State Licensure and/or Federal Medicare Certification
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, complete the following document to
apply for state licensure. Home Health Agency Application Materials:
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
Home Health Agency Application for Federal Medicare Certification
NOTE: State licensure as a Home Health Agency is a requirement for Federal certification.
Please submit one copy of the CMS Form 1572(a) to the Division of Home Health.
Please submit one copy of the CMS Form 690 to the Division of Home Health.
Please submit one copy of the CMS Form 1561 to the Division of Home Health.
Please submit the CMS Form 855A - Enrollment Application to your Fiscal Intermediary - see QUICK LINKS on the right.
Please submit the Federal Civil Rights Information for Medicare Applicants by clicking here.
All forms and regulations are accessible by using Adobe Reader software. Click here to download it.
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.