Delaware skilled home health agency license: the OHFLC binder review, directors and fees

Skilled, aide-only or personal assistance: pick the right license first

The statute defines a home health agency as a business that provides “two or more home health-care services, 1 of which must be either licensed nursing services or home health aide services,” or that provides home health aide services only.⁠² DHCQ splits this into separate licenses, and a separate rule covers non-medical care:⁠³⁠⁴

Scroll the table sideways to see every column.

Skilled services are “provided directly by a licensed professional” and “must be ordered by a physician or an allowable provider.” An allowable provider is an advanced practice nurse or a physician assistant licensed in Delaware.⁠¹ The covered services are licensed nursing, physical, occupational and speech therapy, audiology, nutrition, social services and home health aide services.⁠¹ Aide-only agencies are limited to personal care, companion and homemaker services, medication reminders and tasks a nurse delegates.⁠⁶ Under the statute, every home health agency service, skilled or not, must be supervised by a registered nurse.⁠²

If you plan to offer only non-medical help with daily activities, see the Delaware personal assistance services agency guide. OHFLC lets you hold more than one license type, but “you can only open one agency at a time.” You can start the second only after the first has a full annual license. OHFLC suggests opening the more involved agency first.⁠³ If you change your mind about the license type, you file a new statement of intent.⁠³

Rule 3350 does not require a license for:⁠¹

• an individual who contracts directly with a patient and is paid by the patient, with no agency collecting periodic fees;
• suppliers of durable medical equipment only;
• staffing agencies that supply workers to licensed home health agencies, as long as they have no direct agreements with patients and work under the licensed agency’s direction;
• prayer-based healing services of a registered church;
• agencies providing only services under the Community-Based Attendant Services Act (16 Del.C. ch. 94);
• a personal assistance services agency providing only PASA services.

You may not advertise or “hold themselves out to the public as being a home health agency” until the license is issued.⁠¹ OHFLC’s FAQ confirms that this includes advertising.⁠³

Where you can operate: an office in Delaware and a two-county reach

The office where you keep personnel and patient records “shall be located in the State of Delaware.”⁠¹ The rule ties your service area to that office. It covers the county where the office is located and “may also include the county or counties in the state of Delaware which are immediately adjacent.” The agency “shall only provide services in the service area,” except during a patient’s time-limited travel.⁠¹

Delaware has three counties, and Kent borders both New Castle and Sussex. So an office in Kent can cover the whole state, while an office in New Castle or Sussex can reach only its own county and Kent. Each additional office needs its own license.⁠¹ For an existing owner using the same policies, OHFLC says the procedure for an added office is “a little different” and asks you to contact the office.⁠³

You do not need commercial space. OHFLC lets agencies “work out of their homes as long as the home has a room that can be designated as an office with a door and a lock and key” to secure records. Unused space inside another business’s premises is acceptable on the same condition.⁠³ You must notify OHFLC in writing at least 30 days before moving the office.⁠¹

There is no certificate of need step. Delaware’s Certificate of Public Review covers health-care facilities. The statute’s definition names hospitals, nursing homes, and freestanding birthing, surgical, acute inpatient rehabilitation and emergency centers, and adds continual care communities and other nontraditional long-term care facilities identified by DHSS or the Delaware Health Care Commission. Home health agencies are not named.⁠⁹

The two people you must have: director and clinical director

OHFLC’s FAQ answers question after question about these two jobs with the same line: “The experience cannot be waived.”⁠³

• Director (full-time). Either a bachelor’s degree or an RN license, plus 5 years of health care experience and at least 1 year of supervisory experience in home health care, full-time or equivalent.⁠¹ The director runs daily operations, reports to the governing body after reviewing policies each year, and handles complaints and grievances.⁠¹
• Clinical director (full-time employee). A registered nurse with at least 1 year of home health care experience and at least 1 year of administrative or supervisory health care experience. The rule requires the director or the clinical director to be available at all times during operating hours.⁠¹ OHFLC requires the RN license to be a Delaware license.⁠³
• One person, two roles. The same person may hold both jobs “if that individual is dually qualified.”⁠¹
• Backups. The director must designate a “similarly qualified” alternate in writing, and the clinical director needs an “equally qualified designee.”⁠¹ OHFLC confirms that the alternate director must have equal experience.⁠³

OHFLC’s answers to applicants add the following limits:⁠³

• Supervisory experience gained at a non-medical home care agency “does not qualify as healthcare supervisory experience.”
• Twenty years as a nurse without 1 year of home health supervisory experience does not qualify you as clinical director.
• One person cannot direct two agencies, even in different states, because the job is full-time during operating hours.

If either the director or the clinical director changes, you must tell OHFLC in writing within 30 days.⁠¹

According to OHFLC, the agency hires its directors and clinical directors once it holds its OHFLC license. Until their background checks clear and OHFLC approves their résumés, they work on a conditional basis.⁠³ You still have to name the director and list management personnel with their credentials in the application.⁠¹ Line up qualified people before you file.

How the OHFLC application actually runs

Rule 3350 sets out the legal steps. OHFLC’s “Opening a Home Health Agency” page fills in how they work in practice. OHFLC also warns: “Do not spend any money on business licenses, insurance, office space, hiring personnel, etc. until you are recommended for licensure by the OHFLC.”⁠³

1. Send a statement of intent. In writing, describe the services you plan to offer and request a licensure application.⁠¹ Receiving an application form does not guarantee a license.⁠¹
2. Build the binder. Complete the HHAS application and document compliance checklist, and organize your documents in a binder following the checklist. Do not use plastic page covers.⁠³ The rule requires the application to include:⁠¹
   • the other agencies you own or manage;
   • your policies and procedures manual;
   • the officers, directors, partners or managing members, and the governing body;
   • anyone on that list who holds a financial interest of 5% or more;
   • a disclosure of any of those people, or of any employee, with a felony record;
   • the director’s name;
   • management personnel and their credentials;
   • a plan for staff continuing education and training during your first year.
3. Email the checklist, then deliver the binder. Email the checklist as an Excel file, together with your emergency management plan, to [email protected].⁠³ Then bring the binder, a copy of the checklist and payment to 263 Chapman Road, Suite 200, Newark, any weekday from 8 a.m. to 4 p.m.⁠³⁠⁷ Pay by cashier’s check or money order made out to the State of Delaware; OHFLC’s process list says “certified check or money order only.”⁠³ OHFLC keeps the binder, so make a copy for yourself.⁠³
4. Completeness check. If the binder is incomplete, you will be asked to pick it up, along with the fee, and given a list of what is missing.⁠³ A complete binder goes on a waitlist. “Binders are reviewed in the order they are received.”⁠³
5. The wait. OHFLC’s acceptance email states that review takes “6-9 months or longer” and tells applicants not to contact the Division about status.⁠³ OHFLC will not pre-read policies (“that would be unfair to all the other agencies”). It does not recommend policy-writing companies, and you may not hire DHCQ’s compliance nurse to write them.⁠³
6. Revisions. If reviewers ask for changes, you have 30 days to email them. If the revisions still fall short, the application is withdrawn and you start again at step 2.⁠³
7. Part 2: business license and background check access. Once the binder passes, you get a “part 2” checklist. You need a Delaware business license, which you get through Delaware One Stop, at this stage. You also need access to the state Background Check Center, and fingerprinting through the State Bureau of Identification comes “after you pass your binder review.” OHFLC says “you will not get your license until you have access.”⁠³
8. 90-day initial license. An initial license lasts 90 days and “will permit an agency to hire or contract with personnel and establish a patient caseload.” It cannot be renewed.⁠¹ OHFLC says each agency must find its own patients.⁠³
9. Unannounced survey. OHFLC surveys every agency on site during its first 90 days of operation. At that point you “must be in operation and caring for patients.” An agency that has no patients, or that is not in substantial compliance, will not be licensed.⁠¹⁠³ Someone who can access policies, personnel files, patient files and competency tests, and who can speak for the agency, must be present.⁠³ If the survey finds deficiencies, you need an accepted plan of correction before you get the annual license.⁠³

You can reach OHFLC at (302) 292-3930 or toll-free at 1-800-942-7373, and by email at [email protected].⁠⁷ OHFLC oversees “more than 300 acute and outpatient healthcare providers, including home care agencies,” and asks applicants to send questions by email.⁠³

The HHAS application, document compliance checklist and statement of intent forms are linked from DHCQ’s applications and forms page. Their item lists could not be downloaded for this guide, so this guide does not reproduce the checklist. The rule’s application contents are listed in step 2 above. Ask OHFLC for the current HHAS Part 1 application and document compliance checklist, and build the binder from those, before you spend money on staff or space.

Fees as published

The fee amounts are set by statute, not by DHCQ.⁠²

The statute and the DHCQ matrix agree on these amounts: $500 initial and $300 annual.⁠²⁠⁴ Each office is licensed separately, so a second office means a second application.⁠¹ Staff screening costs are separate. The statute puts the cost of the SBI background check and the drug screen on “the person making the request.”⁠⁵

Policies and plans OHFLC grades in the binder

OHFLC’s review compares your documents with rule 3350, section by section. OHFLC says: “The regulations tell you what policies you need and what needs to be in the policy.”⁠³ The rule requires:⁠¹

• Governing body records. A governing body that is “ultimately responsible” for the agency, bylaws reviewed and dated every year, and annual meetings with minutes when the body has more than one member.
• Service and policy descriptions. A description of each service you offer and written policies for each one.
• Patient rights and grievances. Policies on patient rights and complaints. The complaint policy must tell patients that they can report concerns to the Department at its designated telephone number.
• Missed visits and backup staff. A missed-visit procedure (contacting the patient, finding a substitute, documenting the missed visit), a “sufficient pool” of staff and a backup system.
• Infection control. Infection control, communicable disease exposure, and reporting of communicable diseases to the Department.
• Personnel policies. Job qualifications, pre-employment requirements, orientation, in-service education, annual performance reviews and competency testing, and a process for checking professional licenses.
• Contracts. A written contract for every contracted service. It must state that patients pay only the agency and that the contract has a renewal clause or is renewed every year.
• Patient agreement. A written agreement with each patient listing visit frequency, costs, payment method and billing procedures. The statute separately requires this agreement and bars payments made to individual workers.⁠²
• Quality improvement. A quality improvement program that includes reviews of all unexpected patient deaths and all medication errors.
• Emergency management. An emergency management plan “consistent with the national standards (i.e., FEMA, ASPR, TRACIE)” and with local and state plans. It must cover continuing care during emergencies, staff notification, communication with emergency agencies, and prioritizing patients.
• Insurance. Rule 3350 requires “appropriate insurance coverage in force to compensate patients for injuries and losses,” with no dollar minimum.

Staffing: screening, health checks and the 75-hour aide rule

Under 16 Del.C. §§ 1145-1146, home health agencies are “home-care agencies,” and those sections set the screening rules:⁠⁵

• Criminal history first. An employer “may not employ an applicant for work in a private residence before obtaining a criminal history.” The criminal history combines the FBI record and the Delaware State Bureau of Identification record. You may hire someone conditionally for up to 60 days, but only after you have verification that SBI has fingerprinted them.
• Drug screen. You may not employ an applicant before you have the results of their drug screen.
• Penalties. Skipping either step can bring a civil penalty of $1,000 to $5,000 per violation.

The DHCQ matrix also requires adult abuse registry checks, child abuse registry checks and service letters for skilled agencies.⁠⁴ OHFLC says the child abuse check applies even if you serve only adults.⁠³ For anyone who has worked for a health care or child care employer in the last five years, you need a service letter from each of those employers. Anyone else needs one from their current or most recent employer.⁠³ Owners go through the same screening as employees.⁠³ For questions about background checks, call DHCQ at (302) 421-7400.⁠⁷

Health checks have one conflict you should know about. Rule 3350 requires a physical exam “within 12 months prior to employment/referral” and a baseline TB test at hire, following CDC recommendations.⁠¹ OHFLC’s FAQ instead says the physical “must have been completed within three (3) months prior to employment/referral.”⁠³ Because OHFLC conducts the survey, the 3-month window is the safer practice. The sources do not say which window surveyors apply to skilled agencies, so ask OHFLC in writing before you schedule staff physicals.

Aide qualifications and training:⁠¹⁠⁴

• Qualification. A home health aide needs one of the following: 1 year of practical experience in a licensed hospital, nursing home or home care setting; a completed home care course; or nursing school with the clinical practicum finished.
• 75 hours of initial training. New aides must complete, or show proof of, at least 75 hours of training that includes a supervised practicum. The training must cover 13 listed topics, from infection control to reading temperature, pulse and respiration.
• Break in service. An aide who has been out of work for more than 2 years must repeat the 75 hours or demonstrate competence in each training area.
• Annual requirements. Aides need 12 hours of in-service training every year and a competency test at hire and annually.
• Training supervisor. An RN with at least 1 year of home health and administrative or supervisory experience must supervise staff development.
• Orientation. All staff must complete orientation, which must cover disaster preparedness and Delaware home health regulations.
• Dementia training. Employees and contractors who give direct patient care must complete dementia-specific training every year.⁠¹

Contracted staff must meet the same requirements as employees.⁠¹ If you plan to staff with certified nursing assistants, the DHCQ CNA registry is reachable at (302) 421-7403.⁠⁷

Patient care clocks surveyors check

Before the first survey, set up your records so they show each of these deadlines from rule 3350:⁠¹

Every other supervisory visit must be made in person. The visits in between may be made by a telehealth mechanism with encrypted real-time audio and video.⁠¹ Incident reports must be kept for six years.⁠¹ Before serving a patient inside a licensed health care facility, you need that facility’s written permission.⁠¹

Medicare and Medicaid in 2026

A Delaware license lets you serve private-pay patients. OHFLC’s FAQ says that only after a skilled agency “has received their full (Annual) license” can it contact OHFLC about Medicare certification. Aide-only agencies and PASAs cannot bill Medicare at all.⁠³

Medicare enrollment is frozen. Effective May 13, 2026, CMS stopped enrolling new home health agencies, branches and practice locations in Medicare nationwide. The only applications still being processed are those a Medicare contractor received before that date.⁠¹⁰ CMS’s survey memo adds:⁠¹¹

• Initial applications filed during the moratorium are denied and must be filed again after it ends.
• CMS makes no exceptions for individual providers.
• Accreditation will not give a new agency “deemed status” while the moratorium lasts.

The moratorium runs for six months and can be extended in six-month increments.⁠¹² As of October 12, 2026, no extension notice had been found, so the first six-month period runs to about November 12, 2026. CMS says it will announce any extension or lifting in the Federal Register, so check there before you plan around a Medicare start date.

Buying a young agency does not get you around the freeze. An agency that undergoes a non-exempt change in majority ownership within 36 months of its initial Medicare enrollment must re-enroll as a new agency, and the moratorium blocks that re-enrollment.⁠¹⁰ Delaware adds its own barrier: under rule 3350, any change of ownership voids the license and the agency must reapply as a new agency.⁠¹ After the freeze ends, agencies that apply within 6 months of the moratorium being lifted are assigned the “high” screening level.⁠¹⁰

CMS left Medicaid moratoria to each state.⁠¹⁰ No Delaware notice on home health Medicaid enrollment was found. OHFLC does not handle reimbursement and refers Medicaid questions to (302) 454-7622, and to DMMA provider services at 800-999-3371 for questions about the managed care organizations.⁠³ The sources reviewed do not say whether Delaware Medicaid is enrolling new home health agencies, so ask DMMA provider services before you count on Medicaid or managed care referrals.

Renewal, ownership changes and enforcement

• Annual license. The annual license lasts 12 months from the date it is issued. Apply to renew at least 30 days before it expires.⁠¹ If you renew late, or if you are not in substantial compliance, you can be placed on a provisional license for less than a year. A provisional license cannot be renewed until OHFLC approves your plan of correction and you put it into effect.⁠¹
• Inspections. OHFLC inspects “periodically,” and inspections “may be scheduled or unannounced.”⁠¹
• Ownership changes. Report a proposed change in ownership or control at least 30 days in advance. The change “voids the current license,” and the agency must reapply as a new agency.⁠¹ Changes that count include transferring the majority interest, reorganizations that create an equal second majority owner, and any transfer with “a measurable impact upon the operational control” of the agency.⁠¹ Licenses cannot be transferred.⁠¹
• Penalties. Sanctions range from a reprimand to revocation. They also include provisional status with a freeze on new admissions, and civil or administrative penalties of up to $10,000 per violation, with each day counted separately.⁠¹ A revocation extends to the owners, officers, and anyone holding a financial interest of 5% or more.⁠¹
• Closing. Give patients, their physicians and payers at least 30 days’ notice before you voluntarily surrender the license. At least 30 days before closing, tell the Department where patient records will be kept.⁠¹

For other DHCQ-licensed settings in Delaware, see the guides to assisted living facilities, family care homes and adult day care facilities, or the Delaware state overview.

Sources

1. 1
   Delaware Department of Health and Social Services, via Delaware Administrative Code, 16 DE Admin. Code 3350, Skilled Home Health Agencies (Licensure) Checked 12 Oct 2026 · Back to text ↑
2. 2
   Delaware General Assembly, Delaware Code Online, 16 Del.C. § 122(3)o, Home health agencies (Title 16, Chapter 1, Subchapter II) Checked 12 Oct 2026 · Back to text ↑
3. 3
   Delaware DHSS, Division of Health Care Quality, Opening a Home Health Agency Checked 12 Oct 2026 · Back to text ↑
4. 4
   Delaware DHSS, Division of Health Care Quality, Delaware Home Care Licensure Matrix (10-24-2023) Checked 12 Oct 2026 · Back to text ↑
5. 5
   Delaware General Assembly, Delaware Code Online, 16 Del.C. §§ 1145-1146, Criminal background checks and mandatory drug screening for home-care agencies Checked 12 Oct 2026 · Back to text ↑
6. 6
   Delaware Department of Health and Social Services, via Delaware Administrative Code, 16 DE Admin. Code 3351, Home Health Agencies - Aide Only (Licensure) Checked 12 Oct 2026 · Back to text ↑
7. 7
   Delaware DHSS, Division of Health Care Quality, Contact the Division of Health Care Quality (DHCQ) Checked 12 Oct 2026 · Back to text ↑
8. 8
   Delaware DHSS, Division of Health Care Quality, Home Health Agencies - Skilled (licensed agency list) Checked 12 Oct 2026 · Back to text ↑
9. 9
   Delaware General Assembly, Delaware Code Online, 16 Del.C. Chapter 93, Delaware Health Resources Board (Certificate of Public Review) Checked 12 Oct 2026 · Back to text ↑
10. 10
    Centers for Medicare & Medicaid Services, Federal Register, Announcement of Nationwide Temporary Moratoria on Medicare Enrollment of Home Health Agencies and Hospices (2026-09717) Checked 12 Oct 2026 · Back to text ↑
11. 11
    Centers for Medicare & Medicaid Services, QSO-26-11-HHA & Hospice: Six-Month National Moratoria on Hospice and HHA Enrollment Checked 12 Oct 2026 · Back to text ↑
12. 12
    Centers for Medicare & Medicaid Services, Provider Enrollment Moratoria Checked 12 Oct 2026 · Back to text ↑

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