Pennsylvania Medicaid pays for in-home personal care and related services through 2 programs, including the Community HealthChoices (CHC) and the OBRA Waiver. Pennsylvania operates Community HealthChoices (CHC) under combined §1915(b)/(c) waiver authority. The Aging Waiver and Independence Waiver have transitioned into CHC. Financial Management Services are available to participants who self-direct services in CHC, OBRA, and the Act 150 program.
Which Pennsylvania waivers can a home care agency bill?
Each waiver below lists who it covers, the services it pays for, and how providers bill.
Community HealthChoices (CHC)
Population
Older adults and adults with physical disabilities who are dually eligible or need long-term services and supports (LTSS)
Services covered
personal assistance services
home health
adult day services
respite
home-delivered meals
homemaker
behavioral support
service coordination
Billing format
Capitated managed care via CHC-MCOs; EVV via DHS aggregator (Gainwell + Sandata) or the provider's own EVV system that interfaces with the DHS Aggregator
To bill Medicaid for home care you need a state license, a Type 2 NPI, state Medicaid enrollment and screening, waiver or managed care contracts, EVV and authorizations.
Private pay means higher rates and fast payment; Medicaid means steady volume at state-set rates with authorizations and EVV. Compare rates, cash timing and admin before you mix them.
Track units remaining, the end date and the service code for every client, and check them before each schedule change. Hours over the cap are unbillable.
Four units equal one hour. How to convert units to hours, the common HCPCS codes, how states round partial units, and how to stay inside the authorization.
These free tools are made by the team behind Caregiver Scheduling,
caregiver scheduling software for home care agencies.
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