DC home care agency license: Certificate of Need first, then DC Health
A business that sends nurses into DC homes to provide skilled nursing plus at least one other therapeutic service needs a Home Care Agency license from DC Health. Before DC Health will license you, you need a Certificate of Need from the State Health Planning and Development Agency (SHPDA). SHPDA tells applicants to allow about six months for that step. Since May 13, 2026, CMS has also stopped enrolling new home health agencies in Medicare nationwide.
Contents10 sections
Key takeaways
- You need a Certificate of Need from SHPDA to open a home health agency in DC. The DC Health application has to list it, along with a Certificate of Occupancy.46
- The CON costs the greater of 3% of your capital expenditure or $5,000, up to $300,000. SHPDA says to allow six months from your letter of intent to a decision.7
- SHPDA's home health criteria say supply is adequate but the workforce is short. You must commit in writing to serving Medicare and Medicaid patients and show a plan for charity care.8
- Every agency serving DC patients must run an operating office inside the District, staffed at least 8 hours a day, Monday through Friday.3
- Fees in 22-B DCMR 3902 are a $600 initial application fee plus an annual fee of $400 to $1,300, depending on how many DC patients you admit (as published on 2026-10-12).3
- CMS has frozen new Medicare home health enrollments nationwide since May 13, 2026, including in DC. DC Health warns applicants about the freeze on its licensing portal.512
Quick facts
| Licensing agency | DC Health, Health Care Facilities Division |
|---|---|
| Certificate of need | Required: State Health Planning and Development Agency (SHPDA) |
| Law | D.C. Code §44-501 et seq.; 22-B DCMR Chapters 31 and 39; CON: D.C. Code §44-401 et seq. |
| License fees | $600 initial application; $400–$1,300 annual fee by DC admissions (as published on 2026-10-12) |
| Insurance | $1,000,000 malpractice per incident and $1,000,000 general liability per occurrence |
| License term | One year; renewal due 90 days before expiration |
| Medicare | New enrollments frozen nationwide since May 13, 2026 |
Fees are from 22-B DCMR 3902 as published on dcregs.dc.gov, checked October 12, 2026. The CON fee is from SHPDA's "How to Obtain a Certificate of Need" page on the same date.
Home care agency or home support agency?
The DC Code defines a home care agency as an agency, other than a hospice, that “directly provides skilled nursing services and at least one other therapeutic service” to a sick or disabled person at home or in a community residence facility.1 The Code lists physical, speech or occupational therapy, medical social services and personal care services as therapeutic services.1 A nursing agency that also sends personal care aides therefore meets the definition. It is unlawful to operate one without a license. Agencies run by the federal government are exempt, as are agencies run by and for a church that relies only on spiritual healing.2
The Chapter 39 rules do not match that definition. Rule 3900.4, published March 19, 2004, says a licensed agency provides “at least one” of these: skilled nursing, physical therapy, occupational therapy, speech-language pathology, IV therapy, medical social services, or home health or personal care aide services.3 Since then, DC Health has created a separate license for agencies that provide only non-medical care. Under 22-B DCMR Chapter 99, those agencies get a Home Support Agency license, and “personal care services do not include skilled services.”13
| Your model | DC license | Certificate of Need |
|---|---|---|
| RNs/LPNs providing skilled nursing, plus therapy, social work or aide services | Home Care Agency (22-B DCMR Ch. 39)3 | Yes, from SHPDA6 |
| Aides providing personal care, companion and homemaker services only, with no skilled services | Home Support Agency (22-B DCMR Ch. 99)13 | Not addressed in the SHPDA requirements reviewed |
| Nursing and personal care inside a group residence | Community Residence Facility or Assisted Living Residence license, not this one | — |
A therapy-only agency (for example, physical therapy with no nursing) fits the 2004 rule list but not the statute’s “skilled nursing plus one other” definition.13 Neither source says how DC Health licenses that model. Ask the Health Care Facilities Division, in writing, before you build a therapy-only business plan.
If your plan is aides only, see the DC home support agency guide. Residential models are covered in the community residence facility and assisted living residence guides.
The Certificate of Need comes before the license
SHPDA’s page says a Certificate of Need is required for anyone proposing to “establish a new health care facility, health care service, or home health agency.”6 The statute treats “the construction, development, or other establishment of … a home health or home nursing service” as a new institutional health service. You must obtain the CON “prior to proceeding.”1011 DC Health’s licensing rules close the loop: an initial license application must list your Certificate of Need and your Certificate of Occupancy.4
There is one wrinkle. The Code’s definition of a “health care facility” includes a home health agency “which has an annual operating budget of at least $500,000.”10 The home health service clause has no dollar figure.10 If you plan a small start and think the threshold might exempt you, do not assume it. SHPDA’s FAQ says to submit a letter of determination if you are unsure whether you need a CON.9
How SHPDA reviews a home health application
SHPDA sets out the process in its own words.7 In order:
Letter of intent
File it in SHPDA’s online system (dcshpda.com) with your name, address, phone, proposed location, a brief description, estimated capital expenditure and planned start date. It becomes void if you do not file an application within 180 days, unless you get a written extension.7
Public notice
Place an advertisement in a newspaper of general circulation in DC describing the project and stating that you are filing a letter of intent. Submit a copy with the letter.7
Sixty-day wait
The rules require 60 days between the letter of intent and the application. SHPDA may waive this for good cause.7
Pre-application conference
You must meet a designated SHPDA staff member before you apply.7
Application and fee
File the application online. The fee is the greater of 3% of your proposed capital expenditure or $5,000, with a $300,000 maximum. Make it payable to the DC Treasurer and mail it to SHPDA’s PO box.7
Completeness review
Staff check the application within 15 workdays and send questions if anything is missing. Review cycles start around the 20th of each month, and an application must be complete by the 10th to be considered that month.7
Ninety-day review
Any interested person may request a public hearing during the first 30 days. The Project Review Committee of the Statewide Health Coordinating Council meets publicly, usually on the second Thursday of the month, and votes to recommend approval, approval with conditions, or denial.7
SHPDA tells applicants to “allow six months between the time a letter of intent is submitted and the time the final decision is made.”7 An approved CON gives you up to three years, as SHPDA decides, to become operational. Extensions are possible if you show substantial progress.9
What SHPDA wants to see from home health applicants
SHPDA put a 120-day moratorium on new home health CON applications in 2021 (68 DCR 2857, March 19, 2021). During that pause it rewrote its home health criteria.8 The resulting document finds “a stable, adequate and well-distributed supply” of agencies but “an insufficient workforce.”8 That shapes what you have to prove:
- Unmet need. Show which providers and services already exist and why they do not meet the need of your target population. Back this with utilization data or evidence from government, payers or health organizations.8
- Payer access. Give a written commitment to serve Medicare and Medicaid patients, plus documentation of Medicare and Medicaid certification.8
- Charity care. Provide written policies for serving indigent patients free of charge under the uncompensated care obligation in D.C. Code §44-405(a).8
- Access barriers. Address intake burden, hours, translation and sign language interpretation, and non-discrimination under the DC Human Rights Act, including on payer source and ability to pay.8
- Workforce. Describe how you will meet workforce demands for DC residents.8
- Quality and track record. Give clear evidence of your organization’s qualifications and experience with the proposed services. Include a written policy on medical supervision and coordination by a medical director or designated supervisor.8
For CON purposes, SHPDA uses the 22-B DCMR 4099.1 definition. A home health agency is “primarily engaged” in skilled nursing plus at least one other therapeutic service, and it must have at least one employee besides the proprietor if it is a sole proprietorship.8
Questions go to SHPDA at (202) 442-5875, 8:15 a.m. to 4:45 p.m.6
The Medicare freeze since May 13, 2026
CMS stopped enrolling new home health agencies in Medicare nationwide on May 13, 2026. Starting that day, “no new HHAs or HHA branches or practice locations will be enrolled into Medicare” unless the Medicare contractor received the application earlier. The notice names the District of Columbia.12 The moratorium lasts six months, which runs to November 13, 2026, and can be extended in six-month increments. CMS says it will publish any extension in the Federal Register.12 We found no extension notice as of October 12, 2026. Check the Federal Register before you plan around the end date.
DC Health posts this warning at the top of its licensing portal for anyone “seeking licensure as a Home Care Agency to qualify for certification as a CMS provider.”5 The DC wrinkle is the CON criteria. They ask for a commitment to Medicare and Medicaid and documentation of certification.8 A new agency cannot get Medicare certification while the freeze lasts. Raise that conflict in your pre-application conference.
CMS left Medicaid moratoria to each state.12 We found no DC Medicaid moratorium notice for home health agencies, and the DC Health portal notice mentions only the CMS freeze.5 The Medicaid link is more direct than it looks: under 29 DCMR 5001.1, a provider paid by DC Medicaid for personal care aide services must be a licensed home care agency and be enrolled as a Medicare home health agency.14 While the freeze lasts, a new agency cannot meet the second condition. Ask the Department of Health Care Finance how it is treating new applicants.
Requirements to have in place before you file with DC Health
An office inside the District
Every home care agency serving DC patients must “maintain an operating office within the District of Columbia,” staffed at least eight hours a day, Monday through Friday.3 The office holds patient records for all DC patients and the agency’s policies. Records kept elsewhere must be produced within 24 hours when DC Health asks. Your license is posted there.3 Each license covers only the premises stated on it.2 An agency based in Maryland or Virginia still needs a DC office. Chapter 31 does let DC Health waive inspection requirements for agencies licensed in another jurisdiction.4
Insurance
22-B DCMR 3901.1 sets three minimums:3
- Blanket malpractice coverage for all professional employees: at least $1,000,000 per incident.
- General liability (property damage, bodily injury, libel and slander): at least $1,000,000 per occurrence.
- Product liability, when applicable.
Contractors must also meet the 3901 insurance and bonding requirements, and your written contract has to say so.3
Governing body and Director
The agency needs a governing body. It adopts bylaws and policies, appoints the Director, and reviews all policies every year.3 The annual review must include feedback from 10% of your DC patients or 40 DC patients, whichever is less. It must also cover every complaint, and the results go into a written report the board acts on.3
The Director must be a licensed physician, a licensed registered nurse, or someone with health services administration training and at least one year of supervisory or administrative experience in home health or a related program.3 Report any change of administrator to DC Health promptly.4
Written policies
Rule 3905.2 lists the minimum policy set. It covers contractor agreements, personnel, admissions and denials, discharges and referrals, records retention and disposal, patient rights, complaints, the provision of each service you offer, infection control and unusual incidents. The governing body must approve them.3 Your admission policy must cover charges for each service, refunds, advance directives, DNR orders and consent to share information between agencies. Every patient gets a written summary at admission.3
Staffing rules in Chapter 39
| Service | Who provides it |
|---|---|
| Skilled nursing | RN, or LPN supervised by an RN; RN visits the LPN on site at least every 62 days3 |
| IV therapy | RN or LPN with IV training or experience3 |
| Physical therapy | Licensed physical therapist3 |
| Occupational therapy | Licensed occupational therapist, on physician order3 |
| Speech-language pathology | Certified speech-language pathologist, on physician order3 |
| Medical social services | LICSW, LISW or LGSW, on physician order3 |
| Home health or personal care aide | Aide with 75 hours of training (16 hours supervised practical) and a passed competency evaluation3 |
Aide rules in 3915 are specific:
- At least 16 classroom hours come before supervised practical training. A certified nurse aide can qualify as a home health aide with a 12-hour supplement on home care topics.3
- After the first year, each aide needs at least 12 hours of in-service training a year, including care of people with disabilities.3
- On-site supervision is required at least every two weeks for skilled services and every 62 calendar days for other services.3
- Trained aides may do simple wound care and gastrostomy tube feeding, with a licensed nurse supervising on site at least every two weeks.3
Chapter 39’s definitions say home health aides and personal care aides must be qualified under Chapters 51 and 50 of Title 29 DCMR.3 Chapter 50 is the Medicaid personal care aide chapter administered by the Department of Health Care Finance.14 Chapter 39 itself does not name a Board of Nursing credential for aides. Ask DC Health which aide credential it expects to see in your personnel files.
Every employee must have a communicable-disease screening within six months before hire and every year after. Every licensed, certified or registered employee must hold that credential under DC law. Staff must show agency ID before entering a home.3 You must also comply with the Health-Care Facility Unlicensed Personnel Criminal Background Check Act, D.C. Code §44-551 et seq.3 DC Health may run its own checks on the applicant, covering police records, licensure, education, residency, warrants and malpractice history.4
Clinical rules you will be inspected against
- Tell referral sources and people asking for services whether you can serve them within 48 hours. Keep records of declined requests for one year.3
- The initial assessment includes a home visit.3
- A physician must sign the plan of care within 30 days of the start of care. A plan for personal care aide services only may be signed by an advanced practice registered nurse.3
- Review skilled services at least every 62 days and send the physician a summary. Nurses write progress notes at least every 30 days.3
- Accept a ventilator-dependent patient only if the patient is stabilized, a home equipment trial has succeeded, and you have an emergency notification plan.3
- Give seven calendar days’ written notice before a discharge or referral, except in the situations the rule lists.3
- Answer complaints within 14 calendar days. If the patient is dissatisfied, send a written reply within 30 days that includes DC agency contacts and DC Health’s Home Health Hotline.3
- Keep clinical records for at least five years after discharge.3
Filing with DC Health and the first year
DC Health has accepted only online applications since May 3, 2023. New licenses, renewals, changes of ownership and payments all go through the Healthcare Facilities licensing portal.5 The license itself is issued as a “Public Health: Health Care Facility” endorsement to your DC basic business license.2
File at least 60 days before you plan to open
Include the license fee, and list your CON and Certificate of Occupancy.4
Initial inspection
DC Health inspects on site and sends written findings within 15 days. You have 30 days to correct deficiencies before a license is issued.4 The DC Fire Department inspection provisions in Chapter 31 do not apply to home care agencies.4
Provisional license
A newly approved agency gets a provisional license of up to 90 days.4
Unannounced follow-up
DC Health inspects again, without notice, within 90 days of your start. If you are in full or substantial compliance, you get a regular license of up to one year.4 If not, the provisional license can be renewed while you correct deficiencies within 60 days.4
Fees as published
| Item | Fee |
|---|---|
| Initial application | $600 |
| Annual fee, 1–150 DC patients | $400 |
| Annual fee, 151–750 DC patients | $700 |
| Annual fee, 751–1,250 DC patients | $1,100 |
| Annual fee, 1,251 or more DC patients | $1,300 |
| Late fee (each tier) | $100 |
| Duplicate license | $50 |
| Certification of validity of license | $50 |
The annual fee tier depends on your annual census of admissions of DC patients.3 These amounts date from the March 19, 2004 rulemaking. DC Health’s portal page does not publish a separate fee schedule, so confirm the amount the portal charges when you apply.5 The SHPDA CON fee (at least $5,000) is separate.7
Renewal, ownership changes and enforcement
A DC license expires one year from issue or last renewal.2 File the renewal at least 90 days before expiration. DC Health may add a late filing fee.4 Renewal inspections are unannounced. DC Health may accept private accreditation or federal certification instead of its own inspection, in whole or in part.4 If a Medicare-certified agency loses federal certification, its license is automatically suspended or converted to provisional or restricted status.4
Report changes in operation, program or services that could affect licensure within five days.4 A change of ownership needs written notice to DC Health at least 30 days ahead. That includes a change of 10% or more of a corporate owner’s stock, and DC Health may require reinspection and relicensure.2 A change of majority ownership within 36 months of a home health agency’s initial Medicare enrollment requires enrolling as a new agency, and the freeze bars that.12
DC Health investigates complaints alleging life-threatening conditions within 24 hours and other complaints within 30 days. Deficiencies that are not life-threatening must be corrected within 30 days of the report.4
Sources
- 1
- 2 Council of the District of Columbia, D.C. Code §44-502, License requirements Checked 12 Oct 2026 · Back to text ↑
- 3
- 4
- 5 DC Health, Office of Health Facilities Licensing Portal Checked 12 Oct 2026 · Back to text ↑
- 6 DC Health, State Health Planning and Development Agency, Certificate of Need Checked 12 Oct 2026 · Back to text ↑
- 7
- 8
- 9
- 10
- 11 Council of the District of Columbia, D.C. Code §44-406, Certificate of need Checked 12 Oct 2026 · Back to text ↑
- 12
- 13
- 14
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Related guides
- DC home support agency license: opening a non-medical personal care agency in the DistrictDistrict of Columbia · Non-medical home care agency
- DC community residence facility license: three regulators, an old rulebook, an online applicationDistrict of Columbia · Small residential care home
- DC assisted living residence license: DC Health rules, fees and stepsDistrict of Columbia · Assisted living facility
District of Columbia and neighboring states
Compare all 51| State | License | Who needs it | State fee |
|---|---|---|---|
| District of Columbia (this guide) | Home Care Agency license | Skilled nursing plus another therapy service in clients' homes | $600 initial application; $400–$1,300 annual fee by DC admissions |
| Maryland | Home Health Agency License | Skilled nursing and therapy in homes; needs MHCC certificate of need first | $0 to apply (OHCQ application dated March 18, 2026) |
| Virginia | Home Care Organization (HCO) license, home health services | Any organization sending health professionals into homes; no minimum size | $1,500 initial or renewal; $50 late renewal; $250 reissue; $75 exemption |
Shortened from each state's guide and our 51-state table, as of each guide's last review. Fees are the state's own; local permits and background checks cost extra.