Louisiana HCBS provider license: opening a personal care attendant agency

One license, eight modules: where personal care fits

Louisiana does not have a separate “home care agency” or “companion agency” license. Since July 1, 2011, the Louisiana Department of Health (LDH) has issued a single Home and Community-Based Services (HCBS) provider license. Each service you offer is a module on that one license: Adult Day Care, Family Support, Personal Care Attendant (PCA), Respite Care, Substitute Family Care, Supervised Independent Living (including Shared Living Conversion), Supported Employment and Monitored In-Home Care ⁠¹. The license lists the modules you are approved for, and you may provide only those ⁠³⁠⁶.

A non-medical home care business usually needs the PCA module. The rule lists what PCA services cover ⁠⁶:

• assistance and prompting with personal hygiene, dressing, bathing, grooming, eating, toileting, ambulation or transfers, and behavioral support, plus “any non-complex medical task which can be delegated”;
• help with housekeeping, laundry, cooking, shopping, budgeting and bill paying under the plan of care;
• accompanying or transporting the client to community, health and leisure activities.

State law defines PCA services as services “required by a person with a disability” to become physically independent or to stay in, or return to, the community. For this purpose, “person with a disability” includes “an adult who requires assistance with activities of daily living” ⁠². In practice, that covers most older adults who need hands-on help.

If you also want to give family caregivers a break in the client’s home, add the in-home respite module. Providers of in-home respite must meet the PCA module requirements as well as the respite rules ⁠⁶. Respite under the statute covers a person with a disability or an “infirm elderly” person, meaning someone 60 or older who needs continuous care and supervision ⁠². Social adult day programs for 10 or more adults are a separate module of this same license. Medical-model centers need a different license, covered in the Louisiana adult day health care guide.

Businesses the license does not cover

R.S. 40:2120.2 lists who is not an HCBS provider ⁠²:

• a business that solely prepares and delivers meals, solely provides sitter services, or solely provides housekeeping;
• anyone providing services gratuitously (without pay);
• an individual LPN or RN with a Louisiana license in good standing who contracts directly with a client or family for personal nursing services;
• staffing agencies that supply contract workers to LDH-licensed providers;
• workers employed through an LDH self-direction program;
• caregiver registries that meet R.S. 40:2120.8.

The sitter exclusion is narrow. LDH’s rule defines sitter services as keeping someone company, going with them on trips and outings, preparing and delivering meals, or housekeeping, and it states that a sitter “shall not provide hands-on personal care attendant service with respect to ADLs” ⁠⁶. A companion business that starts helping clients bathe or use the toilet needs the HCBS license.

Act 507 of the 2025 Regular Session added the caregiver registry carve-out. A registry matches families with caregivers (nurses, aides, attendants, companions or homemakers) whose services are not paid by a federal or state program. It may not employ, direct or supervise the caregivers, provide clinical oversight, or set the terms of the care relationship. It must run background checks on the people it lists, and it may not place caregivers in licensed facilities ⁠²⁠⁵. A registry that does any of the prohibited things does not meet R.S. 40:2120.8, so the exclusion does not apply to it.

If you plan to send nurses or therapists, or to bill Medicare, you need a home health agency license instead. See the Louisiana home health agency guide.

Facility Need Review comes first

This step decides whether you can open at all. LDH says plainly that it “does not issue nor have a requirement for a certificate of need,” but its Facility Need Review (FNR) does the same job for certain provider types ⁠⁹. The PCA, respite, supervised independent living and monitored in-home caregiving modules are all on the FNR list. You need FNR approval before HSS will accept your license application ⁠¹⁠⁹⁠¹⁰. Anyone who operates without a required approval must stop providing services immediately and cannot get a license until approval is granted ⁠¹⁰.

The review standard is strict. The FNR committee looks at need in your LDH administrative region, which is your geographic service area. It “shall approve the FNR application only if the data contained in the application, and other evidence effectively establishes the probability of serious, adverse consequences to recipients’ ability to access healthcare if the provider is not allowed to be licensed” ⁠¹⁰. The committee may consider how many other HCBS providers already serve the same population in the region, as well as evidence about access to care. The burden of proof is on you, and the committee “shall not approve” an application that lacks that data and evidence ⁠¹⁰. The committee is made up of LDH leadership, including the heads of the Office of Aging and Adult Services and the Office for Citizens with Developmental Disabilities and the Medicaid director ⁠¹⁰.

To apply, read LAC 48:I Chapter 125, gather your supporting documentation, and submit it through LDH’s online FNR portal with the $200 non-refundable fee. You can also email the HCBS FNR application to [email protected] or mail it to HSS, and send a check with the HSS Payment Transmittal Form to LDH Licensing Fee, P.O. Box 734350, Dallas, TX 75373-4350 ⁠⁹. LDH will not process an FNR application that arrives without supporting documentation ⁠⁹.

Approval comes with conditions ⁠¹⁰:

• It is tied to the services, physical location and region named in your application, and it expires if you change them.
• It cannot be transferred. A buyer of a licensed agency must file a new FNR application to transfer the approval.
• You must be licensed within six months of approval. LDH may grant one 90-day extension for delays beyond your control, but “inappropriate zoning is not a basis for extension.” Missing the deadline voids the approval automatically.

Because of the six-month deadline, have your office, administrator, line of credit and insurance lined up before approval arrives. Providers licensed by January 31, 2009, or with a complete application filed by June 30, 2008, were grandfathered ⁠¹⁰. That does not help a new entrant. The HCBS section of the FNR rule (§12523) sets no decision deadline, and LDH’s FNR page publishes no processing times or approval rates ⁠⁹⁠¹⁰. Ask the FNR program ([email protected]) how long review is currently taking before you commit to a lease or a line of credit.

Owners and the administrator

Each owner must be at least 18. LDH rejects the application if an owner or administrator has a felony conviction involving violence, abuse or negligence of a person; misappropriation of another person’s property; cruelty, exploitation or sexual battery of the infirm; drugs; sexual crimes; firearms or deadly weapons; Medicare or Medicaid fraud; or fraud or misappropriation of public funds ⁠⁶. The packet must include a statewide Louisiana State Police criminal check, with sex offender registry status, for every owner and the administrator ⁠⁶⁠⁷.

The administrator must live in Louisiana, have a high school diploma or equivalent, and meet one of three tracks ⁠⁶:

The administrator must be a full-time employee, not a contractor, and may not run more than one licensed HCBS provider ⁠⁶. HSS checks these facts on paper. Its checklist asks for a resume showing months and years and the populations served, a diploma, and preferably a Louisiana driver’s license or state ID as proof of residency ⁠⁷.

The agency also needs an identifiable governing body of three or more persons that meets formally at least twice a year, keeps minutes and bylaws, and approves the annual budget ⁠⁶. A sole owner still has to put together a three-person governing body.

The office: Louisiana’s business-location rules

HSS will not license a home-based agency. Under LAC 48:I §5005 and §5031, the business location ⁠⁶:

• must be in the LDH region the license covers and may not be “located in an occupied personal residence”;
• must be commercial office space or, if in a residential area, zoned for commercial use and used only for the business;
• needs its own entrance and exit, and signs showing your name, address and hours;
• may not share office space with another business (shared foyers, kitchens, conference rooms and hallways are allowed, but records may not be kept there);
• must have at least one employee or contractor on duty during posted hours;
• needs a published phone number answered 24 hours a day, seven days a week, a 24-hour fax line, internet access and an e-mail address you give to LDH. Calls must be returned within one business day.

Report planned changes to your hours to HSS within five business days, and unplanned changes within two ⁠⁶. Your packet must include a floor sketch of the office that marks entrances and exits and lists the 24-hour phone number ⁠⁷. After licensure, the location must “consistently” serve at least two clients to stay operational ⁠⁶.

Proof of financial viability

R.S. 40:2120.2 defines financial viability, and LDH checks it at application and at every renewal ⁠²⁠⁶⁠¹¹:

• Line of credit of at least $50,000 from a federally insured, licensed lending institution, current when you apply and issued in the applicant’s name at the address on the application. The bank letter must name the agency and the office address and be signed by an authorized bank representative ⁠⁶⁠⁷. LDH states that “personal loans or bank balances of $50,000 or more do not meet this requirement,” and it grants no waiver or extension ⁠¹¹.
• General and professional liability insurance of at least $300,000.
• Workers’ compensation insurance. No minimum amount is specified ⁠⁷.

Each certificate of insurance must list the LDH Health Standards Section, P.O. Box 3767, Baton Rouge, LA 70821-3767, as certificate holder. Each policy must require 30 days’ notice to the certificate holder before cancellation or change ⁠⁶⁠⁷. At renewal, you must also show that the insurance stayed in effect for the whole license term ⁠⁶.

Filing the license application

Once you have FNR approval, send HSS the initial packet. The checklist lists ⁠⁷:

1. FNR approval letter

2. HCBS license application

   (LDH’s licensure application, file HSS-HCBS-01) with the modules checked ⁠¹¹. Email it to [email protected] or mail it to Health Standards Section, P.O. Box 3767, Baton Rouge, LA 70821-3767.

3. Fees and the Payment Transmittal Form

   , sent to the Dallas lockbox. Fees are non-refundable.

4. Office floor sketch

   with the 24-hour phone number.

5. Administrator documents

   resume, proof of Louisiana residency, diploma and proof of a qualifying track.

6. State Police criminal and sex offender checks

   for all owners and the administrator.

7. Line of credit letter and certificates of insurance

8. Disclosure of Ownership and Controlling Interest Statement

   , listing any interest in other licensed agencies.

9. Organizational chart

   with key administrative staff and governing body members.

10. Certificates for the three mandatory online provider training classes

    , completed by every owner and the administrator.

The fire marshal and Office of Public Health approvals on the checklist apply only to adult day care and center-based respite. A PCA-only office does not need them under the HCBS rule ⁠⁶⁠⁷. If HSS finds the packet incomplete, you have 90 days from its notice to send the missing items. After that the application is closed, and you start over with a new packet and a new fee, subject to FNR ⁠⁶.

Training, the one-client rule and the initial survey

Louisiana’s sequence is unusual. After HSS accepts a complete packet and your training is documented, you must admit one client and call the HSS field office to schedule the initial survey. Before scheduling, you must be “fully operational,” in compliance with every licensing standard, and serving only one client ⁠⁶. If you do not admit a client and call within 30 days of HSS’s notice, the application is closed and you pay a new fee to restart ⁠⁶. LDH repeats that it authorizes the initial survey only after a complete application and the training videos are both done ⁠¹.

The initial survey is announced; follow-up surveys are not. If you comply fully, you get a full license. If the problems found do not threaten clients, HSS may issue a provisional initial license and check again. Deficiencies not fixed by that follow-up mean reapplying from the beginning ⁠⁶.

If time matters more than money, LAC 48:I Chapter 41 offers an expedited licensing process. Initial HCBS licensing is a Tier 1 request, with a fee of $7,000. HSS must then survey within 10 working days of the readiness date you give, and refunds the fee if it misses that window. If you are not ready when surveyors arrive, you lose the fee ⁠¹². Expedited processing does not skip FNR, which the rule requires before any HCBS license is issued ⁠⁶⁠¹⁰.

Fees as published on 2026-10-12

R.S. 40:2120.4 caps the base license at $600 a year for in-home services, plus $200 each for adult day care and out-of-home respite. It also exempts councils on aging from licensing fees ⁠⁴. LDH’s fee schedule lists $200 for stand-alone center-based respite and $250 for a satellite branch of a parent company ⁠⁸. The $250 figure is above the $200 statutory add-on, and the sources do not say how LDH reconciles the two; a founder planning center-based respite should ask HSS which fee applies. This does not affect a PCA-only agency.

Staffing rules you will be surveyed on

Direct care workers. Each unlicensed attendant must meet Louisiana’s direct service worker requirements in R.S. 40:2179-2179.1 and must have a statewide criminal background check at hire. Before touching a client, each worker must complete 16 hours of training. Topics include your policies, emergency response, client rights, abuse and neglect reporting using LDH’s approved curriculum, critical incidents, universal precautions, documentation, managing aggressive behavior and scald prevention. Workers must then pass a written or oral competency evaluation, complete basic first aid within 45 days of hire, and take 8 hours of continuing training every year ⁠⁶. Training from a previous HCBS employer carries over if you get proof of completion and evidence of continued competency ⁠⁶.

Supervision. A designated supervisor makes an unannounced, in-person visit to each worker within 60 days of hire and at least once a year after that. The agency also visits each client’s home quarterly to review the service plan ⁠⁶. Each client needs a written back-up staffing plan, and PCA providers must name at least one trained back-up worker for each client ⁠⁶.

Professional staff. The core rules do not name a required nurse position for the PCA module. You must employ, contract with or have access to licensed professionals (nurses, therapists, social workers, psychologists) as each client’s service plan requires, and verify their licenses every year ⁠⁶.

Assessment and paperwork. Before any service begins, you must assess each client’s life safety, home environment, health conditions and medications, ADLs and IADLs, and finances. Repeat the assessment at least once a year and whenever needs change. You may not admit someone you cannot safely serve ⁠⁶. The governing body must approve written policies on confidentiality, marketing (including a ban on kickbacks and coercive solicitation), personnel, client rights, grievances, client funds, emergency preparedness, abuse and neglect, incidents, documentation, admissions and discharges, transport safety and staff social media use. You also need a written quality enhancement plan ⁠⁶.

Getting paid: Medicaid personal care enrollment

Most Louisiana PCA agencies bill Medicaid, and the HCBS license with a PCA module is the entry ticket. Louisiana Medicaid’s two personal care enrollment packets both require a copy of that license ⁠¹³⁠¹⁴:

• Provider type 24, Personal Care Services: for Long Term Personal Care Services (LT-PCS), managed by LDH’s Office of Aging and Adult Services, and for EPSDT personal care for children ⁠¹³.
• Provider type 82, Personal Care Attendant (Waiver): for waiver participants, including the Community Choices Waiver and developmental disability waivers run with the Office for Citizens with Developmental Disabilities. Medicaid “will not reimburse you for waiver services provided to participants who are not enrolled in one of the waiver programs” ⁠¹⁴.

Both packets go to the Gainwell Provider Enrollment Unit, P.O. Box 80159, Baton Rouge, LA 70898-0159. They need the PE-50 enrollment form, ownership disclosure, direct deposit forms and an IRS document showing your EIN ⁠¹³. After enrollment, your agency appears in Medicaid’s Provider Locator Tool, which participants use to choose providers ⁠¹³. State law also bars Medicaid payment to an unlicensed HCBS provider ⁠³.

Renewal, branches and ownership changes

The license lasts one year and expires on the last day of the twelfth month after issuance. It covers one geographic location and cannot be sold or transferred ⁠³⁠⁶. LDH mails a renewal notice about 75 days before expiration. The renewal packet is due at least 30 days before expiration and must include the fee and fresh proof of the line of credit and insurance ⁠⁶⁠¹¹.

You may serve clients only in your LDH region. To serve one client outside it, you need a written, client-specific waiver from HSS, granted only when no licensed provider there can serve the client or for other good cause ⁠⁶. Branch offices need prior written HSS approval and must be in the same region. HSS will not consider one until the parent agency has held a full license for the previous 12 months, and it may limit how many branches a provider opens in a region ⁠⁶. To expand into another region, you need a separate license and, for PCA, a separate FNR approval ⁠⁶⁠¹⁰. An existing HCBS provider adding PCA, respite, MIHC or supervised independent living must get FNR approval for each new service ⁠⁶.

A change of ownership costs $600 in licensing fees, and the buyer must also file a new FNR application with proof of the sale to transfer the approval ⁠⁸⁠¹⁰.

Recent and pending changes

• 2024 FNR rewrite. LDH repromulgated Chapter 125 in February 2024 (Louisiana Register 50:221) and amended other sections in July 2024 and March 2025. The HCBS section, §12523, dates from February 2024 (50:231) and contains the “serious, adverse consequences” standard and the six-month licensing deadline described above ⁠¹⁰.
• 2025 caregiver registry law. Act 507 of 2025 created the R.S. 40:2120.8 registry rules and removed qualifying registries from the HCBS definition ⁠²⁠⁵. As of 2026-10-12, LDH’s HCBS rulemaking page lists no rule implementing R.S. 40:2120.8 ⁠¹⁵. If you run a referral-only business, ask HSS in writing whether it treats you as a registry.
• 2026 MIHC proposal. On March 10, 2026, LDH announced a Notice of Intent to amend the monitored in-home caregiving rules in Chapter 51 and update the MIHC registered nurse and care manager requirements. As of 2026-10-12, LDH’s rulemaking page lists no final rule ⁠¹⁵. This does not change the PCA module.
• Rule text currency. LDH’s posted Chapter 50 compilation is dated March 14, 2022, and the rulemaking page lists no Chapter 50 action since then, only the 2026 Chapter 51 notice ⁠⁶⁠¹⁵. The Louisiana Register is the official record of later amendments, so check it and ask HSS whether the posted text is still current.

Sources

1. 1
   Louisiana Department of Health, Health Standards Section, Home and Community Based Service Providers (HCBS) Checked 12 Oct 2026 · Back to text ↑
2. 2
   Louisiana State Legislature, La. R.S. 40:2120.2: definitions (home- and community-based service providers) Checked 12 Oct 2026 · Back to text ↑
3. 3
   Louisiana State Legislature, La. R.S. 40:2120.3: licensure of home- and community-based service providers Checked 12 Oct 2026 · Back to text ↑
4. 4
   Louisiana State Legislature, La. R.S. 40:2120.4: rules and regulations; licensing standards; fees Checked 12 Oct 2026 · Back to text ↑
5. 5
   Louisiana State Legislature, Act No. 507 of the 2025 Regular Session (HB 541): caregiver registries Checked 12 Oct 2026 · Back to text ↑
6. 6
   Louisiana Department of Health, LAC 48:I, Chapters 50 and 51: Home and Community-Based Services Providers Minimum Licensing Standards (compilation as of March 14, 2022) Checked 12 Oct 2026 · Back to text ↑
7. 7
   Louisiana Department of Health, Health Standards Section, HCBS Initial Application Checklist Checked 12 Oct 2026 · Back to text ↑
8. 8
   Louisiana Department of Health, Health Standards Section Licensing Fees: Waiver Programs Checked 12 Oct 2026 · Back to text ↑
9. 9
   Louisiana Department of Health, Health Standards Section, Facility Need Review (FNR) Checked 12 Oct 2026 · Back to text ↑
10. 10
    Louisiana Department of Health, LAC 48:I, Chapter 125: Facility Need Review (March 2025) Checked 12 Oct 2026 · Back to text ↑
11. 11
    Louisiana Department of Health, Health Standards Section, HCBS License Renewal Checked 12 Oct 2026 · Back to text ↑
12. 12
    Louisiana Department of Health, LAC 48:I, Chapter 41: Expedited Licensing Process for Healthcare Facilities and Providers Checked 12 Oct 2026 · Back to text ↑
13. 13
    Louisiana Medicaid, PT-24 Personal Care Services provider type packet/checklist (Rev. 05/2024) Checked 12 Oct 2026 · Back to text ↑
14. 14
    Louisiana Medicaid, PT-82 Personal Care Attendant (Waiver) provider type packet/checklist (Rev. 05/2024) Checked 12 Oct 2026 · Back to text ↑
15. 15
    Louisiana Department of Health, Health Standards Section, HCBS Rulemaking Checked 12 Oct 2026 · Back to text ↑

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