health.pa.gov Apply for a Home Care Agency/Registry License : Pennsylvania Department of Health
Name of the Organization : Pennsylvania Department of Health
Type of Facility : Apply for a Home Care Agency/Registry License
State : Pennsylvania
Country : United States of America
| Want to comment on this post? Go to bottom of this page. |
|---|
Website : http://www.health.pa.gov/facilities/Registries/Home%20Care%20and%20Hospices/Pages/HH-Landing-Page.aspx#.V1-0m-Qgsqg
Application Form : https://www.statusin.org/uploads/24105-HCAapp.pdf
Apply for a Home Care Agency/Registry License :
** The following series of documents contain the application materials for a Home Care Agency/Home Care Registry.
Related : Pennsylvania Department of Health Obtain Birth Certificate : www.statusin.org/24092.html
** Please note that all questions must be answered, and all requested supporting documentation must be provided.
** If you fail to submit all requested information, the application materials will be mailed back to you.
** If your application is in accordance with Pennsylvania Home Care Agency rules and regulations, the Division of Home Health will issue you a license.
** Please keep in mind the length of time for the licensure process depends upon the accuracy of information provided.
Payment :
** A Check or Money Order Payable to “Commonwealth of Pennsylvania” for the amount of the fee must accompany this application.
** Currency is not acceptable.
** The regular fee per license is $100.
Return the completed and signed original application with a mail check or money order to :
Pennsylvania Department of Health
Division of Home Health
132 Kline Plaza, Suite A
Harrisburg, PA 17104
Important : Please retain a copy of your entire packet for your records.
Home Care Agency/Registry Licensure Survey :
1. List the number of direct care workers employed and/or rostered by the agency.
2. Describe or attach your agency or registry’s prerequisites for hiring and/or rostering of direct care workers. If attached, please label as Exhibit A.
3. Do you hire or roster individuals on a provisional basis pending the outcome of a criminal background check and ChildLine verification, if necessary?
4. Does the agency or registry provide services to consumers less than 18 years of age?
5. If services are provided to consumers less than 18 years of age, have all staff, including office staff and direct owner(s) had child abuse clearances completed or initiated?
** Attach a sample(s) copy of the information packet which will be provided to the consumer prior to the commencement of services.
The Packet Must Include The Following :
a. A form or other document that will show a list of services to be provided to the consumer, the hours when they will be provided and the identity of the direct care worker that will provide the services.
b. Cost of the services to be provided on an hourly or weekly basis.
c. Department of Health contact information for inquiries about licensure requirements and agency/registry compliance.
d. Department of Health hotline and local AAA Ombudsman telephone numbers.
e. Hiring/Competency requirements of direct care workers.
f. Disclosure addressing employee or independent contractor status of the direct care worker providing services to the consumer, and the resultant tax and insurance obligations and other responsibilities of the consumer.