Kansas Skilled Services home health agency license: KDHE desk review, 200-mile rule and fees

One license, two levels: why most agencies need Skilled Services

Kansas does not issue separate licenses for home health and home care. There is one Home Health Agency license under K.S.A. 65-5101 et seq., and KDHE issues it at one of two levels.⁠⁹ Kansas has required these licenses since July 1, 2017.⁠⁹

• Skilled Services covers skilled home health services, Home and Community Based Services (HCBS) and non-medical supportive care. KDHE describes it as encompassing “all home health services allowable by law in Kansas.”⁠⁸
• Non-Medical Supportive Care Services covers only chore, companionship and hands-on help with daily activities, with no nursing. That level has its own guide: Kansas supportive care home health agency license.

You need the Skilled Services level if you will provide any of the “home health services” in the statute: nursing, physical therapy, speech therapy, nutritional or dietetic consulting, occupational therapy, respiratory therapy, home health aide or medical social service, given at the patient’s residence on a full-time, part-time or intermittent basis.⁠¹ Every skilled service needs an order from the patient’s physician, nurse practitioner, clinical nurse specialist or physician assistant.⁠⁹

Payer rules also push agencies to this level. KDHE says HCBS waiver services need a skilled license “as they may include medical services driven by a plan of care.”⁠⁸ Its introduction letter says KDADS, which runs the HCBS waivers, requires Skilled Services licensure for all waiver programs, and that “many payor programs, including Veterans Affairs,” require it too.⁠⁹ KDHE calls the supportive-care-only level “extremely limited in nature,” mainly for private pay, private duty and some private insurance.⁠⁹ If you plan to take waiver clients, plan on the skilled license even if your first patients are private pay.

Who must be licensed and who is exempt

K.S.A. 65-5102 requires a license for any agency, “including medicare and medicaid providers,” that provides home health, supportive care or attendant care services, or that “holds itself out” as providing them or as a home health agency.⁠² Advertising the services counts, even before your first visit. The regulations add that no one may provide these services before the license is issued.⁠⁷

The statutory definition leaves out the following:⁠¹

• local health departments that are not federally certified home health agencies
• durable medical equipment companies that provide services through specialized equipment
• independent living agencies recognized by KDADS
• entities that are not reimbursed by Medicare Part A and provide only licensed physical therapy, occupational therapy or speech-language pathology services

K.S.A. 65-5112 also exempts:⁠⁵

• individuals who personally provide care and are not employed by or under the direct control of a business
• religious organizations serving adherents who rely on prayer or spiritual healing
• Medicare-certified hospices serving only hospice patients
• PACE programs serving only PACE participants
• Medicare-certified outpatient physical therapy agencies serving only their outpatients

If KDHE finds an agency operating without a license, the agency is offered a 60-day temporary license while it applies. If it is not licensed within 30 calendar days, the KDADS secretary assesses a fine. No temporary license is offered where the agency’s services present imminent harm.⁠² Violating the act is a class B misdemeanor.⁠¹⁸

If your business is residential rather than in-home, KDADS licenses it as an adult care home instead. See the Home Plus, assisted living and adult day care guides.

Your parent office and the 200-mile service area

Choose your location before you fill in the application, because many other requirements depend on it.

• Service area. Your service area is the region within a 200-mile radius of your parent office. You may serve patients only inside it.⁠⁷ The attestation form you sign repeats this: the agency will not serve patients or establish branch offices “beyond 200 miles of the parent location.”⁠¹²
• Parent office. The parent office must have a local street address and a local telephone number. It must be continuously staffed during the office hours you post and advertise, and those hours must be posted where the public can see them. A post office box cannot be your parent office.⁠⁷
• Exceptions. An agency providing home health services can ask KDHE for an exception to the service area. You must state that a specific service is needed outside your area and that no other agency provides it there. An exception lasts one year.⁠⁷
• Out-of-state agencies. KDHE may grant licenses without an on-site survey to agencies licensed in a bordering state, if Kansas has a reciprocal agreement with that state and its licensing agency recommends the applicant in writing. If the bordering state does not license home health agencies or its requirements are not substantially the same as Kansas’s, an agency located there that does business in Kansas must meet every Kansas requirement and operate from offices located in Kansas.⁠³ The application asks whether you are associated with a Medicare-certified agency that has a reciprocal agreement with Kansas.⁠¹⁰

The application asks you to list every Kansas county you will serve and each branch office.⁠¹⁰ KDHE must be told before you move the parent office or change its phone number.⁠⁷

Administrator, alternate administrator and clinical manager

A Skilled Services agency needs three leadership roles.

Sources: ⁠⁷⁠¹¹

“Qualified health professional” means a physician, RN, physical therapist, occupational therapist, respiratory therapist, speech therapist, dietitian or social worker.⁠⁷ KDHE’s introduction letter lists an RN clinical manager as a requirement for every skilled agency.⁠⁹

The governing body must appoint the administrator in writing. Either the governing body or the administrator may select the alternate. KDHE wants written evidence of both appointments and proof that each person lives within 200 miles of the parent office. If they are licensed health professionals, send their current Kansas license and official transcripts. If not, send a resume and proof of education.⁠¹¹ You must notify KDHE in writing within five days of any change of administrator or alternate.⁠⁷

Home health aides: a Kansas CNA plus 20 hours

In Kansas, a home health aide must already be a certified nurse aide in good standing on the KDADS nurse aide registry. The aide must also complete a 20-hour home health aide course approved by the state and works under RN supervision.⁠¹ After the course, the aide must pass a state test before being certified and listed on the registry.⁠⁷

Rules from K.A.R. 28-51-113:⁠⁷

• A Kansas CNA enrolled in a 20-hour course can work as a home health aide trainee under RN supervision. Your RN must keep a department-approved form in the trainee’s file attesting to minimum competencies.
• Trainees must be certified within 90 days of the course start date to keep providing home health services. Trainee status is available for one 90-day period only.
• Before enrolling, candidates are prescreened and tested for reading comprehension at an eighth-grade level.
• A course can be sponsored by a home health agency, a Board of Regents postsecondary school, or a postsecondary school accredited by the North Central Association. Correspondence courses are not accepted.

Workers who provide only supportive care or HCBS attendant care are not “home health aides” under the statute.⁠¹ HCBS workers must instead demonstrate competency before working without a supervisor present and be re-evaluated every year.⁠¹¹ Under K.S.A. 65-5116, no unlicensed employee may prefill insulin syringes. Doing so is a class C misdemeanor.⁠¹⁹

Background checks go through KDADS

You may not operate an agency if any worker has an adverse finding on a state or national registry or a conviction or juvenile adjudication for an offense on the prohibited list.⁠⁶ Kansas requires home health agencies to request criminal record checks through KDADS rather than running them yourself. KDHE explains that only the KDADS channel gives access to the juvenile records that can bar employment.⁠¹¹

Rules from K.S.A. 65-5117:⁠⁶

• An applicant has 20 calendar days after receiving authorization to be fingerprinted, or the application is treated as withdrawn.
• The employer pays the fee for the criminal history information. The fingerprint collection fee is paid at the collection site.
• You may hire an applicant provisionally, once, for up to 60 calendar days while the result is pending.

Your application packet must include a background check policy and the Kansas list of prohibited offenses in effect when you apply.⁠¹¹

What goes into the upload packet

KDHE does not mail you a packet. The Skilled Services HHA Application Requirements and Instruction Guide is a checklist. Each section of the checklist matches a folder on KDHE’s file transfer system, and each numbered item needs at least one document in its folder.⁠¹¹ Once you upload a file you cannot open it again, so KDHE recommends gathering everything before you start.⁠¹¹

The folders are: governing body, administrators, personnel policies, personnel records, contracts, abuse/neglect/exploitation, provision of services, nursing, therapy, social services, nutrition, supervision, patient and client records, home health aide, supportive care, HCBS, patient rights, background checks, and miscellaneous.⁠¹¹ Items that applicants often underestimate:

• Policies must be written for Kansas. Every policy must be specific to Kansas and issued under the agency name on the application, even if a parent company operates in other states. Policies must be visibly approved by the governing board and in effect. Leave no item blank or marked “See Attached” or “Not Applicable.”⁠¹¹
• Ten personnel files. Upload full personnel records for 10 employees. They must include the administrator, alternate, clinical manager, an RN and other supervisors, with a roster that maps each person to a folder. If you have fewer than 10 employees, say so on the roster. Do not send I-9s, W-4s or Social Security cards.⁠¹¹
• Health and screening records. Each personnel file needs a self-reported health history, a health assessment showing the employee can perform the job, and a two-step tuberculosis skin test, all completed before patient contact. It also needs reference checks done before hire, and performance evaluations within six months of hire and yearly after that.⁠¹¹
• Separate policies for each service type. The checklist asks for separate admission, plan-of-care, record, progress-note and supervision policies for skilled services, HCBS and supportive care.⁠¹¹
• Abuse reporting. The abuse, neglect and exploitation policy must quote the K.S.A. 39-1430 definitions and give the KDHE complaint hotline, 1-800-842-0078. It must also require training at hire and every year after.⁠¹¹
• Bill of rights. Include a sample patients’ and clients’ bill of rights form with an acknowledgment of receipt. K.A.R. 28-51-111 lists the rights it must contain, including the right to be free from restraints at home.⁠⁷⁠¹¹

Filing order

1. Register the entity

   If you are a corporation or LLC, register with the Kansas Secretary of State. The application asks for the entity name exactly as filed, and the attestation form confirms the registration.⁠¹⁰⁠¹²

2. Email the application

   Send the Skilled Services HHA Application, the Skilled Services Attestation Form, the agency and personal Authorization for Release of Information forms, the ownership attachments, and the license and resume for both administrators to [email protected].⁠¹⁰ The form asks for every owner’s percentage and any corporate owner holding 5% or more. It also asks whether you hold accreditation with deemed status or a CLIA certificate or waiver.⁠¹⁰

3. Pay the fee

   Since July 1, 2025, home health agency fees are paid online through PayIt. Checks are also accepted by mail.⁠⁸⁠¹⁰

4. Upload the packet

   After KDHE receives your application and fee, it emails a username and password for the file transfer system.⁠¹⁰

5. Request review

   Put a signed letter on agency letterhead titled “Begin Review Process” in the miscellaneous folder (folder 3). It must use KDHE’s wording: “(INSERT YOUR AGENCY NAME) has completed the documentation submission process for a Home Health Agency Skilled Services license. Please begin the review process.” The review does not start until KDHE has this letter.⁠¹¹

6. Answer KDHE’s questions

   A reviewer emails you about missing items. When every document meets the rules, KDHE issues the license.⁠¹⁰

KDHE publishes no processing timeline. Its staff answer questions about the process but “do not provide individual consultation or business advice.”⁠⁹ K.S.A. 65-5104(a) says a license is issued after “approval of the secretary after a survey inspection,” while KDHE’s own instructions describe only the desk review. K.S.A. 65-5105(a) likewise refers to the “survey inspection required for licensing.”⁠⁴ KDHE’s introduction letter says a state-level survey is required to maintain the license, but neither the letter nor the application instructions say whether the first survey happens before or after the license is issued.⁠⁹⁠¹⁰ Ask KDHE’s Bureau of Facilities and Licensing (785-296-0127) when your first on-site survey will occur and what to have ready.⁠¹⁰

Fees as published

Fees depend on your “total unique patient and client count,” meaning each separately identifiable person served in a licensure year, counted once. A new agency estimates the number it will serve in the year after it applies.⁠⁷

Sources: ⁠⁷⁠¹⁰

For comparison, the supportive-care-only level costs $250 or $500 initially and $100 or $350 to renew.⁠⁷ A change of ownership requires a new application with the full license fee.⁠³

Operating rules that start on day one

These requirements affect your staffing plan from your first patient:

• RN evaluation within 48 hours of each referral, and an RN updates the plan of care whenever the patient’s status changes.⁠⁷
• Plans of care reviewed at least every 60 days by an RN, or by a physical therapist when only therapy is provided.⁠¹¹
• Supervisory home visits by a physician, RN or qualified health professional every two weeks when nursing or therapy is provided. When only personal care is provided, a visit is required at least every 60 days.⁠¹¹
• An RN available or on call during all hours that home health services are provided. If you serve patients after hours, you need a written coverage policy and an on-call schedule for evenings, weekends and holidays.⁠⁷⁠¹¹
• Therapists re-evaluate each patient monthly.⁠¹¹
• HCBS workers receive on-site supervision and evaluation at least every three months.⁠¹¹
• Clinical records retained for at least five years after the patient’s last discharge.⁠¹¹

Surveys, renewal and changes

A license lasts one year.⁠⁷ File the renewal application, marked “Annual Renewal,” with the attestation form and fee at least 30 days before expiration. Include a Secretary of State Certificate of Good Standing if you are registered there, and license verification for the administrators.⁠⁷⁠⁸ If the report and fee are not filed within 30 calendar days of the renewal expiration date, the license is automatically canceled.⁠³

To renew, you must be “in operation.” That means you served at least five patients or clients in the past 12 months and at least one in the most recent three months.⁠⁷ An agency licensed but never staffed will lose eligibility.

KDHE must conduct an on-site survey at least once every 36 months and may inspect at other times during business hours. Refusing entry is grounds for denial, suspension or revocation.⁠³⁠⁴ Surveyors can demand clinical and administrative records, and you must produce them within 30 minutes.⁠⁷ The preliminary survey report that you and the inspector sign at the exit interview is the final record of deficiencies. KDHE cannot add deficiencies from that visit later.⁠¹⁷

A license cannot be transferred. A buyer must apply for a new license before the sale takes effect, and KDHE may issue a temporary operating permit for up to 90 days pending the survey.⁠³ Changes of name, address, administrator, ownership or service area must be reported in writing within five days.⁠⁷⁠¹² Closing requires at least 30 days’ written notice to KDHE.⁠⁷

Medicare and HCBS are separate steps

A state license only lets you operate. KDHE says Medicare certification “is a separate action and requires additional activities after application licensure.”⁠¹¹ KDHE is also the state survey agency for Medicare-certified agencies. Its Skilled Services page names a separate contact for Medicare certification.⁠⁸

That route is closed to new agencies for now. Effective May 13, 2026, CMS stopped enrolling new home health agencies, branches and practice locations anywhere in the United States, unless the Medicare contractor received the application before that date.⁠¹⁵ CMS’s survey memo adds four points:⁠¹⁶

• Applications filed during the moratorium are denied and must be filed again after it ends.
• No individual exceptions are allowed.
• Accreditation will not produce deemed status for a new agency.
• An appeal can argue only that the moratorium does not apply to you.

The moratorium runs for six months and may be extended in six-month increments. After it is lifted, agencies that apply within six months are placed in the “high” screening level.⁠¹⁵ A Federal Register search on October 13, 2026 found no extension or end notice beyond the May 15 announcement. Check before you file.

CMS left Medicaid moratoria to each state.⁠¹⁵ For Kansas HCBS waiver work, KDHE’s letter tells applicants to check each waiver’s requirements with the KDADS HCBS program. Some waivers or parts of waivers also require CMS certification, which a new agency cannot get during the moratorium.⁠⁹⁠¹²

Rule changes KDHE has proposed

The regulations in force are the May 20, 2022 version of K.A.R. 28-51.⁠⁷ On September 8, 2025, KDHE published a summary of proposed amendments to 11 regulations. It describes the changes as drafts that still need several reviews, including a formal public comment period.⁠¹³ The main proposals:

• Licenses and fees. Three distinct licenses (skilled home health services, HCBS and supportive care) would replace the two levels used since 2017, each with its own fees.⁠¹³
• Application. A “complete application packet” would be defined, and incomplete packets would not start KDHE’s approval timeline. Applicants would need to be in good standing with the Secretary of State.⁠¹³
• Administrator. Administrators of skilled and HCBS agencies would need to be qualified health professionals with a current Kansas license, an undergraduate degree and one year of supervisory or administrative home health experience. Administrators would have to live within the service area, or in a neighboring county of another state, and within 60 minutes of the parent office.⁠¹³
• Staff and operations. A director of nursing and alternate would be required depending on the administrators’ qualifications. The service area would be limited to Kansas. Background checks would be repeated every two years, and restraints would be banned.⁠¹³

KDHE held listening sessions and posted its answers to industry feedback, saying it may revise the proposals.⁠¹⁴ As of October 12, 2026, KDHE’s pages show no Kansas Register hearing notice or adopted amendment, so the 2022 rules above still apply. Check the Kansas Register before you hire an administrator or set prices around the current fee table.

Sources

1. 1
   Kansas Office of Revisor of Statutes, K.S.A. 65-5101, Home health agencies: definitions Checked 12 Oct 2026 · Back to text ↑
2. 2
   Kansas Office of Revisor of Statutes, K.S.A. 65-5102, Home health agencies required to be licensed; temporary license; penalty Checked 12 Oct 2026 · Back to text ↑
3. 3
   Kansas Office of Revisor of Statutes, K.S.A. 65-5104, Issuance of license; annual report and fee; transfers; reciprocal agreements Checked 12 Oct 2026 · Back to text ↑
4. 4
   Kansas Office of Revisor of Statutes, K.S.A. 65-5105, Survey inspections Checked 12 Oct 2026 · Back to text ↑
5. 5
   Kansas Office of Revisor of Statutes, K.S.A. 65-5112, Act not applicable to certain individuals or organizations Checked 12 Oct 2026 · Back to text ↑
6. 6
   Kansas Office of Revisor of Statutes, K.S.A. 65-5117, Home health agency background checks Checked 12 Oct 2026 · Back to text ↑
7. 7
   Kansas Secretary of State, Kansas Register, K.A.R. 28-51-100 to 28-51-118, Home Health Agency Licensure (Kansas Register Vol. 41, No. 18, May 5, 2022) Checked 12 Oct 2026 · Back to text ↑
8. 8
   Kansas Department of Health and Environment, Skilled Services (Home Health Agencies) Checked 12 Oct 2026 · Back to text ↑
9. 9
   Kansas Department of Health and Environment, HHA Letter of Introduction (revised 03/2024) Checked 12 Oct 2026 · Back to text ↑
10. 10
    Kansas Department of Health and Environment, Skilled Services HHA Application (revised 03/2024) Checked 12 Oct 2026 · Back to text ↑
11. 11
    Kansas Department of Health and Environment, Skilled Services HHA Application Requirements and Instruction Guide (revised 03/2024) Checked 12 Oct 2026 · Back to text ↑
12. 12
    Kansas Department of Health and Environment, Skilled Services Attestation Form Checked 12 Oct 2026 · Back to text ↑
13. 13
    Kansas Department of Health and Environment, 2025 Home Health Agency Regulations Summary of Changes Guide (September 8, 2025) Checked 12 Oct 2026 · Back to text ↑
14. 14
    Kansas Department of Health and Environment, HHA Listening Sessions Questions and Feedback Checked 12 Oct 2026 · Back to text ↑
15. 15
    Centers for Medicare & Medicaid Services, Federal Register, Announcement of Nationwide Temporary Moratoria on Enrollment of Home Health Agencies (91 FR, May 15, 2026) Checked 12 Oct 2026 · Back to text ↑
16. 16
    Centers for Medicare & Medicaid Services, QSO-26-11-HHA/Hospice: Nationwide moratoria on enrollment of hospices and home health agencies Checked 12 Oct 2026 · Back to text ↑
17. 17
    Kansas Office of Revisor of Statutes, K.S.A. 65-5106, Survey report; list of deficiencies; exit interview Checked 12 Oct 2026 · Back to text ↑
18. 18
    Kansas Office of Revisor of Statutes, K.S.A. 65-5114, Violation of act; misdemeanor Checked 12 Oct 2026 · Back to text ↑
19. 19
    Kansas Office of Revisor of Statutes, K.S.A. 65-5116, Unlicensed employees prohibited from prefilling insulin syringes Checked 12 Oct 2026 · Back to text ↑

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