Kentucky home health agency license: certificate of need, OIG licensing and Medicare

Is your business a home health agency in Kentucky?

Under 902 KAR 20:081, a home health agency provides part-time or intermittent health services in the patient’s residence. Those services follow a plan of care prescribed by a physician, advanced practice registered nurse (APRN) or physician assistant.⁠² The statute goes further. KRS 216.935(4) defines a home health agency as an organization “licensed as a home health agency by the Cabinet for Health and Family Services and is certified to participate as a home health agency under Title XVIII of the Social Security Act”, meaning Medicare.⁠¹ Kentucky’s model is therefore a Medicare-certified skilled agency, not a private-pay nursing service.

Every licensed agency must provide part-time or intermittent skilled nursing. It must also offer at least one of these: physical, speech or occupational therapy; medical social services; or home health aide services. Services must be available five days a week, with backup arrangements for weekends and emergencies.⁠² An agency that sends only aides or only therapists does not fit the license.

Three neighboring categories are often confused with it:

The personal services statute excludes services that “require the order of a licensed health-care professional to be lawfully performed in Kentucky”, along with services provided by a licensed health facility.⁠¹⁹ Once your aides work under a nursing plan of care for skilled patients, you are in home health territory. See the personal services agency guide for the non-medical route.

Two narrower exemptions exist. A continuing care retirement community needs no certificate of need to provide home health services to its own on-campus residents.⁠⁶ A hospital’s home care department or a health department’s nursing division still has to be licensed as a home health agency and must keep its expenditures separately identifiable.⁠²

The certificate of need: Kentucky’s real gate

KRS 216B.061 bars anyone from establishing a health facility without a certificate of need (CON). It also requires one to “increase a geographical area” designated on a CON or license.⁠⁴ KRS 216B.015 lists home health agencies among health facilities.⁠⁵ Your CON and your license therefore both define which counties you may serve. Form OIG 004 makes you check each county by name, or “Statewide.”⁠¹⁵ Adding a county later means going back to the Division of Certificate of Need.

How the State Health Plan measures need

The review standards are in the “2025 Update to the State Health Plan,” January 2026 edition, incorporated by 900 KAR 5:020.⁠⁷ The plan calculates need county by county. It applies age-group target rates (patients per 1,000 population, based on statewide use over the last two calendar years) to projected county population. It then subtracts the average number of unduplicated patients actually served in the county over those two years, as reported in the Kentucky Annual Home Health Services Report.⁠⁸

The plan uses two definitions that decide which threshold applies to you:⁠⁸

• Establish: open a parent home health agency, or a subunit as Medicare defines it, in a county where you are not already licensed.
• Expand: add a Kentucky county that borders your existing service area, without opening a new parent or subunit.

Each approval is counted against the remaining need. The plan adds 250 patients to a county’s inventory for every new agency or subunit approved there and 125 for every expansion. It adds 50 for a hospital agency serving only its own county. Those numbers come off once the annual report shows the agency has actually served patients in that county.⁠⁸ A county that looks open in one report can therefore close after a competitor’s approval.

The plan sets the thresholds, but the county-by-county need figures come from the Kentucky Annual Home Health Services Report, which changes every year. OIG’s annual reports page lists the 2025 utilization surveys for providers, not county need tables.⁠⁸ Ask the Division of Certificate of Need which counties show projected need of 250 (new agency) or 125 (expansion) before you commit to a county.

Filing calendar and review

Home health applications share a batching cycle with long-term care beds, hospice and private duty nursing. Public notice appears in the Certificate of Need Newsletter published on the third Thursday of February, May, August and November. You must file at least 50 and no more than 80 calendar days before the notice you are targeting. An application filed more than 80 days early is returned with its fee.⁠⁹

1. File the application and fee

   Use CON Form 2A, 2B or 2C with the fee from 900 KAR 6:020. An application is not complete until the fee is paid.⁠¹⁰⁠¹²

2. Completeness review

   Fifteen days after the batch filing deadline, the cabinet reviews applications for completeness. If it asks for more information, you have 15 days to supply it. An application that is not complete within one year of filing expires.⁠¹⁰

3. Formal review

   A home health application under the 250/125 criteria goes to formal review, which is completed within 90 days of the start of review.⁠⁹ Once the application is deemed complete, you may add information only at a public hearing.⁠¹⁰

4. Decision

   The cabinet notifies parties of its final action within 3 days. If your application is disapproved, you cannot refile an identical one within 12 months of the original filing date unless circumstances change.⁠¹⁰

Nonsubstantive review (a 35-day decision) applies only to the hospital or nursing-facility expansion described above and to other listed categories. It is not available to an independent startup.⁠¹¹

The fee is refunded only if the cabinet receives your withdrawal notice within 5 working days of receiving the application.⁠¹² After approval, you file a CON Form 8 progress report every six months. The CON is complete once OIG approves the project for licensure and you have submitted a final cost breakdown and the progress report fee.⁠¹³

The 2026 Medicare enrollment freeze

Effective May 13, 2026, CMS stopped enrolling new home health agencies, branches and practice locations in Medicare anywhere in the country. The only exception is an application the Medicare contractor received before that date. The moratorium lasts six months and may be extended in six-month increments. CMS left it to each state to decide whether to restrict Medicaid enrollment.⁠²⁵ As of October 12, 2026, a Federal Register search found no notice extending or lifting it. Once it ends, new agencies that apply within the following six months go into CMS’s “high” screening level.⁠²⁵

This matters more in Kentucky than in most states for three reasons:

• The statutory definition of a home health agency includes Medicare certification.⁠¹
• Kentucky Medicaid’s home health regulation pays only “a Medicare and Medicaid-certified agency licensed in accordance with 902 KAR 20:081.”⁠²¹
• The CON need math counts patients served, so an approved agency that cannot bill Medicare cannot build the patient volume the plan assumes.

Neither 902 KAR 20:008 nor Form OIG 004 says what OIG does with a provisional license application from an agency that cannot enroll in Medicare while the moratorium runs.⁠³⁠¹⁵ Ask the Division of Health Care whether it will license an agency that has no Medicare certification, and in what order, before you spend on a CON filing timed for 2026 or early 2027.

When Medicare enrollment reopens, federal rules require new agencies to hold “initial reserve operating funds.” The amount must cover the first three months after billing privileges begin, not counting expected Medicare receivables. CMS sets the amount using first-year costs per visit of at least three comparable agencies.⁠²⁴

Building an agency that passes 902 KAR 20:081

OIG’s completeness review looks at your ownership, personnel, operating and administrative policies, and the services you will provide.⁠³ The rule tells you what those documents must contain.

Governance, policies and records

• Licensee responsibility. The licensee is legally responsible for operating the agency and for complying with federal, state and local law.⁠²
• Patient acceptance and plan of care. Written policies must cover how you accept patients and how the plan of care is set up and reviewed. The physician, APRN or PA must review each plan of care at least every 60 days. Verbal orders must be put in writing and signed by the prescriber within 30 days. Drug orders follow the same 30-day rule.⁠²
• Open admission. Services must be available “regardless of age, sex, and ethnic background.”⁠²
• Clinical records. You must keep a record for every patient, including services provided through arrangements with another agency. Records belong to the agency, the original may leave only by court order, and confidentiality follows HIPAA.⁠²
• Program evaluation. Your own staff must evaluate the program at least every two years, including a sample review of patient records.⁠²
• Long-range plan. You must review it every year. It covers needs in your service area, your role, staff expansion over two years, goals, and any volunteer or community education work.⁠²
• Agreements. You need coordination agreements with hospitals and long-term care facilities in your service area. Each service you contract to another agency needs a written agreement covering seven required points, including supervision of contract staff and how often the agreement is reviewed.⁠²

Medicare’s federal conditions add a governing body with full legal responsibility, an administrator, and a clinical manager available during all operating hours.⁠²³

Clinical staff qualifications

Therapy services must be provided or supervised by a licensed physical, occupational or speech therapist, under a written order. Respiratory therapy must be provided or supervised by a licensed nurse with respiratory therapy training and experience. A medical social worker needs a bachelor’s degree in social work or a related field, one year of social work in a health care setting, and a license from the Kentucky Board of Social Work. A “qualified medical social worker” holds an accredited master’s degree.⁠² You must also designate a physician, registered nurse or physician assistant to supervise the agency’s performance.⁠²

Hiring, screening and aide training

Before anyone starts, your written personnel policies must provide for the following:⁠²

• A pre-employment medical exam, repeated at least every three years, for staff who visit patients’ homes.
• Annual tuberculin screening under 902 KAR 20:205.
• Pre-employment abuse registry checks under KRS 216.937 and KRS 209.032.
• A criminal background check. You may not place someone in direct care if they have a felony conviction related to theft, illegal drugs, abuse, neglect or exploitation of a child or adult, or a sexual crime, or a misdemeanor conviction related to abuse, neglect or exploitation of an adult.

Policies must also cover wage scales, orientation, on-the-job training, annual performance evaluations and job descriptions for each category of staff.⁠²

Kentucky’s dementia rule is a specific state requirement. An aide must finish 6 hours of initial dementia training before serving a patient who shows symptoms of Alzheimer’s disease or other dementia, then 3 hours every year. An aide who has gone 24 months or more without such patients must repeat the 6 hours within 60 days of resuming that work.⁠² The statute frames the initial 6 hours as due within the first 60 days of employment.⁠¹⁸ Your curriculum must be approved by the cabinet through the process in 910 KAR 4:010. You must give each aide a completion certificate and keep the records, and the cabinet can fine agencies that fall short.⁠²

Applying for the license with OIG

After the CON, the licensing steps run in this order under 902 KAR 20:008:

1. Wait until you are ready to be inspected

   Form OIG 004 says a completed application “should not be submitted to the Office of Inspector General until the facility is ready for an inspection.”⁠¹⁵

2. Submit Form OIG 004 with the fee

   Check “Provisional Licensure for Home Health Agency,” list any satellites, check the counties you will serve, and give ownership details. That means every owner, and every officer, director or partner, with mailing address, email and phone. Mail the form, the $500 fee and supporting documents to the Office of Inspector General, 275 East Main Street, 5E-A, Frankfort, KY 40621.⁠¹⁵⁠³ OIG links the form from its health care applications page.⁠¹⁶ If you are missing the fee or any parts of the application, OIG may return it.⁠¹⁵

3. Pass the background screen on owners

   OIG returns the application and fee if anyone with a significant financial interest held a significant interest in a facility that lost or gave up its license within the past seven years after an action that put patients at risk of death or serious harm. It does the same if the application contains false information.⁠³

4. Receive the provisional license and start services

   A complete application with no deficiencies earns a provisional license, and you begin serving patients. If you have not started within 10 business days, notify the cabinet in writing with the reason and your expected start date. Tell the cabinet within 3 business days of starting. Post the license in a public area.⁠³

5. Unannounced inspection within 3 months

   OIG inspects within three months of the provisional license’s effective date. You have 10 days to answer any violation notice with a written plan of correction. If the license is denied, you must stop providing services immediately. If it is approved, the full license is backdated to the date of the provisional license.⁠³

OIG does not publish a processing time for the provisional license. The Division of Health Care’s number is 502-564-7963.⁠¹⁷

The OIG 004 on the cabinet’s site is the January 2017 edition incorporated in 902 KAR 20:008. OIG’s applications page links this PDF as the home health agency application and says to contact the office before submitting, because many facility types need a certificate of need or fire marshal approval first.⁠¹⁶ It does not describe an online filing option, so confirm the current submission method with the Division of Health Care.

Fees as published

Renewal, reporting and changes

A license expires one year from its effective date. OIG renews it with a validation letter if you file a completed application, pay the fee, have no pending adverse action, and have answered the cabinet’s requests for annual utilization surveys and service information.⁠³ When requested, the annual utilization survey must be filed online for the previous calendar year by March 15.⁠¹⁴ Those surveys feed the Kentucky Annual Home Health Services Report, which drives the CON need calculation.⁠⁸

Notice deadlines after you open:⁠³

• Change of ownership (more than 25% of the agency, or of the equity or voting rights of the legal entity): written notice within 30 calendar days. No new provisional license is needed.
• Name or administrator change: notice within 10 calendar days.
• Owner, officer, director or partner contact details: must be kept current with the cabinet.

Inspections can be unannounced and can happen at any time during operating hours. Denying or delaying an inspector’s access is grounds for denying a license.⁠³ Adding counties is a CON matter, not a notice: it requires a certificate of need under KRS 216B.061(1)(g).⁠⁴

Getting paid by Kentucky Medicaid

Kentucky Medicaid pays home health services under 907 KAR 1:030. A provider must be a Medicare- and Medicaid-certified agency licensed under 902 KAR 20:081. It must comply with 907 KAR 1:671 through 1:673 and the Home Health Services Manual.⁠²¹ Coverage rules that shape your service mix:⁠²¹

• Services must be prior authorized as medically necessary.
• Physical, occupational and speech therapy are each limited to 20 visits per recipient per calendar year unless more are found medically necessary.
• Housekeeping unrelated to health care, personal hygiene supplies and drugs are not covered.
• Recipients who have elected hospice care are not covered under the home health program.

For members of a Medicaid managed care organization, the MCO rather than the department decides whether therapy visits beyond those limits are medically necessary.⁠²¹ CMS’s May 15, 2026 notice left it to each state to decide whether to impose a home health moratorium in Medicaid.⁠²⁵ 907 KAR 1:030 contains no such restriction, but ask the Department for Medicaid Services whether it has set one since.⁠²¹

Rule changes to track

• January 22, 2026: the “2025 Update to the State Health Plan” (January 2026 edition) took effect through 900 KAR 5:020. The same date, 900 KAR 6:075 was amended. The 250/125 home health criteria carry forward.⁠⁷⁠¹¹⁠⁸
• May 13, 2026: the CMS nationwide moratorium on new home health agency enrollment began.⁠²⁵
• July 15, 2026: KRS 216B.061, the statute listing actions that require a CON, was amended by 2026 Ky. Acts ch. 105. The statute’s current text lists the same actions that require a CON (including establishing a health facility and increasing a designated geographic area), and its only facility-specific provisions concern ambulatory surgical centers. This guide could not tell from the statute page whether the amendment changed anything for home health applicants, so ask the Division of Certificate of Need.⁠⁴
• February 10, 2022: 902 KAR 20:081 was last amended, adding the dementia training rules for aides. 902 KAR 20:008 (fees and licensing procedure) was recertified effective September 3, 2025.⁠²⁠³

If you are weighing other Kentucky care businesses, the assisted living community license and the family care home license are exempt from CON. See also the adult day health care program license. More home health licensing comparisons are on the home health license page.

Sources

1. 1
   Kentucky Legislative Research Commission, KRS 216.935, Definitions for KRS 216.935 to 216.939 Checked 12 Oct 2026 · Back to text ↑
2. 2
   Kentucky Legislative Research Commission, 902 KAR 20:081, Operations and services; home health agencies Checked 12 Oct 2026 · Back to text ↑
3. 3
   Kentucky Legislative Research Commission, 902 KAR 20:008, License procedures and fee schedule Checked 12 Oct 2026 · Back to text ↑
4. 4
   Kentucky Legislative Research Commission, KRS 216B.061, Actions requiring certificates of need Checked 12 Oct 2026 · Back to text ↑
5. 5
   Kentucky Legislative Research Commission, KRS 216B.015, Definitions for chapter Checked 12 Oct 2026 · Back to text ↑
6. 6
   Kentucky Legislative Research Commission, KRS 216B.020, Certificate of need exemptions Checked 12 Oct 2026 · Back to text ↑
7. 7
   Kentucky Legislative Research Commission, 900 KAR 5:020, State Health Plan for facilities and services Checked 12 Oct 2026 · Back to text ↑
8. 8
   Kentucky Cabinet for Health and Family Services, 2025 Update to the State Health Plan, Certificate of Need Review Standards (January 2026) Checked 12 Oct 2026 · Back to text ↑
9. 9
   Kentucky Legislative Research Commission, 900 KAR 6:060, Timetable for submission of certificate of need applications Checked 12 Oct 2026 · Back to text ↑
10. 10
    Kentucky Legislative Research Commission, 900 KAR 6:065, Certificate of need application process Checked 12 Oct 2026 · Back to text ↑
11. 11
    Kentucky Legislative Research Commission, 900 KAR 6:075, Certificate of need nonsubstantive review Checked 12 Oct 2026 · Back to text ↑
12. 12
    Kentucky Legislative Research Commission, 900 KAR 6:020, Certificate of need application fee schedule Checked 12 Oct 2026 · Back to text ↑
13. 13
    Kentucky Legislative Research Commission, 900 KAR 6:100, Certificate of need standards for implementation and biennial review Checked 12 Oct 2026 · Back to text ↑
14. 14
    Kentucky Legislative Research Commission, 900 KAR 6:125, Certificate of need annual surveys Checked 12 Oct 2026 · Back to text ↑
15. 15
    Kentucky Cabinet for Health and Family Services, Office of Inspector General, Form OIG 004, Application for License to Operate a Home Health Agency, Non-Residential Hospice, or Private Duty Nursing Agency (January 2017) Checked 12 Oct 2026 · Back to text ↑
16. 16
    Kentucky Cabinet for Health and Family Services, Office of Inspector General, Applications for Health Care and Long-Term Care Checked 12 Oct 2026 · Back to text ↑
17. 17
    Kentucky Cabinet for Health and Family Services, Office of Inspector General, Division of Health Care Checked 12 Oct 2026 · Back to text ↑
18. 18
    Kentucky Legislative Research Commission, KRS 216.9375, Minimum training requirements for direct-care staff (dementia) Checked 12 Oct 2026 · Back to text ↑
19. 19
    Kentucky Legislative Research Commission, KRS 216.710, Definitions for KRS 216.710 to 216.714 (personal services) Checked 12 Oct 2026 · Back to text ↑
20. 20
    Kentucky Legislative Research Commission, 906 KAR 1:180, Personal services agencies Checked 12 Oct 2026 · Back to text ↑
21. 21
    Kentucky Legislative Research Commission, 907 KAR 1:030, Home health agency services (Medicaid) Checked 12 Oct 2026 · Back to text ↑
22. 22
    Electronic Code of Federal Regulations, 42 CFR 484.80, Home health aide services Checked 12 Oct 2026 · Back to text ↑
23. 23
    Electronic Code of Federal Regulations, 42 CFR 484.105, Organization and administration of services Checked 12 Oct 2026 · Back to text ↑
24. 24
    Electronic Code of Federal Regulations, 42 CFR 489.28, Special capitalization requirements for HHAs Checked 12 Oct 2026 · Back to text ↑
25. 25
    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 ↑

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