DC home support agency license: opening a non-medical personal care agency in the District

Home support agency or home care agency?

DC Health regulates two kinds of in-home agency. Its regulations quick reference lists them as separate chapters: Chapter 39 for Home Care Agencies and Chapter 99 for Home Support Agencies ⁠⁴.

• Home support agency (Chapter 99). This is “an entity licensed in accordance with this chapter that employs home health aides to provide personal care services to clients” ⁠¹. Personal care services are “limited to individual assistance with or supervision of activities of daily living, companion services, homemaker services, reporting changes in client’s condition, and completing reports,” and they “do not include skilled services” ⁠¹.
• Home care agency (Chapter 39). Under the licensure act, this is an agency that “directly provides skilled nursing services and at least one other therapeutic service” to a sick or disabled person at home ⁠³. If you plan to offer skilled nursing, or to bill Medicare, that is the license you want. This site has no DC home care agency guide yet. As of 2026-10-12, the DC Health licensing portal warns home care agency applicants about a six-month CMS moratorium on new home health enrollment that CMS announced on May 13, 2026 ⁠⁵. The Certificate of Need statute defines a health care facility to include a “home health agency” with an annual operating budget of at least $500,000 ⁠⁸; it does not mention home support agencies, and Chapter 99 contains no Certificate of Need or moratorium requirement. If you plan a home care agency, ask DC Health whether that threshold applies to it.

Chapter 99 lists what a home support agency’s aides may do ⁠¹:

• bathing, grooming, dressing and help with toileting
• incontinence care, including bed pans, changing urinary drainage bags and monitoring intake and output
• help with transfers, walking and prescribed exercise
• help with self-administration of medication
• reading and recording temperature, pulse, respiration, blood pressure, height and weight
• meal preparation that follows dietary guidelines, and help with eating
• keeping the living area in a condition that supports health and comfort
• going with or driving clients to medical appointments, work and recreation, and helping them at work
• shopping for items related to nutrition and health
• companion services

The rule defines companion services as “non-healthcare related services, such as cooking, housekeeping, errands, and social interaction” ⁠¹. Companion and homemaker services fall inside the definition of personal care, but the license itself is tied to employing home health aides. Chapter 99 has no exemption for an agency that offers only companion or homemaker services, and the sources do not say whether such an agency needs this license. Ask the Office of Health Facilities in writing, describing your services and staff, before you operate without one.

The license applies to “each home support agency serving one or more clients in the District of Columbia” ⁠¹. There is no minimum size below which you are exempt. Chapter 99 also brings in 22-B DCMR Chapter 31, which governs inspections, licensing and enforcement for all facilities licensed under the act ⁠¹.

Set up the DC office before you apply

DC Health checks the office before it issues even the provisional license, so lease and fit out the space first.

• Location and staffing. The operating office must be “within the District of Columbia” and “staffed at least eight (8) hours per business day” ⁠¹. The rule defines a business day as Monday through Friday, 8:00 a.m. to 6:00 p.m., excluding public holidays ⁠¹.
• One license per office. “A separate license shall be required for each operating office” ⁠¹. A second location means a second application.
• Public access. Post your business hours so they can be read from outside the office. Keep the office open to employees, clients, prospective clients and their representatives during business hours ⁠¹.
• Website. You must keep a public website showing your business hours, services, ownership information, key personnel, and a phone number and email address ⁠¹.
• Records on hand. Client records, personnel records, policies and procedures, and incident and complaint files must be kept at the office on paper or be “immediately available electronically.” Anything held elsewhere has to reach DC Health within two hours of a request ⁠¹.
• The name. A home support agency “shall not use the word ‘health’ in its title” ⁠¹. Check this before you form the entity or buy a domain.

If you move the office later, give DC Health written notice at least 60 days ahead. Include the new lease, a certificate of insurance and a certificate of occupancy for the new address, a Clean Hands certificate, and a certificate of good standing for a corporation. Clients and staff need written notice at least 30 days ahead ⁠¹. The rule spells out this list only for relocations. Section 9902.3 does not list those documents for an initial application, but it allows DC Health to require “any other information” ⁠¹. Check the portal’s reference guides on the DC Health home support agency page for the current document list, and ask the Office of Health Facilities whether a certificate of occupancy applies to your address.

Leadership: Director, nurse coordinator and governing body

The agency needs a governing body that takes full legal responsibility for its operation. The governing body adopts bylaws and policies and names a full-time Director ⁠¹. In this rule, “full-time” means working, at minimum, during each of the agency’s established business days ⁠¹.

The Director must meet one of two tests ⁠¹:

1. A registered nurse licensed in the District of Columbia

   , or

2. A non-nurse with training and experience in health services administration

   , including at least one year of supervisory or administrative experience in health services or related health programs.

If the Director is not a registered nurse, you must also employ a full-time Client Service Coordinator. This person is a DC-licensed registered nurse with at least one year of administrative or supervisory experience in personal care, home health care or related health programs ⁠¹. The nurse in charge, whether that is the Director or the Coordinator, is responsible for the quality of client services. That nurse must be available throughout business hours and must take part in service planning and aide assignments ⁠¹.

A few other leadership rules affect staffing from the first day:

• The Director must name in writing a similarly qualified person to act in the Director’s absence ⁠¹.
• The Director, the Coordinator or a designee named in writing must be on call outside business hours ⁠¹.
• You must tell DC Health in writing within 15 days of any change of Director ⁠¹.
• Once a year, the governing body must review all policies, all complaints and incidents, and feedback from 10% of your DC clients or 40 DC clients, whichever is fewer. It must act on a written report of that review and keep documentation for DC Health ⁠¹.

Aides, background checks and health screening

Personal care has to be performed by “qualified home health aides pursuant to 17 DCMR § 9300 et seq.” ⁠¹. That chapter is the DC Board of Nursing’s home health aide certification rule. The Board’s curriculum totals 125 hours: 65 classroom, 20 lab and 40 clinical ⁠⁷. DC Health contracts with Credentia for aide testing. Aides can be certified by examination or by endorsement of a credential from another jurisdiction ⁠⁶. Every staff member who needs a DC license, certification or registration must hold it under District law, and you must document that each one is valid ⁠¹.

Before and during employment, the rule requires the following ⁠¹:

• Criminal background checks. Unlicensed staff are checked under the Health-Care Facility Unlicensed Personnel Criminal Background Check Act (D.C. Code § 44-551 et seq.). Licensed staff are checked under the criminal background check requirements of D.C. Code § 3-1205.22.
• Communicable disease screening. Each new hire must have been screened and found free of communicable disease within the six months before the hire date, following CDC guidelines.
• Hepatitis vaccine. Each employee’s personnel file must record whether they accepted or declined the vaccine.
• Personnel files. Each file holds references, verification of past employment, a signed position description, training and competency records, any required CPR certification, and annual evaluations.
• Identification. Every employee must show a valid agency ID before entering a client’s home.

Aide supervision is where the nursing cost of this “non-medical” license shows up. “Each home health aide shall be supervised by a registered nurse,” on site at least once every 90 days. The agency must have “an adequate number of registered nurses” to do that supervision ⁠¹.

Policies, client agreements and nurse assessments

You submit the policies and procedures manual with the application, and DC Health reviews it before it issues the provisional license ⁠¹. The governing body must approve the manual. At a minimum, it must cover these 12 topics ⁠¹:

• personnel
• admissions and denials of admission
• discharges and referrals
• coordination of services
• records retention and disposal
• client rights and responsibilities
• the complaint process
• each service you offer
• billing
• supervision of services
• infection control
• management of incidents

Separate written personnel policies must cover wage scales, leave, benefits, annual evaluations, probation, discipline, grievances, position descriptions and ongoing training ⁠¹.

The client-facing rules shape your intake process:

• Respond within 48 hours. Tell anyone who asks for services whether you can serve them, and why, within 48 hours. Keep a record of every request you turn down for at least one year ⁠¹.
• Nurse assessment first. A registered nurse must assess each prospective client, including a home visit, before personal care begins. The assessment confirms the person does not need services beyond personal care ⁠¹.
• Service plan. A registered nurse writes the service plan at admission and reviews it at least every 90 days ⁠¹.
• Written service agreement. Both sides sign it before services start. It must list the visit schedule, the cost of each service, the procedure for missed visits, your after-hours emergency contact, and DC Health’s Complaint Hotline number. It must also require that all payments go to the agency or its billing representative, “and no payments shall be made to or in the name of individual employees” ⁠¹.
• Discharge notice. Give clients at least seven days’ written notice of a discharge or referral. Exceptions include emergencies, a physician’s order to admit the client to an inpatient facility, a risk to staff safety, and the client’s refusal of further services ⁠¹.

Applying through the DC Health portal

DC Health’s Office of Health Facilities has taken new and renewal facility license applications, and payments, only through its online licensing portal since May 3, 2023. It no longer accepts paper applications ⁠⁵. Chapter 99 sets out the order of steps:

1. Create a portal account and file the application

   Under § 9902.3, the application must include all entities the applicant owns or manages; the policies and procedures manual; the identity of officers, directors, partners or members, and of the governing body, depending on the entity type; the articles, bylaws, partnership agreement or LLC operating agreement; everyone with a financial interest of 5% or more; a disclosure of whether any officer, director, partner, employee or governing body member has a felony record; the names of the Director and the Client Service Coordinator; and a list of management staff with their credentials ⁠¹.

2. Fix deficiencies within 30 days

   DC Health may return an incomplete application, and a return is not a denial. If you resubmit and deficiencies remain, the application is returned again, and you have to file a new application with a new processing fee ⁠¹.

3. Pass the on-site walk-through

   DC Health inspects the business location “to verify the that the office is capable of operating” ⁠¹.

4. Receive the 90-day provisional license

   It is issued once the application is complete, the walk-through is passed, and your policies show compliance. The provisional license lets you “hire staff and establish a client caseload” ⁠¹.

5. Reach five clients and notify DC Health

   By the end of the 90 days, you need a census of at least five clients, and you must tell DC Health you have reached it ⁠¹.

6. Pass the on-site survey

   During the provisional period, DC Health surveys the agency to confirm that it meets the definition of a home support agency, complies with the chapter, and is actually serving clients ⁠¹.

7. Receive the permanent license

   It runs 12 months, counting the provisional period ⁠¹.

If you miss the census or the survey, DC Health may extend the provisional license once, for up to 90 more days, on conditions it sets. If the survey found you out of substantial compliance, the extension requires an approved corrective action plan. An agency still out of compliance after two provisional periods “shall be denied a permanent license” ⁠¹. This gives you about six months at most to build a caseload of five, so line up referral sources before the provisional license is issued.

Chapter 99 does not give a processing deadline for DC Health’s review of the application.

Fees and insurance

Fees are set by your DC client census at the time you apply or renew ⁠¹.

Section 9905.1 sets the insurance minimums ⁠¹:

• Malpractice: blanket coverage for all professional employees of at least $1,000,000 per incident.
• General liability: comprehensive coverage for personal property damage, bodily injury, libel and slander of at least $1,000,000 per incident or occurrence and $2,000,000 aggregate.

Incidents, complaints and records

The reporting deadlines are short ⁠¹:

• Incidents. Report to DC Health within 48 hours any incident involving a client that happens in the presence of staff. Send a full investigation report within 30 days. “Incidents” include significant injury, death, misappropriation of a client’s money or property, and anything that brings in police or emergency responders.
• Complaints. Respond within 14 days and keep an annual log of every complaint and incident.
• Nurse and aide discipline. Report any action or condition affecting the fitness to practice of a registered nurse or home health aide that could be grounds for discipline under the Health Occupations Revision Act or 17 DCMR Chapter 93 within five business days.

Keep client records for at least five years after discharge, personnel records for five years after separation, and complaint and incident records for five years ⁠¹. If the agency dissolves with no new owner, you must keep client records retrievable for five years. You must also tell DC Health and every client, within 30 days, where the records are held ⁠¹. DC Health “shall have access to home support agency records at all times” ⁠¹.

Renewal, ownership changes and enforcement

• Renewal. Apply at least 90 days before the license expires ⁠¹. DC Health will not renew if you no longer meet the definition of a home support agency, are not in substantial compliance, have a deficient practice that is an immediate threat to clients, or have fewer than five clients ⁠¹. Because the five-client floor applies at every renewal, a very small agency can lose its license by shrinking.
• Change of ownership. A sale, purchase, transfer or reorganization of ownership rights is a modification of ownership or control. It requires a new application as a new agency ⁠¹. The license covers only the named applicant and premises, and an unapproved transfer means “immediate forfeiture” of the license ⁠¹.
• Enforcement. DC Health can deny, suspend, summarily suspend or revoke a license ⁠¹. Instead, it may issue a provisional license tied to a corrective timetable, or a restricted license that bars new admissions or specific services. Either lasts up to 90 days and can be renewed only once ⁠¹.

Payment sources

Chapter 99 does not deal with Medicaid or other public payers. DHCF’s 2012 final rule on Medicaid personal care services (29 DCMR Chapter 50) says a provider reimbursed for personal care “shall be a home health agency,” meet the Medicare conditions of participation, be enrolled as a Medicare provider, and comply with the licensure act, and that applicants file a Medicaid Home Health Provider enrollment application with DHCF ⁠⁹. That rule predates Chapter 99, and the sources do not say whether DHCF now enrolls a home support agency. Ask DHCF before you base a business plan on Medicaid revenue. If you need Medicare certification, you need a home care agency, not a home support agency ⁠³⁠⁵. For residential options in the District, see the assisted living residence guide.

Sources

1. 1
   DC Department of Health, Notice of Final Rulemaking: 22-B DCMR Chapter 99, Home Support Agencies Checked 12 Oct 2026 · Back to text ↑
2. 2
   District of Columbia Office of Documents and Administrative Issuances, DCMR Chapter 22-B99: Home Support Agencies (section list and effective dates) Checked 12 Oct 2026 · Back to text ↑
3. 3
   Council of the District of Columbia, D.C. Code § 44-501: Definitions (Health-Care and Community Residence Facility, Hospice and Home Care Licensure) Checked 12 Oct 2026 · Back to text ↑
4. 4
   DC Department of Health, HCFD/ICFD Regulations Quick Reference Guide Checked 12 Oct 2026 · Back to text ↑
5. 5
   DC Department of Health, Office of Health Facilities Licensing Portal Checked 12 Oct 2026 · Back to text ↑
6. 6
   DC Department of Health, Home Health Aide (Board of Nursing) Checked 12 Oct 2026 · Back to text ↑
7. 7
   DC Department of Health, Board of Nursing Home Health Aide Curriculum Checked 12 Oct 2026 · Back to text ↑
8. 8
   Council of the District of Columbia, D.C. Code § 44-401: Definitions (Certificate of Need) Checked 12 Oct 2026 · Back to text ↑
9. 9
   DC Department of Health Care Finance, Notice of Final Rulemaking: 29 DCMR Chapter 50, Medicaid Reimbursement for Personal Care Services (D.C. Register Vol. 59, No. 9, March 2, 2012) Checked 12 Oct 2026 · Back to text ↑

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