New Direct Care Worker ID Requirement Starting Oct. 1

The Office of Health Insurance Programs (OHIP) has a new requirement for all Medicaid Managed Care plans starting Oct. 1, 2026. Home Care Registry IDs must be included on all Home Health Aide, Personal Care, and Consumer Directed Personal Assistance Services (CDPAS) encounters submitted for Medicaid and HARP members. Direct Care Worker information must be populated within the applicable rendering provider loops outlined below.

Direct Care Workers who do not have a National Provider Identifier (NPI) will be identified using Home Care Registry IDs for all Home Health Aide and Personal Care encounters and using Statewide Fiscal Intermediary (SFI) Personal Assistant IDs for all CDPAS encounters for dates of service starting Oct. 1, 2026.

Providers must submit Home Care Registry ID or SFI Personal Assistant ID as the rendering provider on all Home Health Aide, CDPAS, and Personal Care encounters as follows: 

For encounters where all lines are provided by the same Direct Care Worker, the 2310A/2310B loops can be used. If the encounter has services provided by multiple Direct Care Workers, the provider information should be submitted on the 2420C/2420A loops.

Claims Submission and Electronic Data Interchange (EDI) Clearinghouse Guidance

Claims for Home Health Care provided by Licensed Home Care Services Agencies (LHCSAs), Certified Home Health Agencies (CHHAs) and Consumer Directed Personal Assistance Services (CDPAS) provided by the Statewide Fiscal Intermediary (SFI) must have the Home Care Registry ID or Statewide Fiscal Intermediary Personal Assistant ID reported here: 837P: Loop 2420A REF02 / 837I: 2420C REF02.

Direct Care Workers are not required to have an NPI. Therefore, EDI Clearinghouses must ensure they accept the Home Care Registry ID or SFI ID for Licensed Home Care Services Agencies, Certified Home Health Agencies, and the Statewide Fiscal Intermediary to submit these HIPAA compliant segments. See the Homecare Worker ID EDI Letter for an example.