How to start a private duty nursing agency in Pennsylvania

Pennsylvania requires a Home health agency license (PA Department of Health) with Medicare certification; enrolled under specialty 051 Private Duty Nursing from Pennsylvania Department of Health (license); Department of Human Services (MA enrollment) to operate a private duty nursing agency.

License required

Yes

License

Home health agency license (PA Department of Health) with Medicare certification; enrolled under specialty 051 Private Duty Nursing

Issuing agency

Pennsylvania Department of Health (license); Department of Human Services (MA enrollment)

Regulation

55 Pa. Code §1101.42 (prerequisites for participation); DHS home health agency enrollment requirements

1. Obtain a PA Department of Health home health agency license
2. Obtain Medicare certification and CMS enrollment at the service location
3. Enroll with PA Medical Assistance as a home health agency, selecting specialty 051 (Private Duty Nursing) and the applicable program eligibility
4. Revalidate each service location every 5 years

Program

Pennsylvania Medical Assistance (Medicaid) / HealthChoices, PA Department of Human Services, Office of Medical Assistance Programs

Enrollment portal

PROMISe Provider Portal — Electronic Provider Enrollment (PE) Application

Fiscal agent

PROMISe (DHS claims and enrollment system); the DHS electronic enrollment manual was prepared by Gainwell

Application fee

Since February 27, 2023, applicants pay the enrollment application fee described in MA Bulletin 01-16-14 ('ACA Enrollment Application Fee'). To claim an exemption, submit the documentation that bulletin describes. Under the federal rule (42 CFR 455.460), institutional providers pay the CMS application fee when they first enroll, re-enroll or revalidate. The fee is $750 for calendar year 2026. Individual physicians and non-physician practitioners do not pay it. A fee already paid to Medicare or to another state's Medicaid program counts.

Fingerprinting

High-risk providers must complete fingerprint-based criminal background checks; this requirement returned February 27, 2023 (MA Bulletin 99-16-13 sets the risk levels). If fingerprints are not submitted, the service location in PROMISe is closed. Under federal rules (42 CFR 455.434 and 455.450), the state places provider types in 'limited', 'moderate' or 'high' risk levels. High-risk providers, and anyone who owns 5% or more of one, must submit fingerprints for a criminal background check.

Site visit

Moderate- and high-risk providers get a site visit from DHS or its contractor (MA Bulletin 99-16-13). If the visit cannot confirm the application, for example because the location is not operating, or the provider does not cooperate, the service location is closed.

Revalidation

Federal rule (42 CFR 455.414) requires the state to revalidate every enrolled provider at least once every 5 years. DHS sends revalidation notices 90 and 30 days before the due date (MA Bulletin 99-16-10 has the details). The revalidation date is visible in ePEAP. A missed due date closes the service location in PROMISe, and the provider must then file a reactivation application.

Full Pennsylvania Medicaid enrollment guide →

CON program

No

Pennsylvania certificate of need details →

Model

hybrid

State vendor

Sandata (with fiscal agent Gainwell Technologies)

Services in scope

• personal care
• home health

Alternate EVV allowed

Yes

Program

https://www.pa.gov/agencies/dhs/resources/for-providers/evv

Pennsylvania EVV requirements →

State minimum wage

$7.25 an hour

Effective

2009-07-24

Scheduled increases

No scheduled change found in the official sources reviewed.

HCBS 80/20 rule

Federal baseline: 42 CFR 441.302(k) requires the state to show that each provider spends at least 80% of Medicaid payments for homemaker, home health aide and personal care services under 1915(c) waivers on direct care worker pay and benefits. Compliance starts 2030-07-09 (for managed care, the first rating period starting on or after that date); annual payment-adequacy reporting under 441.311(e) starts 2028-07-09. A state may set a lower share for state-defined small providers and exempt providers facing hardship, each only through a public notice-and-comment process. The eCFR text has not changed since 2024-07-09. No state-published 80/20 implementation step (small-provider criteria, hardship exemption or reporting guidance) was found for this state in the official sources reviewed.

Nursing care agencies (private duty nursing) — active organization NPIs (NPPES)

321 (as of Sep 13, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

2,952,912 (as of Jun 1, 2026)

All Pennsylvania Private duty nursing Medicaid rates, ranked →

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