State Licensure and Inspection Requirements for Home Care Firms

Home care services are usually provided by home care organizations that include home health agencies; hospices; homemaker and home care aide (HCA) agencies; staffing and private-duty agencies; and companies specializing in medical equipment and supplies, pharmaceuticals, and drug infusion therapy. Home health care may include occupational and physical therapy, speech therapy, and skilled nursing. It may also include assistance with cooking, cleaning, other housekeeping, and monitoring one’s medication regimen as well as helping older adults with activities of daily living, such as bathing, dressing, and eating. Home health care professionals are often licensed practical nurses, therapists, or home health aides with many working for home health agencies and home health care franchises.

There are many considerations individuals assess in deciding which home care firm to use including how long the organization has been serving the community, the services and costs provided, whether the organization is a Medicare provider and if a national accrediting body certifies the agency’s quality of care. Another important consideration in choosing a home care firm is whether it is currently licensed for operation. Licensure varies depending on the state and generally depends on the type of home care organization.

Home Health Care Agencies

Home health care agencies are regulated by state and federal laws and often are Medicare and Medicaid certified. Licensure applications vary from state to state but typically there are three common components: proof of agency authorization must be provided, criminal checks must be conducted, and proof must be provided that key staff members (typically, administrators and director(s) of nursing) are qualified under state regulations. Additionally, due to regulatory requirements, services provided by these agencies are highly supervised and controlled.

There are 14 states that do not accept license applications unless it can be proven through a Certificate of Need (CON) Application that the need for a home health care agency is pressing. CON programs are aimed at restraining health care facility costs and allowing coordinated planning of new services and construction. Laws authorizing such programs are one mechanism by which state governments seek to reduce overall health and medical costs. Thirty-six states currently allow the establishment of a new home health care agency without a Certificate of Need Application. All but four (Iowa, Michigan, Massachusetts and Ohio) require the submission of a state license application.

Every state that requires a license application also requires a license inspection that will either be conducted by its own inspectors or by an accrediting body. Eighteen states currently require that the licensure inspection take place before a license is issued. All other states will issue a provisional license and then follow up with an inspection visit.

In addition, depending on the state, a home health care agency can be subject to subsequent inspections on a one-year, two-year or three-year cycle by authorized representatives of the state’s department of health. Inspections may be scheduled in advance or be unannounced.

Homemaker & HCA Agencies

Homemaker and HCA agencies employ homemakers or chore workers, HCAs, and companions who support individuals through meal preparation, bathing, dressing, and housekeeping. Personnel are assigned according to the needs and wishes of each client. Some states but not all require these agencies to be licensed and meet minimum standards established by the state.

In-Home Hospice

Hospice care involves a core interdisciplinary team of skilled professionals and volunteers who provide comprehensive medical, psychological, and spiritual care for the terminally ill and support for patients’ families. Hospice care also includes the provision of related medications, medical supplies, and equipment. It is based primarily in the home, enabling families to remain together. Trained hospice professionals are available 24 hours a day to assist the family in caring for the patient, ensure that the patient’s wishes are honored, and keep the patient comfortable and free from pain. Most hospices are Medicare-certified and licensed according to state requirements.

It’s critical that home health care organizations comply with the state and federal regulations where they operate, and keep their licenses current and in compliance with home care licensure rules.

Manchester Specialty provides focused insurance and risk management solutions to the home health care and hospice industry. We work exclusively with local brokers and would be happy to review your operation and how well your insurance program addresses the various exposures your operation faces. You or your local agent/broker can contact us at 855.972.9399 for more information about our products and services.

Sources: CMS, Home Health Care Licensing