Facilities, Providers & Managed Care Plans > Home Health Services and Hospices > State Licensure and/or Medicare Certification
STATE LICENSURE AND/OR MEDICARE CERTIFICATION
 
All of the forms and regulations are accessible by using Adobe Reader software.  If you need the free Adobe viewer, click here to download it.
 
State Licensure Rules & Regulations                                                         
 
 
Additional State Licensure Information
 
A home health care agency is defined by the Pennsylvania Department of Health as "...an organization staffed and equipped to provide skilled nursing care and at least one other therapeutic service - home health aides, physical therapy, speech therapy, occupational therapy, or medical social services - to persons on a part-time basis or intermittent basis in their place of residence (PA Code 28 §601.6)."
 
If the above definition is met, follow these steps to apply for state licensure:
 
You may request an application by calling 717-783-1379, or download all six of the forms below.
 
 
To request exceptions please click here and complete and return back to the Division.
  1. Once you have reviewed the rules and regulations and completed all of the forms, submit the completed application with the appropriate/required fee to: Pennsylvania Department of Health, Division of Home Health, 132 Kline Plaza, Suite A, Harrisburg, PA 17104-1579.
  2. If your application is in accordance with Pennsylvania home health agency rules and regulations, the Division will issue you a license.  Please keep in mind the length of time for the licensure process depends upon the accuracy of information provided.
If you have any questions, please call the Division of Home Health at 717-783-1379. 
 
 
Application for Federal Medicare Certification
 
Note: State licensure as a Home Health Agency is a requirement for Federal certification.
 
Federal Medicare Regulations: Home Health
 
 
OASIS Regulations: Home Health
 
 
For persons interested in the application process for Medicare certification for a Home Health Agency, here are the steps to follow:
 
  1. Request a copy of the federal Medicare regulations for Home Health Agencies and an application from the Division of Home Health, or click on the links above for the regulations, and for the required forms click the links under Medicare Forms.
  2. For more information concerning Medicare Certification, click here to be taken to the CMS website.
  3. Submit the completed applications materials to the Pennsylvania Department of Health, Division of Home Health, 132 Kline Plaza, Suite A, Harrisburg, PA 17104-1579.
  4. Submit the completed CMS-855A Enrollment Application to the selected Fiscal Intermediary.  For a listing of Fiscal Intermediaries click here.
  5. After review and acceptance of the application materials and notification from CMS of the approval of the CMS-855A, the Department will conduct a survey before recommending the agency for Medicare certification.
Medicare Forms
 
The following forms are in pdf format.
 
Please submit one copy of CMS Form 1572(a)
 
Please submit five copies of CMS Form 1561
 
 
Click here for the application needed to participate with your Fiscal Intermediary.