Establishing a Certified Home Health Agency

Purpose: This procedure describes the steps to become a licensed and certified home health agency. According to G.S. 131E-136(4) (PDF, 13 KB), a "home health agency" means a home care agency which is certified to receive Medicare and Medicaid reimbursement for providing nursing care, therapy, medical social services, and home health aide services on a part-time, intermittent basis as set out in G.S. 131E-176(12) (PDF, 45 KB). Each site providing home health services must have a separate certificate of need and a separate license. The North Carolina Medical Care Commission has rulemaking authority for home health services. The statutes that apply to home health are North Carolina General Statutes 131E-135 through 142 and the rules are under Title 10A of the North Carolina Administrative Code (10A NCAC 13J).

Please be aware that there may be variations in the process since individual projects may have special circumstances. The flow chart is intended to be a general guide to aid the applicant in completing the overall project.

Contacts: For questions regarding any part of this process, please contact the appropriate sections of the N.C. Division of Health Service Regulation:

Acute & Home Care Licensure and Certification Section 919-855-4620
Certificate of Need Section 919-855-3873
Medical Facilities Planning Section 919-855-3865

Procedure Summary: In order to operate a Medicare-certified home health agency in North Carolina, an applicant first consults the State Medical Facilities Plan (SMFP) to determine if there is a projected need for one. If the SMFP does not indicate need for an additional agency, no certificate of need can be issued for development of a certified home health agency. If the SMFP indicates need for an additional agency, the applicant must apply for a certificate of need. Applicants successfully obtaining a certificate of need must then apply for and obtain a license. Steps to obtain certification for Medicare and Medicaid are taken after the agency is licensed and in operation.

Procedures:

  1. Review the State Medical Facilities Plan: Medical Facilities Planning Section
    1. Applicants can learn the number of certified home health agencies needed in the annual State Medical Facilities Plan (SMFP), which is published for each calendar year and which specifies where in the state they are needed.
    2. Applicants can also find the certificate of need review schedule and deadline for submittal of applications for these agencies, if there is a projected need, in the SMFP. No one may develop a new certified home health agency without first obtaining a certificate of need. A certificate of need cannot be issued if the SMFP does not show a need for the agency in the county where it is proposed.
  2. Obtain a Certificate of Need: Certificate of Need Section
    1. The applicant submits a certificate of need application for the proposed certified home health agency according to the review schedule outlined in the SMFP.
    2. The Certificate of Need (CON) Section advertises a written public comment period and local public hearing. Within 30 days of the beginning of the review period, written comments may be filed by any person, including the applicant, regarding the proposals under review.
    3. A public hearing is conducted by the CON Section within 30 to 50 days from the beginning of the review period, at which time the applicant is given the opportunity to respond to written comments submitted to the CON Section and inquiries made at the hearing.
    4. A decision to approve or disapprove an application is made by the CON section within 150 days of the beginning of the review period.
    5. A certificate of need is issued 35 days after the date of approval if a petition for a contested case hearing is not filed.
    6. After a certificate of need is issued, the applicant contacts the Acute and Home Care Licensure and Certification Section about its respective requirements for the development of a certified home health agency.
  3. Obtain a license: Acute and Home Care Licensure and Certification Section
    1. The applicant requests a licensure application from the section.  Since certified home health agencies provide more than one “home care” service, a multi-purpose licensure application is used and a multi-program license may be issued.  The applicant submits a completed application to the Acute/Home Care/Licensure and Certification Section.
    2. The section reviews the application for completeness.
    3. If the proposed home health agency is accredited by any of the bodies specified in the Home Care Licensure Act (N.C. G.S. 131E – 138, PDF, 12 KB), it is deemed to be in compliance with the home care licensure rules and a license is issued designating the services that the agency is authorized to provide.
    4. If the proposed home health agency does not qualify for deemed status, an initial licensure survey is scheduled.
    5. If the proposed home health agency is in substantial compliance with the home care licensure rules at the time of the survey, a survey report is generated and a license is issued.
    6. If the proposed home health agency is not in substantial compliance with the home care licensure rules, the applicant will be informed at the time of the survey what additional information is needed to be in substantial compliance.
    7. If there is a question of safety or adequacy of care, then the section attempts to assist the proposed home health agency to reach compliance through consultations. If those efforts fail, licensure is denied.
  4. Obtain certification: Acute and Home Care Licensure and Certification Section
    1. Licensed home care agencies that have obtained a certificate of need for certified home health services must contact the section for the federal forms to request Medicare/Medicaid certification.  Your fiscal intermediary must submit approval for Form CMS 855 prior to an initial medicare survey.
    2. The agency completes all required information and returns it to the section.
    3. If the application packet has been approved by the section and by the agency’s fiscal intermediary (Form CMS 855), the section schedules an unannounced on-site survey.  As soon as the agency is ready for operation, it must notify the section office in writing as early as possible and must have served 10 skilled care patients and 7 active (not medicare patients) to request an on-site survey.
    4. The section conducts the survey.  If an agency has deficiencies during the initial survey, the effective date of certification will be the latest date a plan of correction is signed by the agency.
    5. The section conducts the survey. If an agency has deficiencies during the initial survey, the effective date of certification will be the latest date a plan of correction is signed by the agency.
    6. The section forwards all information to the Atlanta Centers for Medicare & Medicaid Regional Office for approval.
    7. The Atlanta Regional Office of the Centers for Medicare Medicaid Services assigns the provider number and notifies the agency’s fiscal intermediary.