Pennsylvania home health agency license: DOH rules and the 2026 Medicare freeze

Start with the payment problem

The state license and Medicare billing are two separate approvals. In 2026 a new Pennsylvania agency can get only the first.

The Department of Health licenses every home health agency in the state. Medicare certification is a separate step that an agency “voluntarily” seeks, and the Department runs those federal surveys under contract with CMS ⁠¹. Its licensure page states that “State licensure as a home health agency is a requirement for federal certification” ⁠². The usual route was therefore a state license first, then a CMS-855A enrollment and a federal survey or accreditation.

That route has been closed since May 13, 2026. CMS’s Federal Register notice (91 FR 27954, published May 15, 2026) says that “no new HHAs or HHA branches or practice locations will be enrolled into Medicare” unless the Medicare contractor received the application before the effective date. The moratorium applies in every state, territory and the District of Columbia ⁠⁹. Pennsylvania’s Medical Assistance program depends on Medicare certification as well. Under 55 Pa. Code § 1249.41, a home health agency must be “certified by the Department of Health as meeting the requirements for Medicare home health agencies” to take part in MA ⁠¹². Chapter 1249 also defines a home health agency for MA purposes as one “licensed by the Commonwealth and certified for participation in Medicare” ⁠¹².

In practical terms, a Pennsylvania agency licensed in 2026 can serve private-pay patients and commercially insured patients (if insurers will contract with it). It cannot bill Medicare or fee-for-service Medical Assistance for home health services until CMS lifts the moratorium and the agency then completes certification. The details of the freeze are below, after the licensing steps you can complete now.

What the license covers, and what it does not

Chapter 601 defines a home health care agency as an organization “staffed and equipped to provide skilled nursing and at least one therapeutic service—physical therapy, occupational therapy, speech pathology, medical social services or home health aides.” Those services go to disabled, aged, injured or sick people “on a part-time or intermittent basis in their place of residence” ⁠⁴. Part-time intermittent service means less than 8 hours a day or less than 40 hours a week ⁠⁴. The Department repeats this definition on its licensure page and tells applicants to apply only if they meet it ⁠².

Two structural rules shape your staffing plan:

• One service in-house. You must provide at least one of the two qualifying services “directly through agency employes.” The second qualifying service, and any additional ones, can be provided by written contract with another organization ⁠⁴.
• No outsourcing of control. “Administrative and supervisory functions may not be delegated to another agency or organization,” and you must monitor and control any service you do not provide directly ⁠⁴.

Under the Health Care Facilities Act, operating or even “hold[ing] itself out to be” a health care facility without a license is prohibited, and home health care agencies are on the Act’s list of health care facilities ⁠⁵.

Home care, hospice and home health are three licenses

The same Division of Home Health handles all three, but the Act requires separate licenses for “home health care, home care, hospice or long-term nursing care” ⁠⁵.

• Non-medical home care (personal care, companionship, IADL help without skilled nursing) falls under 28 Pa. Code Chapter 611. The Act’s definition of a home care agency is “exclusive of a home health care agency,” and Chapter 611 lists home health care agencies among the organizations it does not cover ⁠⁵⁠¹⁶. The fee is lower and the rules are different. See the Pennsylvania home care agency and registry guide.
• Hospice is a separately defined facility: palliative and supportive care for “dying persons and their families,” delivered by an interdisciplinary team with bereavement care ⁠⁵. The hospice application fee is also $250 ⁠⁵. Hospice faces the same 2026 freezes. CMS imposed a matching Medicare hospice moratorium the same week ⁠¹⁷, and Pennsylvania’s Department of Human Services added a six-month MA enrollment moratorium on new hospices effective May 15, 2026 ⁠¹³.

If you also want to sell non-skilled hourly care, the published sources leave a gap. The Act’s separate-license rule suggests a second, Chapter 611 home care license, but Chapter 611 excludes home health agencies from its scope, and the Department’s home health materials do not address the overlap ⁠⁵⁠¹⁶. Ask the Division of Home Health ([email protected]) in writing before you offer both ⁠¹.

If your clients will live in the building you run, the license is a different one entirely: a personal care home or an assisted living residence, both licensed by the Department of Human Services.

No certificate of need

Founders coming from states with a home health CON often ask about this. Pennsylvania’s Health Care Facilities Act still contains a certificate of need chapter, and section 808(a)(5) still lists “that a certificate of need has been issued if one is necessary” among the conditions for a license ⁠⁵. However, section 904.1 provides that “the authority, obligations and duties arising under Chapter 7 and all other provisions of this act pertaining to certificates of need shall terminate four years after the effective date of section 904.1,” and the compiler’s note in the Department’s posted copy adds that section 904.1 “took effect December 18, 1992” ⁠⁵. The Department’s home health pages and its February 2025 application packet describe no CON review or need determination ⁠¹⁠²⁠³.

The Department’s posted copy of the Act is a compilation dated September 5, 2006 ⁠⁵. No later reinstatement of CON appears in the Department’s materials, but this guide did not trace every amendment since then.

The people your application has to name

Chapter 601 sets qualifications for a small set of roles, and the application asks for each one by name with supporting documents ⁠³⁠⁴.

The administrator may also serve as the supervising physician or RN ⁠⁴. Therapists, social workers and speech pathologists must meet the licensure or certification definitions in § 601.6. A social worker, for example, needs a CSWE-accredited master’s degree and 1 year of health care social work experience ⁠⁴.

The aide training program needs extra care. The packet asks for a program that “clearly defines each topic and how many hours/minutes per topic,” and the hours “must total the minimum requirements of the Home Health regulations” ⁠³. Section 601.35 lists the subjects aides must be trained in. They include helping patients toward self-reliance, nutrition and meal preparation, the aging process, reporting changes in condition, ethics, confidentiality and recordkeeping ⁠⁴.

Background checks

The packet cites Act 169 of 1996, which requires people seeking employment at home health agencies to obtain a criminal history background check. The application says documentation that checks are complete “for all employees must also be submitted” ⁠³. The administrator’s check can come from the Pennsylvania State Police or FBI fingerprints. For the supervising nurse and clinical staff, the packet asks for PATCH results from the State Police ⁠³. The Department accepts State Police checks requested for “employment” purposes only, not “volunteer” or “other” ⁠¹. For how Pennsylvania treats disqualifying offenses under the Older Adults Protective Services Act, see the background-check section of the home care agency guide, which covers the same statute.

Building the application packet

The Division’s Initial Home Health Agency Application was last revised February 4, 2025 ⁠³. The home health licensure page describes an email submission, not an online portal ⁠².

1. Confirm you meet the definition

   The Department tells applicants to complete the application only “if the above definition is met,” meaning skilled nursing plus one other therapeutic service ⁠².

2. Set up the entity and office

   You need a physical site address (no PO boxes), office hours when staff are physically present, and a list of the counties you will serve. Those counties “must be adjoining counties from physical location of agency” ⁠³. Surveyors will arrive for the on-site inspection during the hours you list ⁠³. Applicants based out of state must give an in-state address where legal documents can be served ⁠³.

3. Fill in the forms, typed

   The packet contains the identifying information and fee page, an agreement and affirmation signed under the unsworn-falsification statute, a Password Agreement for the administrator, a Civil Rights Survey, the ten-question “Information Requested of Health Care Providers,” and the Chapter 601 documentation checklist ⁠³. “Handwritten submissions will not be accepted,” and hand delivery is not accepted either ⁠³.

4. Disclose ownership and history

   You list every person or entity with 5% or more direct or indirect ownership or control, your formation documents and bylaws or operating agreement, and the health care experience of the people who direct the business. You also list every facility you or your owners have run, any adverse state or federal action, and any fraud charges or civil penalties ⁠³⁠⁴. A question on charity care is included only for information. The form says an unwilling answer “will not affect the Department’s decision” ⁠³.

5. Attach only the requested policies

   The checklist follows Chapter 601 section by section: organizational chart, governing body, administrator appointment, budget policies, personnel policy outline, professional advisory and evaluation policies, patient acceptance and plan-of-treatment policies (including a sample plan of care and a verbal order policy), staff licenses and job descriptions, aide training and supervision policies, and clinical record policies ⁠³. “ONLY include the documents/policies requested” ⁠³.

6. Mark confidential pages

   Anything you submit may be released under the Right-to-Know Law. To protect trade secrets or confidential proprietary information, you must claim the exemption at submission, state the basis, and mark each affected page. “A blanket statement … is not acceptable” ⁠³.

7. Email the packet and mail the fee

   Send the packet to [email protected]. You may need to split it into several emails because Commonwealth servers reject large attachments ⁠². Mail a check or money order for $250, payable to “Commonwealth of Pennsylvania,” with the agency name in the memo line, to the Division of Home Health, 2525 N. 7th Street, Harrisburg, PA 17110 ⁠²⁠³. “Your application will not be forwarded for review until the required fee is received” ⁠³.

8. Answer revision requests within 30 days

   Once the application is forwarded for review, you receive a confirmation email with the review time frame, and the Division asks you not to call about status. If revisions are needed, you get an email listing them. If you miss the 30-day deadline, the application is withdrawn, and reapplying means a complete new packet and a new fee ⁠³.

9. Pass the licensure survey

   The Department issues a regular license “after a survey conducted by the Department indicates that the applicant is in substantial compliance,” and the survey may include an on-site inspection ⁠⁴. The license arrives by email ⁠³.

You may not admit or treat any patient until the Department approves you ⁠³. Before the initial license, you also sign Chapter 51’s civil rights compliance statement ⁠⁶. The Department publishes no standard processing time. It says only that the length of the process “depends upon the accuracy of information provided” ⁠².

Chapter 601 still says the fee is $50 and gives an old Harrisburg post office box for forms (§ 601.11). Section 807(b) of the Health Care Facilities Act sets $250 for a home health agency, which is the amount the application requires ⁠³⁠⁴⁠⁵.

Rules surveyors check once you are open

Surveys are both initial and periodic, and the Department conducts them “unannounced” ⁠¹. Chapter 601 allows inspections “at any time,” scheduled or not ⁠⁴. These are the operating requirements a new agency most often needs to build into its systems from the first patient:

• Plan of treatment. Every patient follows a written plan established by the attending physician. The physician reviews it with agency staff at least every 60 days, or more often if the patient’s condition requires ⁠⁴.
• Verbal orders. The nurse records and signs an oral order immediately, and the physician countersigns within 7 days ⁠⁴. Under the Department’s survey guidance, a late countersignature is not cited if you document every attempt to obtain it. Any oral order not countersigned within 30 days is cited “regardless of the number of attempts” ⁠¹⁵.
• Reports to physicians. A written summary report goes to each patient’s attending physician at least every 60 days ⁠⁴.
• Quality review. At least quarterly, professional staff review a sample of active and closed records. The group of professional personnel, or outside professionals working with consumers, evaluates the whole program every year. You collect statistics for that evaluation and report statistical data to the Department yearly on its forms ⁠⁴.
• Aide supervision. An RN or other appropriate professional makes a supervisory visit to the patient’s home at least every 2 weeks ⁠⁴.
• Records. Clinical notes are written on the day of service and filed into the record at least weekly. Records are kept 7 years after discharge, including if the agency closes ⁠⁴.
• ID badges. Licensed practitioners and employed providers wear a tag with their full name and professional designation when clinically feasible ⁠⁶.
• Civil rights. You keep a dated nondiscrimination policy, notify employees, post the policy and publicize it in the community at least every 3 years ⁠⁶.

Incident reporting

Chapter 601 requires an immediate phone report, followed by a written report, of any catastrophic incident such as a fire or flood, or anything that may interrupt services ⁠⁴. Chapter 51 adds immediate written notice of events that seriously compromise patient safety. Examples include complaints of patient abuse (confirmed or not), hospital transfers caused by injuries or accidents, deaths or serious injuries from medication errors, unlicensed practice, and receipt of a strike notice ⁠⁶.

License term, renewal and enforcement

A regular license expires 1 year from the date of issue ⁠⁴. The Act sets a one-year term for every licensed facility other than hospitals. It also says the license cannot be transferred without the Department’s prior written approval and must be posted conspicuously ⁠⁵. The $250 fee applies to renewals too ⁠⁵.

Chapter 601 says only that renewal forms come from the Department and must be accompanied by the fee ⁠⁴. The Division’s home health pages publish no renewal instructions or filing deadline, so ask the Division how and when to file well before your license’s one-year expiration date ⁠¹⁠².

When a survey finds deficiencies, your administrator answers them through a plan of correction submitted electronically against CMS Form 2567, using the password issued under the Password Agreement ⁠³. The Department can respond in several ways:

• Provisional license. This is possible when deficiencies are numerous or serious, provided you are correcting them on an agreed timetable, there is no pattern over 2 or more years, and patients are not in danger. Each provisional license lasts up to 6 months and can be renewed three times ⁠⁴.
• Revocation, nonrenewal, limitation or suspended admissions. Grounds include a serious violation, failure to submit a reasonable correction timetable, cyclical deficiencies over 2 or more years, fraud in obtaining a license, lending a license, and serious Medicare or Medical Assistance violations ⁠⁴. Notice comes by certified mail, and you can appeal to the State Health Facility Hearing Board ⁠⁴.
• Civil penalties. Chapter 51 allows penalties of up to $500 per day ⁠⁶.

The Department posts an Exception Request Form for asking to depart from a rule ⁠⁷. Section 601.5 allows exceptions when the policy objective of the rule is still met ⁠⁴.

The federal moratorium, in detail

The terms come from the Federal Register notice and the CMS survey memo to state agencies:

• Scope. The freeze covers new home health agencies, branches and practice locations anywhere in the U.S. Applications received by a Medicare contractor before May 13, 2026 continue to be processed ⁠⁹⁠¹⁰.
• Duration. The initial term is six months, and CMS may extend it in six-month increments. Extensions or lifting will be announced in the Federal Register ⁠⁹⁠¹⁰.
• No exceptions. “CMS regulations do not permit exceptions to a moratorium for individual providers or suppliers” ⁠¹⁰. Initial applications filed during the moratorium “will be denied” and must be filed again after it ends ⁠¹⁰.
• Accreditation does not help. During the moratorium, accreditation by a CMS-approved organization “will not serve as the basis for Medicare participation through deemed status” ⁠¹⁰.
• Appeals are narrow. An appeal can argue only that the moratorium does not apply to you ⁠¹⁰⁠¹¹.
• No new branches. Existing agencies cannot add branches, satellite offices or expansion locations to their Medicare enrollment, and CMS or the state survey agency may treat a relocation that changes communities, patients or staff as a new provider ⁠¹¹.
• Buying an agency. Under 42 CFR 424.550(b), a non-exempt change in majority ownership within 36 months of an agency’s initial enrollment (or its last such change) counts as a new enrollment, so it is blocked too ⁠⁹⁠¹¹.

As of October 12, 2026, a Federal Register search returned only the May 15, 2026 home health and hospice notices, with no extension or lifting notice. That puts the end of the initial six-month term at about mid-November 2026 ⁠⁹⁠¹⁷. Check the Federal Register before you plan around a reopening date.

After the moratorium lifts, agencies that apply within 6 months are placed in the “high” screening level for Medicare and Medicaid ⁠⁹. Pennsylvania’s Department of Human Services takes the same position. Its Medical Assistance Bulletin 99-26-06 (August 21, 2026) lists “providers that apply for enrollment in the MA Program within six (6) months after a federally imposed moratorium for the particular provider type has been lifted by CMS” among its high-risk providers ⁠¹⁴.

Medicare certification in Pennsylvania once enrollment reopens

The Department’s licensure page describes the certification route that will apply after the moratorium ends ⁠²:

1. Hold the state license first ⁠².
2. Send CMS Forms 1572(a), 690 and 1561 to the Division of Home Health ⁠².
3. Send the CMS-855A enrollment application to your Medicare contractor, together with the federal civil rights information for Medicare applicants ⁠².
4. Choose between a Department survey and accreditation through The Joint Commission, ACHC or CHAP ⁠².
5. After CMS approves the 855A, the Department surveys the agency before recommending certification ⁠².

The Department’s 2018 notice on initial Medicare surveys explains why most agencies choose accreditation. CMS treats initial certification surveys as the “lowest priority” for agencies that could use deemed status instead. Without an accreditor, “it may take 6-9 months” before the Department can survey you ⁠⁸. A survey also cannot take place until the Department has the contractor-approved 855A and the agency is “operational and furnishing services to the required designated number of patients” ⁠⁸. You therefore need patients you can serve without Medicare before you can be certified. The Medicare provider agreement takes effect on the last day of the survey, or on the date an acceptable plan of correction is received if deficiencies are found ⁠⁸.

Medicare certification also simplifies state oversight. An agency certified for Medicare is “deemed to comply” with Chapter 601 once it meets the application, fee and statistical reporting requirements of § 601.11(a)-(c) ⁠⁴⁠⁵.

Medical Assistance

Pennsylvania’s MA rules for home health services sit in 55 Pa. Code Chapter 1249. The provider participation rule requires Medicare certification on top of the general MA requirements ⁠¹². Because of that rule, the Department of Human Services did not need a separate home health moratorium to stop new MA enrollments. Of the Medical Assistance bulletins DHS issued from April through October 1, 2026, the only moratorium bulletin covers hospices ⁠¹³. A new home health agency cannot enroll for MA home health services until it is Medicare-certified, and it cannot become Medicare-certified while the federal moratorium lasts ⁠⁹⁠¹².

For agencies that do get enrolled, DHS raised the fee-for-service MA fees for direct skilled nursing by a home health agency (codes G0299 for an RN and G0300 for an LPN, each 15 minutes, modifier U8) from $88.00 to $176.00, effective for dates of service on and after July 1, 2026, under Act 21 of 2026. Managed care rates are set by each managed care organization ⁠¹⁸.

MA home health enrollment is a separate track from the Office of Long-Term Living’s waiver and Community HealthChoices enrollment of personal assistance providers, which the home care agency guide covers. This guide did not research whether a licensed home health agency without Medicare certification can enroll with OLTL for non-skilled waiver services.

Changes after licensure

• Ownership. Chapter 51 requires written notice at least 30 days before a transfer of 5% or more of the stock or equity, or before any change in ownership, form of ownership or facility name ⁠⁶. Chapter 601 requires notice within 30 days after a change in partners, officers, directors, principal stockholders or persons in charge ⁠⁴. The Department routes changes of ownership through a separate change-of-ownership process ⁠¹.
• Administrator. Send a new Password Agreement with a State Police check for “Employment,” a resume, copies of professional licenses and a governing body appointment letter to [email protected] ⁠³.
• Other updates. Report them by emailing a letter to the same address. Medicare-certified agencies include the date they sent the 855 to their contractor ⁠¹.
• New services. Give written notice at least 60 days before starting a service you have not offered before, or before stopping one. Do not start a new service until the Department confirms you meet licensure requirements ⁠⁶.

What changed recently

• February 4, 2025: the Division revised its Initial Home Health Agency Application ⁠³.
• May 13, 2026: the CMS nationwide moratorium on new Medicare home health enrollment took effect, announced in the Federal Register on May 15 ⁠⁹. A matching hospice moratorium was announced the same day ⁠¹⁷.
• May 15, 2026: Pennsylvania imposed a six-month MA enrollment moratorium on new hospices (bulletin issued June 12, 2026) ⁠¹³.
• August 21, 2026: DHS required high-risk MA providers to revalidate by December 31, 2026, and classified providers applying within six months after a federal moratorium lifts as high-risk ⁠¹⁴.
• September 30, 2026: MA Bulletin 05-26-01 doubled the fee-for-service MA fees for home health direct nursing codes G0299 and G0300 to $176.00 per 15 minutes, retroactive to dates of service on and after July 1, 2026 ⁠¹⁸.

Under § 601.2, agencies that existed before April 23, 1987 must meet the same Chapter 601 standards as newer ones. As of the Pennsylvania Code update through August 8, 2026, the chapter still shows the outdated $50 fee ⁠⁴. For the other care licenses in the state, see the Pennsylvania state page.

Sources

1. 1
   Pennsylvania Department of Health, Home Health Agencies Checked 12 Oct 2026 · Back to text ↑
2. 2
   Pennsylvania Department of Health, Home Health State Licensure and/or Federal Medicare Certification Checked 12 Oct 2026 · Back to text ↑
3. 3
   Pennsylvania Department of Health, Division of Home Health, Initial Home Health Agency Application (revised February 4, 2025) Checked 12 Oct 2026 · Back to text ↑
4. 4
   Pennsylvania Code and Bulletin, 28 Pa. Code Chapter 601: Home Health Care Agencies Checked 12 Oct 2026 · Back to text ↑
5. 5
   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 ↑
6. 6
   Pennsylvania Code and Bulletin, 28 Pa. Code Chapter 51: General information Checked 12 Oct 2026 · Back to text ↑
7. 7
   Pennsylvania Department of Health, Home Health Regulations Checked 12 Oct 2026 · Back to text ↑
8. 8
   Pennsylvania Department of Health, Initial Medicare Certification Surveys (March 2018) Checked 12 Oct 2026 · Back to text ↑
9. 9
   Centers for Medicare & Medicaid Services, Federal Register, Announcement of Nationwide Temporary Moratoria on Enrollment of Home Health Agencies (HHAs), 91 FR 27954, document 2026-09717 Checked 12 Oct 2026 · Back to text ↑
10. 10
    Centers for Medicare & Medicaid Services, QSO-26-11-HHA & Hospice: Six-Month National Moratoria on Hospice and HHA Enrollment Checked 12 Oct 2026 · Back to text ↑
11. 11
    Centers for Medicare & Medicaid Services, Home Health and Hospice Nationwide Moratorium Q&As (last revised July 9, 2026) Checked 12 Oct 2026 · Back to text ↑
12. 12
    Pennsylvania Code and Bulletin, 55 Pa. Code Chapter 1249: Home Health Agency Services Checked 12 Oct 2026 · Back to text ↑
13. 13
    Pennsylvania Department of Human Services, Office of Medical Assistance Programs, Medical Assistance Bulletin 99-26-03: Temporary Moratorium on Enrollment of New Hospices Checked 12 Oct 2026 · Back to text ↑
14. 14
    Pennsylvania Department of Human Services, Office of Medical Assistance Programs, Medical Assistance Bulletin 99-26-06: Off-Cycle Revalidation of High-Risk Providers Checked 12 Oct 2026 · Back to text ↑
15. 15
    Pennsylvania Department of Health, Physician Verbal Orders guidance (revised March 16, 2016) Checked 12 Oct 2026 · Back to text ↑
16. 16
    Pennsylvania Code and Bulletin, 28 Pa. Code § 611.3: Affected home care agencies and home care registries Checked 12 Oct 2026 · Back to text ↑
17. 17
    Centers for Medicare & Medicaid Services, Federal Register, Announcement of Nationwide Temporary Moratorium on Enrollment of Hospices, 91 FR 27946, document 2026-09718 Checked 12 Oct 2026 · Back to text ↑
18. 18
    Pennsylvania Department of Human Services, Office of Medical Assistance Programs, Medical Assistance Bulletin 05-26-01: Fee Increases for Direct Nursing Services Provided by a Home Health Agency Checked 12 Oct 2026 · Back to text ↑

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