enrollment applications are void after 30 days ⁠²⁰.

For the fee-for-service programs (the OBRA waiver and Act 150), OLTL’s rate schedule effective July 1, 2026 pays agency personal assistance services (W1793) $4.83 to $5.38 per 15 minutes, depending on the region. Agency respite (T1005) is $4.29 to $4.78 per 15 minutes ⁠²². The schedule’s program columns are Act 150 and the OBRA waiver, so it does not tell you what a CHC MCO will pay.

What changed in 2024-2026

• October 16, 2024: Act 96 allowed two-way video to satisfy the face-to-face interview requirement for direct care workers. The Pennsylvania Code now notes that § 611.51(a)(1) is abrogated to the extent of any inconsistency ⁠⁷⁠¹⁵.
• March 31, 2026: the Division of Home Health stopped accepting mailed or emailed applications. Initial, renewal and change-of-ownership filings now go through the online system ⁠⁴.
• July 1, 2026: OLTL published new fee-schedule rates for personal assistance and respite ⁠²².

As of the Pennsylvania Code update through August 8, 2026, none of the Chapter 611 sections cited in this guide shows an amendment other than the § 611.51 note ⁠¹⁠⁷. For other care licenses in the state, see the Pennsylvania state page.

Sources

1. 1
   Pennsylvania Code and Bulletin, 28 Pa. Code § 611.2: License required Checked 12 Oct 2026 · Back to text ↑
2. 2
   Pennsylvania Code and Bulletin, 28 Pa. Code § 611.3: Affected home care agencies and home care registries Checked 12 Oct 2026 · Back to text ↑
3. 3
   Pennsylvania Code and Bulletin, 28 Pa. Code § 611.5: Definitions Checked 12 Oct 2026 · Back to text ↑
4. 4
   Pennsylvania Department of Health, Home Care Agencies and Registries Checked 12 Oct 2026 · Back to text ↑
5. 5
   Pennsylvania Department of Health, Division of Home Health, Home Care Agency/Registry License FAQ Checked 12 Oct 2026 · Back to text ↑
6. 6
   Pennsylvania Department of Health, Home Care Agencies Regulations Checked 12 Oct 2026 · Back to text ↑
7. 7
   Pennsylvania Code and Bulletin, 28 Pa. Code § 611.51: Hiring or rostering of direct care workers Checked 12 Oct 2026 · Back to text ↑
8. 8
   Pennsylvania Code and Bulletin, 28 Pa. Code § 611.52: Criminal background checks Checked 12 Oct 2026 · Back to text ↑
9. 9
   Pennsylvania Code and Bulletin, 28 Pa. Code § 611.53: Child abuse clearance Checked 12 Oct 2026 · Back to text ↑
10. 10
    Pennsylvania Code and Bulletin, 28 Pa. Code § 611.54: Provisional hiring Checked 12 Oct 2026 · Back to text ↑
11. 11
    Pennsylvania Code and Bulletin, 28 Pa. Code § 611.55: Competency requirements Checked 12 Oct 2026 · Back to text ↑
12. 12
    Pennsylvania Code and Bulletin, 28 Pa. Code § 611.56: Health screening Checked 12 Oct 2026 · Back to text ↑
13. 13
    Pennsylvania Code and Bulletin, 28 Pa. Code § 611.57: Consumer protections Checked 12 Oct 2026 · Back to text ↑
14. 14
    Pennsylvania Department of Health, Health Care Facilities Act (35 P.S. § 448.101 et seq.), as posted by the Department of Health Checked 12 Oct 2026 · Back to text ↑
15. 15
    Pennsylvania General Assembly, Act of October 16, 2024 (P.L. 977, No. 96), HB 155 Checked 12 Oct 2026 · Back to text ↑
16. 16
    Pennsylvania Department of Health, Consumer Notice of Direct Care Worker Status (Direct Care Worker Status Form) Checked 12 Oct 2026 · Back to text ↑
17. 17
    Pennsylvania Code and Bulletin, 6 Pa. Code § 15.143: Facility responsibilities (prohibited offenses) Checked 12 Oct 2026 · Back to text ↑
18. 18
    Pennsylvania Department of Aging, Criminal History Background Check Checked 12 Oct 2026 · Back to text ↑
19. 19
    Pennsylvania Code and Bulletin, 28 Pa. Code Chapter 51: General information Checked 12 Oct 2026 · Back to text ↑
20. 20
    Pennsylvania Code and Bulletin, 55 Pa. Code Chapter 52: Long-Term Living Home and Community-Based Services Checked 12 Oct 2026 · Back to text ↑
21. 21
    Pennsylvania Department of Human Services, Long-Term Care for Providers Checked 12 Oct 2026 · Back to text ↑
22. 22
    Pennsylvania Department of Human Services, Office of Long-Term Living, OLTL HCBS Rates, July 1, 2026 Checked 12 Oct 2026 · Back to text ↑
23. 23
    Pennsylvania Department of Human Services, Community HealthChoices (CHC) Checked 12 Oct 2026 · Back to text ↑
24. 24
    Pennsylvania Department of Health, Initial Provider Application Login (Division of Home Health) Checked 12 Oct 2026 · Back to text ↑
25. 25
    Pennsylvania Code and Bulletin, 55 Pa. Code § 2600.4: Definitions (personal care homes) Checked 12 Oct 2026 · Back to text ↑

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