How to start a skilled nursing facility in Pennsylvania

Pennsylvania requires a Long-term care nursing facility license from Pennsylvania Department of Health, Division of Nursing Care Facilities to operate a skilled nursing facility. Fee: Application and renewal fees set by section 807(b) of the Health Care Facilities Act (35 P.S. §448.807(b)); amounts not restated here.

License required

Yes

License

Long-term care nursing facility license

Issuing agency

Pennsylvania Department of Health, Division of Nursing Care Facilities

Fee

Application and renewal fees set by section 807(b) of the Health Care Facilities Act (35 P.S. §448.807(b)); amounts not restated here.

Medicare certification

Separate from the state license. The state survey agency runs an unannounced standard health survey, a Life Safety Code survey and an emergency-preparedness survey against 42 CFR Part 483 Subpart B. For a Medicare SNF the state certifies and the CMS Location decides Medicare participation; for a Medicaid-only NF the state's certification is final and the state Medicaid agency decides participation.

Regulation

28 Pa. Code Chapter 201 (§201.12); Health Care Facilities Act, 35 P.S. §448.807

1. Obtain the application from the Division of Nursing Care Facilities
2. Submit the application and statutory fee with ownership disclosures (5%+ owners, land/building owners), management and staffing plans, training plans and annual audited financial statements
3. List every long-term care facility in any state in which the applicant has held a 5%+ interest
4. Pass the Department's licensure survey
5. For Medicare/Medicaid, complete federal certification and enroll with PA Medical Assistance

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 →

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.

Skilled nursing facilities — active organization NPIs (NPPES)

1,744 (as of Sep 13, 2026)

Medicare/Medicaid-certified nursing homes (CMS Care Compare)

656 (as of Aug 1, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

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

All Pennsylvania Skilled nursing Medicaid rates, ranked →