Pennsylvania is one of the more open states for new home care agencies: there’s no Certificate of Need, and the state filing fees are low. But two things changed in 2026 that catch first-time owners out, and both can cost you months if you miss them.
Change 1: the SAIS portal is now the only way in
Since March 31, 2026, Home Care Agency and Home Care Registry applications are accepted only through the Department of Health’s SAIS online portal. Paper and email applications are no longer held for correction. They’re rejected outright, and applicants lose their place in the queue and have to start again.
Two details people miss:
- The application fee is still mailed separately, to the PA DOH Division of Home Health in Harrisburg.
- Home Health Agency and hospice initial applications currently follow a different route: they’re submitted by email to the Division of Home Health, again with the fee mailed separately.
Change 2: the Medicare clock
On May 13, 2026, CMS froze new Medicare enrollment for home health agencies and hospices nationwide. The freeze is scheduled to end on November 13, 2026, unless CMS extends it.
That date matters more than it looks. Your Pennsylvania license has to come first, and most applications are decided within two to three months of a clean submission, or four to six months if deficiency letters go back and forth. If you plan to bill Medicare, applying for your state license now is what puts you in position to enroll when the freeze ends, instead of starting from zero on that day.
Which Pennsylvania license do you need?
- Home Care Agency (HCA): you employ direct care workers to provide non-skilled personal care, companionship and respite in clients’ homes. Governed by 28 Pa. Code Chapter 611.
- Home Care Registry (HCR): you refer independent direct care workers to clients rather than employing them, with extra disclosure duties to consumers. Also Chapter 611.
- Home Health Agency (HHA): skilled nursing plus at least one therapeutic service, such as physical therapy or home health aide services. Governed by Chapter 601.
- Hospice: state licensure comes before any Medicare survey. Pennsylvania hasn’t finalized its own hospice regulations yet, so the federal Medicare Conditions of Participation apply in the meantime.
Applying under the wrong one is a common and expensive mistake. Agency and Home Health licenses have different fees, staffing rules and Medicare paths, and switching usually means starting over.
What it costs
The state filing fee is $100 for a Home Care Agency or Registry license and $250 for a Home Health Agency. Once you add insurance, business formation and background checks, most new agencies budget roughly $2,000 to $6,000 all in. See the full Pennsylvania cost breakdown.
What the Department of Health will check
- A physical office it can inspect. P.O. boxes aren’t accepted.
- A policies and procedures manual written to Chapter 611 or 601, covering client rights, personnel, infection control, emergencies and training.
- Criminal history checks (Act 34) for owners, office staff and direct care workers. Anyone without two consecutive years of Pennsylvania residency also needs an FBI check and a letter of determination from the Department of Aging.
- Child abuse clearances (Act 151) for staff with direct consumer contact, and TB screening within the past year.
- Competency for every direct care worker before they work unsupervised, through an approved training program, with annual reviews after that.
- A consumer disclosure package given at the start of service, including at least 10 calendar days’ notice before services end.
Allow four to six weeks for clearances to come back, and build that into your plan before you file.
Do you need to be a nurse to own a Pennsylvania agency?
No. For non-medical home care, the state sets no qualifications for the manager at all. Skilled home health needs a qualified Administrator plus a supervising doctor or registered nurse, but ownership itself carries no clinical requirement. More on that in our ownership guide.
How we help in Pennsylvania
We prepare and submit the whole application through SAIS, at a fixed price: $2,495 for a Home Care Agency license and $3,495 for a Home Health Agency license. Our Pennsylvania licensing guide has the full step-by-step process.
Opening in Pennsylvania? Book a free discovery call and tell us which county. We’ll tell you what tends to hold applications up there.
This article is general information, not legal advice. Pennsylvania rules and fees change; we confirm the current requirements as part of every project.
