Georgia home health agency license: certificate of need first, then HFRD

Two gates before your first visit

Most founders expect the state license to be the hard part. In Georgia it is not. A new home health agency also has to clear two other gates, and in October 2026 both are closed.

1. Georgia’s certificate of need

   Under the CON rules, a CON is required “prior to the establishment of a new home health agency or the expansion of the geographic service area of an existing home health agency.”⁠⁶ HFRD’s initial license checklist asks whether you have CON approval. If the answer is no, “the application cannot be completed at this time.”⁠³ DCH has not accepted a home health CON application in any of its last three batching cycles.⁠⁸⁠¹⁷⁠¹⁸

2. Medicare enrollment

   CMS stopped enrolling new home health agencies anywhere in the country effective May 13, 2026.⁠¹⁴ Georgia’s licensing portal shows the same warning on its front page.⁠¹⁶

The state license sits between them. It is regulated by HFRD under chapter 111-8-31 of the Georgia rules, and you must hold it before you operate.⁠¹ HFRD will not complete it without the CON,⁠³ and Medicare billing needs a separate federal enrollment that is frozen.

What Georgia counts as a home health agency

Georgia defines a home health agency as a public, non-profit or proprietary organization “engaged in providing home health services.”⁠¹ Home health services are services given in the patient’s home under a written plan of treatment signed by the patient’s physician. They include part-time or intermittent skilled nursing, provided by or under the supervision of a registered nurse, plus at least one other service:⁠¹

• physical, occupational or speech therapy
• medical social services
• home health aide services

The scope-of-services rule repeats that minimum: skilled nursing and at least one other therapeutic service.⁠¹ HFRD’s program page states a broader expectation: “All home health agencies shall provide nursing, homemaker-home health aide, and physical therapy services.”⁠² The rule is the binding text, but because HFRD reviews your application, confirm with the Home Health/Hospice team which service set it expects before you finalize your service list.

The rule exempts three groups when there is “no claim” that the work is part of a licensed home health agency:⁠¹

• individuals providing personal or paraprofessional services
• licensed professionals working within their own license
• services provided under another Georgia license

How it differs from a Private Home Care Provider license

Georgia’s other in-home license is the Private Home Care Provider (PHCP) license, also issued by HFRD. PHCP services include “nursing services, personal care tasks, and companion or sitter tasks.”⁠¹³ A PHCP agency can therefore send nurses into homes. What it cannot do is operate as a home health agency.

The differences:

• Who directs the care. A home health agency works under a physician-signed plan of treatment that the physician reviews at least every 60 days, and its services are organized as a skilled-nursing package.⁠¹
• Certificate of need. DCH’s CON fact sheet lists home health agencies among projects that need a CON; it does not list private home care providers.⁠⁵
• Overlap. Services provided by licensed home health agencies are exempt from PHCP licensing.⁠¹³

If your plan is private-pay personal care, sitter or companion work, or private-duty nursing, read the Georgia private home care provider guide. A home health agency license is needed to bill Medicare’s home health benefit, and that requires a CON.

The certificate of need: how a home health CON is decided

The CON program is administered by the DCH Office of Health Planning under the State Health Planning and Development Act, O.C.G.A. 31-6-1 et seq.⁠⁵ DCH’s 2025 fact sheet lists “new or expanding nursing homes and home health agencies” among the projects that need a CON.⁠⁵

The need formula

You cannot get a home health CON by showing local demand. You can apply only where DCH’s own formula shows unmet need. For each county, the formula estimates the annual number of home health patients in the horizon year (three years out) using these ratios:⁠⁶

DCH then subtracts the number of patients existing agencies are projected to serve. That projection is each county’s patient count from the latest survey, adjusted for population change.⁠⁶ What remains is the net unmet need, totalled for each of Georgia’s 12 planning areas (the state service delivery regions). The total decides what DCH will accept:⁠⁶⁠⁹

• 250 or more unmet patients: applications to expand an existing agency only.
• 500 or more: applications for a new agency as well.

Even then, you may propose only counties that each show unmet need. You must also take all of the unmet need in any county you apply for, because DCH will not split a county between applicants.⁠⁶

There are two narrow exceptions:⁠⁶

• Special groups. An applicant shows limited access for a special group, such as medically fragile children, newborns and their mothers, or HIV/AIDS patients, with a documented need of at least 200 patients. If approved, the agency may serve only that group.
• Underserved counties. A county is served by no more than two agencies, and either fewer than 1% of its residents received home health services or one of those agencies has served Medicaid patients below the statewide average for two years. This exception is only for applicants already approved in a contiguous county or one within 15 miles, and it is processed under the rules for expanded agencies.

Where the numbers stand in October 2026

The September 2026 projection for horizon year 2029 shows “No Projected Unmet Need” in all 12 planning areas.⁠⁹ Statewide, the formula estimates 225,964 home health patients, while existing agencies are projected to serve 304,109.⁠⁹ The closest region is planning area 12, where projected service exceeds the formula need by 48 patients.⁠⁹

On September 30, 2026, DCH announced that it “will not accept or review” CON applications for new or expanded home health services in the current cycle. It is also not accepting applications under the exceptions.⁠⁸ The April 1, 2026 and October 1, 2025 home health notices said the same.⁠¹⁷⁠¹⁸ The next assessment will happen “on or around March 31, 2027.”⁠⁸ DCH posts each batching notice and need projection on its need projections page.⁠¹⁰

HB 1339 and the 2025 rule update

HB 1339 was signed April 19, 2024. It revised the CON process and added several exemptions, and DCH began accepting requests for letters of determination under the new exemptions on July 1, 2024. DCH also adopted revised CON rules (111-2-2) that took effect January 13, 2025.⁠⁴ DCH’s fact sheet, updated in 2025, still lists home health agencies as needing a CON.⁠⁵ DCH applied the home health need method in its 2026 batching notices.⁠⁸⁠¹⁷

If you think your project is exempt, ask the Office of Health Planning for a letter of determination before you start.⁠⁴

If a cycle opens: the 120-day batching calendar

Home health applications are batched in the fall and spring cycles.⁠⁵ DCH must decide whether there is unmet need at least every six months.⁠⁷ When a notice shows unmet need, the timeline under rule 111-2-2-.08 is:⁠⁷

1. Notice of intent

   File through DCH’s web portal by close of business on the 25th calendar day after DCH publishes the need determination. If you miss it, you are disqualified for that cycle.

2. Application

   File by 12:00 p.m. on the 25th calendar day after DCH receives your notice. It must include the Certification Statement of Completeness and every item it certifies. All properly filed applications are deemed received on that 25th day, which becomes day 1 of the review.

3. Day 30

   Meeting with DCH. Additional information is due by day 45.

4. Opposition

   Opponents file a notice within 30 days. Their meeting takes place no earlier than day 60. You respond by day 75, and final amendments and letters of support are due by day 90.

5. Day 120

   DCH issues its decision. There are no extensions. A favorable decision letter is the certificate of need.

The CON filing fee is $1,000 for a total project cost up to $1,000,000. Above that, the fee is 0.1% of cost, up to $50,000.⁠⁷ DCH’s CON decisions can be appealed to the CON Appeal Panel.⁠⁵

What the CON application must commit you to

Rule 111-2-2-.32 lists what every applicant for a new agency must show:⁠⁶

• a community linkage plan covering referral arrangements and working agreements
• a written plan for recruiting and keeping qualified staff in the proposed area
• intent to meet accreditation standards of The Joint Commission, CHAP or another appropriate accreditor
• a quality improvement plan
• charges that compare favorably with existing agencies in the area
• an agreement to report data to DCH

Two commitments carry ongoing obligations:⁠⁶

• charity and indigent care worth at least 1% of annual adjusted gross revenue
• written commitments to take part in Medicare, Medicaid and PeachCare for Kids

DCH can impose a penalty equal to the shortfall if you deliver less charity care than you committed to.⁠⁵ You and any agency you or your parent organization run must also have no Medicare or Medicaid fraud conviction and no history of uncorrected or repeated conditional-level violations or uncorrected standard deficiencies.⁠⁶

The Medicare moratorium in effect since May 13, 2026

CMS’s notice in the Federal Register (document 2026-09717) imposed a six-month nationwide moratorium on Medicare enrollment of home health agencies, effective May 13, 2026.⁠¹⁴ From that date, no new agencies, branches or practice locations are enrolled unless the Medicare contractor received the application before May 13.⁠¹⁴ CMS’s survey memo to the states adds three points:⁠¹⁵

• Initial applications filed during the moratorium are denied and must be resubmitted after it ends.
• No individual exceptions are allowed.
• Accreditation will not give a new agency Medicare deemed status while the moratorium lasts.

The moratorium can be extended in six-month increments, and any extension will be published in the Federal Register.⁠¹⁴ As of October 12, 2026, no extension notice has been published, so the first period runs to about mid-November 2026. Agencies that apply within six months after it ends are assigned to the “high” screening level.⁠¹⁴ CMS left it to each state to decide on Medicaid and CHIP moratoria.⁠¹⁴ The DCH and portal pages checked for this guide do not announce a Georgia Medicaid moratorium on home health agencies. Confirm with Georgia Medicaid provider enrollment before you count on Medicaid revenue.

The moratorium matters more in Georgia than in states without CON rules. A CON applicant commits in writing to participate in Medicare.⁠⁶ HFRD’s initial license checklist also asks for the CMS-1561 Health Insurance Benefit Agreement and the HHS-690 Assurance of Compliance, which go to the Home Health/Hospice team.⁠³ Until CMS lifts the freeze, a newly licensed Georgia agency cannot bill Medicare.

Buying an existing agency instead

The CON rule exempts a service-area expansion that results from “a non-reviewable acquisition of another existing home health agency.”⁠⁶ HFRD’s change-of-ownership (CHOW) checklist does not ask for CON approval, while the checklists for a new branch, a relocation and added counties do.⁠³

For the state license, HFRD’s CHOW FAQ explains what counts as a change of ownership:⁠¹²

• An asset transfer is a CHOW, including an asset transfer by an LLC.
• A transfer of an LLC membership interest generally is not, and neither is a transfer of corporate stock.
• You must notify HFRD at least 30 days before the change.
• Review typically takes 30 to 60 days after HFRD confirms receipt.

The federal side has a catch. If an agency has a change in majority ownership within 36 months of its initial Medicare enrollment (or of its last such change), it must, unless an exception applies, enroll in Medicare again as a new agency, and the moratorium prohibits that.⁠¹⁴ Check the target agency’s enrollment history before you sign.

Two other routes involve existing licenses:

• County transfers. Two existing agencies can transfer counties between them without a new CON if DCH approves in writing. The request must be filed at least 30 days ahead, and the receiving agency must already serve a contiguous county or the same planning area.⁠⁶
• Service-area changes. A change in services or service area that is subject to CON review needs an approval letter from the Office of Health Planning.⁠¹

Filing the HFRD license application

Applications are filed online through the GAHLES portal.⁠³⁠¹⁶ File at least 30 days before you plan to open. The application must be signed by the executive officer of your governing body.⁠¹ HFRD’s initial review takes 30 business days from submission, and applications are reviewed in the order received.⁠³ For an initial license, the checklist asks for:⁠³

1. CON approval

   from the Office of Health Planning.

2. Notarized identity documents

   an Affidavit of Personal Identification under O.C.G.A. 50-36-1(f)(1)(B), a copy of the photo ID shown to the notary, and a notarized Affidavit of Compliance.

3. The electronic Owner Form

   in GAHLES. Corporations also submit their charter and identify all owners of 5% or more.⁠¹

4. A GCHEXS background check

   a satisfactory fingerprint-based letter from the Georgia Criminal History Check System, dated within 12 months, for every administrator and every individual owner with 10% or more.

5. A local business license

   showing the agency name and address, plus Secretary of State registration for your entity.

6. A first-year budget

   for the agency.

7. The CMS-1561 and HHS-690 forms,

   emailed to [email protected].

8. The license fee

Do not submit until every document is ready. If you do not upload requested documents, HFRD denies the application. Application fees are non-refundable.⁠³ License application and fee questions go to [email protected].⁠²

Once licensed, agencies certified for Medicare or Medicaid are exempt from an additional on-site licensure inspection when they show proof of certification.⁠¹ The license must be displayed. You return it if the agency closes, is leased, moves or changes ownership.⁠¹

Fees as published

The annual fee is due on the anniversary of your license. DCH may revoke a license if the fee is still unpaid 60 days after the written invoice.⁠¹¹ To get the accreditation discount, the agency must be accredited by an organization DCH has approved and must submit a complete copy of its current accreditation decision at renewal or have one on file.⁠¹¹

Running the agency under 111-8-31

The licensing rule sets the organization HFRD inspects against:⁠¹

• Governing body. It holds full legal responsibility, appoints the administrator and adopts bylaws. You must disclose every officer, director and owner, and for a corporation every direct or indirect interest of 5% or more.
• Administrator. A full-time administrator who is a physician, an RN, or someone with training in health service administration and at least one year of supervisory or administrative experience in home health or a related program. The administrator may also be the supervising physician or RN. Someone must be authorized in writing to act when the administrator is absent.
• Group of professional personnel. At least one physician and one RN, plus at least one member who is neither an owner nor an employee. The group meets at least quarterly and reviews the agency’s policies every year.
• Budget and evaluation. An annual operating budget, a three-year capital expenditure plan if you expect capital spending, and a yearly evaluation of the whole program.
• Aide supervision. An RN assigns each home health aide to a patient. An RN or other appropriate professional makes a supervisory visit at least every two weeks.
• Physician orders. Verbal orders go to the physician for countersignature within five business days, and the countersignature must be in the record within 30 days. Progress summaries go to the physician at least every 60 days.
• Contract staff. Staff paid per visit or per hour need written contracts. The contract must say, among other things, that only the agency accepts patients.
• Records. Clinical records are kept for six years after the last encounter for adults, and for six years after a minor reaches the age of majority.

Operating a home health agency without a license is a misdemeanor, punishable by a fine of up to $500, up to six months in jail, or both.⁠¹ Georgia’s other licensed care settings are listed on the Georgia state page, and the home health license overview compares Georgia with other states.

Sources

1. 1
   Georgia Secretary of State, Rules and Regulations of the State of Georgia, Ga. Comp. R. & Regs. ch. 111-8-31, Home Health Agencies Checked 12 Oct 2026 · Back to text ↑
2. 2
   Georgia Department of Community Health, Healthcare Facility Regulation Division, Home Health and Hospice Programs Checked 12 Oct 2026 · Back to text ↑
3. 3
   Georgia Department of Community Health, Healthcare Facility Regulation Division, Home Health Agency Application Checklist (HHA Application Packet) Checked 12 Oct 2026 · Back to text ↑
4. 4
   Georgia Department of Community Health, Office of Health Planning, Certificate of Need (CON) Checked 12 Oct 2026 · Back to text ↑
5. 5
   Georgia Department of Community Health, Certificate of Need Fact Sheet (updated 2025) Checked 12 Oct 2026 · Back to text ↑
6. 6
   Georgia Secretary of State, Rules and Regulations of the State of Georgia, Ga. Comp. R. & Regs. 111-2-2-.32, Specific Review Considerations for Home Health Services Checked 12 Oct 2026 · Back to text ↑
7. 7
   Georgia Secretary of State, Rules and Regulations of the State of Georgia, Ga. Comp. R. & Regs. ch. 111-2-2, Certificate of Need Checked 12 Oct 2026 · Back to text ↑
8. 8
   Georgia Department of Community Health, Office of Health Planning, Certificate of Need Batching Review Cycle Notification for Home Health Services, September 30, 2026 Checked 12 Oct 2026 · Back to text ↑
9. 9
   Georgia Department of Community Health, Office of Health Planning, Home Health Agency Services Need Projection, Horizon Year 2029 (calculated September 18, 2026) Checked 12 Oct 2026 · Back to text ↑
10. 10
    Georgia Department of Community Health, Office of Health Planning, Batching Notices and Need Projections Checked 12 Oct 2026 · Back to text ↑
11. 11
    Georgia Secretary of State, Rules and Regulations of the State of Georgia, Ga. Comp. R. & Regs. ch. 111-8-25, General Licensing and Enforcement Requirements (fee schedule) Checked 12 Oct 2026 · Back to text ↑
12. 12
    Georgia Department of Community Health, Healthcare Facility Regulation Division, Healthcare Facility and Medical Service Provider Change of Ownership (CHOW) FAQ Checked 12 Oct 2026 · Back to text ↑
13. 13
    Georgia Department of Community Health, Healthcare Facility Regulation Division, Private Home Care Program Checked 12 Oct 2026 · Back to text ↑
14. 14
    Centers for Medicare & Medicaid Services, Federal Register, Announcement of Nationwide Temporary Moratoria on Enrollment of Home Health Agencies (HHAs), 2026-09717 Checked 12 Oct 2026 · Back to text ↑
15. 15
    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 ↑
16. 16
    Georgia Department of Community Health, GAHLES: Georgia Healthcare Licensing, Enforcement, and Surveys portal Checked 12 Oct 2026 · Back to text ↑
17. 17
    Georgia Department of Community Health, Office of Health Planning, Certificate of Need Batching Review Cycle Notification for Home Health Services, April 1, 2026 Checked 12 Oct 2026 · Back to text ↑
18. 18
    Georgia Department of Community Health, Office of Health Planning, Certificate of Need Batching Review Cycle Notification for Home Health Services, October 1, 2025 Checked 12 Oct 2026 · Back to text ↑

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