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States · Pennsylvania

Pennsylvania EVV and Medicaid home care, in plain words.

In Pennsylvania most adult home care is paid through Community HealthChoices, so you need a contract with each of the three CHC health plans whose members you serve. You also need a Chapter 611 home care license from the Department of Health.

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Pennsylvania at a glance

EVV, Medicaid and billing in Pennsylvania.

Medicaid agencyPennsylvania Department of Human Services (DHS). Office of Long-Term Living (OLTL) runs Community HealthChoices and LTSS waivers; Office of Developmental Programs (ODP) runs IDD waivers; Office of Medical Assistance Programs (OMAP) covers home health.
EVV modelOpen model: DHS offers the Sandata state system and aggregator; agencies may use an alternate EVV system that sends data to the Sandata aggregator. Community HealthChoices MCOs use HHAeXchange for their members.
State EVV systemSandata (DHS state EVV system and aggregator).
Your own EVV vendor allowed?Yes. Alternate systems must send data to the Sandata aggregator for fee-for-service; for managed care members, follow each MCO’s EVV route (CHC plans use HHAeXchange).
Services that need EVVPersonal care services (OLTL, ODP, OMAP) and home health services.
Where you billPROMISe (MMIS) for fee-for-service; CHC MCO claims through each plan (HHAeXchange portal for CHC home care).

Dates that matter: 85% verified-visit standard (manual edits at or below 15%) for dates of service from 1 Jan 2025. DHS Medical Assistance Bulletin on enforcing the 15% manual-edit threshold; alerts to agencies over 15% began January 2026, with corrective action after two consecutive quarters over the threshold.

Licensing: Home care agency license (non-medical: personal care, companion, homemaker) from the PA Department of Health under 28 Pa. Code Chapter 611; home health agencies licensed separately. Medicaid enrollment through DHS, plus credentialing with each CHC MCO.

Managed care: Yes for most adult LTSS: Community HealthChoices with three MCOs — AmeriHealth Caritas / Keystone First CHC, PA Health & Wellness, UPMC Community HealthChoices. Physical HealthChoices plans cover home health for other members. ODP waivers are fee-for-service.

Programs that pay for care at home

Pennsylvania EVV, from the state

Same rules, same tangle

In Pennsylvania, the visit still gets typed four more times.

The caregiver taps in. The visit goes to Sandata. Then someone in your office carries it by hand into payroll, into billing, into the chart, and to the family on the phone. Every carry is a chance for the numbers to drift. When they do, Pennsylvania denies the claim, and you find out weeks later. That is Tangleware™: good tools, and an owner in the middle.

How one tap at the door runs the whole agencyThe mechanism, the nine agents, and Cary®

CareBravo® in Pennsylvania

Running an agency in Pennsylvania? Tell us.

CareBravo works with the EVV systems states use, including Sandata, HHAeXchange and Netsmart. Each state approves its own connection, and each program has its own rules, so we confirm what is in place for Pennsylvania and your programs before you switch anything. If we are not running in Pennsylvania yet, we will make you an offer to start now while we build it.

Run the Calculator, or ask for the demo and tell us your state.

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Five promises, written like promises.

  1. Nothing stops. Your current system keeps running while CareBravo runs beside it for two weeks on your real data. The Parallel Promise™
  2. 99%, in writing. On Managed Billing, at least 99% of your claims go out without a mistake we caused. If we make one, we fix it free. We cannot promise what a payer decides. Read the guarantee
  3. The floor, stated up front: $250 a month, no seats, no per-user fees, no implementation fee — and corrections never billed twice.
  4. Thirty days’ notice, either way.
  5. Nobody calls unless you ask.

What Pennsylvania owners ask.

What is Pennsylvania’s 85% EVV rule?

At least 85% of your EVV visits must be verified without manual edits, so edits can be no more than 15%. It applies to dates of service from 1 January 2025. Agencies over 15% for two quarters in a row face corrective action from DHS or their health plan.

Do I use Sandata or HHAeXchange?

Both may apply. Fee-for-service visits go to the state’s Sandata aggregator, either through Sandata or your own approved EVV system. Community HealthChoices plans use HHAeXchange for their members. If you serve both, set up both routes before your first visit.

What license do I need for personal care?

A home care agency license from the Pennsylvania Department of Health under Chapter 611. Then enroll with DHS for Medicaid and get credentialed with each Community HealthChoices plan separately. Credentialing with one plan does not carry over to the others.

What counts as a manual edit?

Any change after the visit, such as fixing clock-in or clock-out times, changing the length, or adding a visit later. Visits verified in real time are not manual edits. Train caregivers to clock in and out at the client’s home every time.

Sources for this guide

Checked 28 Oct 2026. State rules change. Confirm with the Pennsylvania Department of Human Services (DHS). Office of Long-Term Living (OLTL) runs Community HealthChoices and LTSS waivers; Office of Developmental Programs (ODP) runs IDD waivers; Office of Medical Assistance Programs (OMAP) covers home health. before you act.

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See What’s Draining Your Agency →View the demo