Louisiana home health agency license: the 1995 moratorium, buying an agency and LDH rules

The licensing limit in R.S. 40:2116.32(F)

Louisiana’s home health statute has a feature most states lack: a standing legislative block on new licenses. Subsection F(1) explains that the federal government changed its survey contract with the state and effectively eliminated “all funding for initial licensure surveys.” It then provides that, except where a survey is “eligible for priority funding under federal guidelines in effect on June 1, 1995,” the LDH Secretary “shall not issue any licenses pursuant to this Part until the department finally publishes a rule” certifying to the Legislature that it has enough money to run initial surveys after completing renewals and complaint investigations.⁠¹

The statute tightens this further:

• The certification must say whether LDH can survey all pending and expected applications. If it can survey only some, LDH must publish a rule explaining how applicants will be prioritized.⁠¹
• None of these rules may be issued as emergency rules, so the certification has to go through full Administrative Procedure Act rulemaking.⁠¹
• At any time after July 1, 2008, if LDH is not conducting new licensing surveys, the House and Senate Health and Welfare committees, meeting jointly and voting by majority in each, may recommend that the governor instruct LDH to publish the rules.⁠¹

LDH’s own Home Health page links to the statute with the note “HHA Moratorium language can be found at Louisiana RS §2116.32 F. (1).”⁠⁴ We found no published certification rule, and neither the statute, the rule nor LDH’s Home Health page says whether HSS is accepting or surveying brand-new applications as of October 12, 2026. Before you sign a lease or hire anyone, ask HSS in writing whether it will accept a new application and, if so, under which exception. The Home Health program desk is listed at 225-342-6446.⁠⁴

The licensing rule still sets out an initial-application process (described below), and the statute’s application requirements remain in force.⁠¹⁠³ Read that process as what applies if LDH certifies funding or your survey qualifies for the federal-priority exception, and as the standard a buyer must meet in a change of ownership.

Is your business a home health agency?

Under R.S. 40:2116.31, a home health agency provides skilled home health care under the order of an authorized healthcare provider, in the patient’s place of residence. It must offer at least skilled nursing and one other service, such as physical therapy, speech therapy, occupational therapy, medical social services or home health aides.⁠² Act 181 of 2021 (effective June 11, 2021) widened “authorized healthcare provider” to cover nurse practitioners, clinical nurse specialists and physician assistants as well as physicians.⁠² No one may “open, conduct, manage, or maintain” such an agency without an LDH license, and LDH is the only licensing authority for home health in Louisiana.⁠¹⁠³

Louisiana licenses non-medical in-home care separately. Personal care attendant services for people with disabilities, respite and similar services fall under the Home and Community-Based Services (HCBS) provider license, and businesses that only provide sitter or housekeeping services are excluded from HCBS.⁠¹² Several HCBS modules require Facility Need Review approval first. Home health does not: it is not on the provider types LDH’s Facility Need Review page says it reviews.⁠⁷ If you plan personal care rather than skilled care, see the Louisiana HCBS provider license guide.

The rule also limits what aides do. A home health aide may not give medications, perform IV or other sterile or invasive procedures, insert feeding tubes or catheters, transport patients, do general housekeeping or shop.⁠³ If your business model depends on those tasks, it belongs under a different license.

Buying an existing agency: the change of ownership route

Because new licenses are restricted, a change of ownership (CHOW) of an agency that is already licensed is the practical way in for many founders. A CHOW does not lower the bar. LAC 48:I §9109 says “the purchaser of the agency shall meet all criteria for an initial application for licensure.”⁠³

LDH’s CHOW page asks for these items, sent to [email protected]:⁠⁶

• a letter of intent naming the old and new owners (entity and d/b/a), the effective date, the address and the phone number;
• diagrams of the ownership structure before and after the change;
• the executed transaction documents (bill of sale, lease and so on);
• the HSS change of ownership application (form dated October 2024);
• for home health, the Medicare 855A/B approval letter.

The Home Health page adds agency-specific CHOW documents:⁠⁴

• the License Application Emergency Preparedness Addendum;
• CMS-1572 (Home Health Agency Survey & Deficiencies Report);
• three originally signed CMS-1561 Health Insurance Benefit Agreements;
• qualifications for the administrator and director of nursing;
• a line of credit of at least $75,000 from a federally insured, licensed lender;
• proof of general and professional liability insurance and workers’ compensation of at least $300,000, with the Department of Health named as certificate holder;
• criminal background checks on the administrator and all owners (and, for a corporation, board members and principal owners);
• proof of citizenship for owners and administrative staff;
• the HHS Office for Civil Rights attestation confirmation;
• written disclosure of any financial or familial relationship with another Louisiana home health provider, and a list of other licensed facilities the owners hold.

LDH’s fee schedule lists a $600 CHOW fee for home health.⁠⁵ LDH’s CHOW page lists the Medicare 855A/B approval letter among the required documents for Medicare-certified home health agencies, so the federal step affects timing.⁠⁶ The page says a CHOW fee is usually the same as a renewal fee unless other changes are needed.⁠⁶ The federal moratorium matters here too. CMS says an agency that goes through a non-exempt change in majority ownership within 36 months of its initial Medicare enrollment must re-enroll as a new agency, and the moratorium bars that re-enrollment.⁠⁹ Check the target agency’s enrollment date before you negotiate.

Money, insurance and people LDH screens

The statute and LAC 48:I §9105 set the financial and personnel tests for initial applicants and CHOW buyers.

LDH-HSS must be named as certificate holder on every policy and certificate.⁠³ You must also submit background checks on owners and administrative staff (and on all directors and officers of a corporation), proof of citizenship or a green card for all of them, and written disclosure of any financial or family tie to another Louisiana home health agency.⁠³ An owner, administrator, officer, director or clinical manager with a felony conviction or guilty or no-contest plea can trigger a provisional license instead of a full one.⁠³

Two practical constraints catch applicants:

• Your résumés are final. After you submit the administrator and clinical manager résumés, you may not add information unless the person changes or HSS approves.⁠³ Submit complete documentation the first time.
• Your name must be distinct. Your d/b/a may not be the same as, or similar to, another licensed agency’s name registered with the Secretary of State.⁠³

Administrator, clinical manager and aides

An administrator who runs more than one agency must name an alternate who works full-time on site at each agency and is qualified as an administrator.⁠³ The administrator and clinical manager may be the same person if that person holds both sets of qualifications.⁠³ The agency must also designate in writing an RN to act for the clinical manager during absences.⁠³

Aide supervision follows set intervals. An RN or therapist must visit every two weeks (no more than 14 days apart) when the patient receives skilled services. When the patient does not, an RN must visit at least every 60 days, while the aide is giving care.⁠³ Each aide must receive at least 12 hours of in-service training every calendar year.⁠³ You must check both the Direct Service Worker Registry and the Louisiana Certified Nurse Aide Registry when you hire, and every six months after that. Anyone with a finding of abuse, neglect or misappropriation may not be employed.⁠³

How the office must operate

Chapter 91 sets operating rules that a surveyor will check from day one:⁠³

• Posted business hours, with the office fully operational at least eight hours a day, five days a week, between 7 a.m. and 6 p.m.
• Patient care available 24 hours a day, seven days a week, and an RN reachable by phone at all times.
• At least two patients at all times. An agency that is not open on the days and hours it declared is “non-operational,” and its license becomes void.
• A geographic service area no larger than a 50-mile radius around the parent office.
• An emergency preparedness plan that follows the Louisiana Model Home Health Emergency Preparedness Plan, activated at least once a year by a real event or a drill.
• A start-of-care visit available within 24 hours of referral. The RN or therapist must complete the initial plan of care within seven days of the start of care, and the practitioner must review the plan at least every two months.
• A quarterly quality assessment and performance improvement (QAPI) program reported to the governing body. This was added in the July 2022 rewrite.
• Written policies covering staff responsibilities, operations, patient care, complaints and compliance, reviewed every year.

Steps if LDH accepts an initial application

If HSS confirms it will take a new application, LAC 48:I §9105 and R.S. 40:2116.32 set this order:⁠¹⁠³

1. Submit the application with the fee

   File the home health license application with the non-refundable fee by corporate check, certified check or money order (or another method LDH sets). LDH will not review an application until the fee arrives.

2. Complete the file within 90 days

   Every application requirement (credit line, insurance, résumés, background checks, disclosures) must be finished within 90 days of your first submission, or the application is closed.

3. Receive written approval

   HSS notifies you in writing when it approves the application, with instructions for requesting the initial survey.

4. Become operational within 90 days

   Once approved, you have 90 days to be fully operational and ready for survey. The statute counts 90 days from payment of the fee. If you miss the deadline, the application closes and you may not apply again for one year.

5. Pass the unannounced initial survey

   At the survey, you must comply with all standards and be caring for two patients. You get “only one opportunity.” If you are not in substantial compliance, you must transfer your patients and close.

6. Display the license

   A full license runs for one year. Post it in a conspicuous place.

LDH’s Home Health page also links the 2018 Expedited Licensing Process rule (LAC 48:I Chapter 41), which applies to providers that LDH licenses.⁠⁴ It does not override the statutory limit in subsection F.

Fees as published

All fees are non-refundable.⁠³⁠⁴

Medicare and Medicaid

Most home health revenue in Louisiana depends on federal enrollment, and LDH ties the state’s Medicaid benefit to Medicare. Chapter 23 of the Louisiana Medicaid provider manual (section 23.4, issued July 1, 2025) says the agency “must be Medicare-certified for Medicare/Medicaid by the Licensing and Certification Unit” of HSS.⁠⁸ Medicaid home health agencies must also use LDH’s electronic visit verification (EVV) system, or an approved alternate, and Medicaid can withhold or deny payment from agencies that do not. The practitioner must reauthorize each Medicaid plan of care every 60 days.⁠⁸ Medicare certification itself is governed by the federal Conditions of Participation in 42 CFR Part 484.⁠¹³

The federal door is closed to new agencies for now. Effective May 13, 2026, CMS imposed a nationwide six-month moratorium on Medicare enrollment of new home health agencies, branches and practice locations. The only exception is applications the Medicare contractor received before that date.⁠⁹ CMS also says that during the moratorium, accreditation will not give a new agency deemed status for Medicare participation.⁠¹⁰ CMS can extend the moratorium in six-month blocks and says it will announce any extension or lifting publicly.⁠⁹⁠¹⁰ The first period ends on or about November 13, 2026; no extension or lifting notice had been published as of October 12, 2026, so ask your Medicare contractor where things stand before you plan around it. Because the Medicaid manual requires Medicare certification, a new agency that cannot enroll in Medicare cannot meet that requirement while the moratorium lasts.⁠⁸⁠⁹

Branches, relocation, changes and renewal

• Branches. A branch needs written LDH approval, and the parent agency must have held a full license for at least one year first. The branch must sit within 50 miles of the parent, serve part of the parent’s area and offer all of the parent’s services.⁠³ You must also file the CMS 855A for the branch with the fiscal intermediary.⁠⁴ The federal moratorium covers new branches too.⁠⁹
• Relocation. An agency licensed after August 15, 1995 may relocate only within 50 miles of the place where it was first licensed.⁠³⁠⁴
• Notices. Tell HSS in writing at least five days in advance about changes in address, name, phone, hours, 24-hour contact procedures, administrator or clinical manager, controlling ownership, or a closure.⁠³
• Renewal. File the renewal application and fee at least 30 days before the license expires.⁠³ LDH renews only agencies in substantial compliance.⁠¹ After any survey that finds deficiencies, LDH must receive your plan of correction within 10 days.⁠³ An agency with more than five violations or more than three valid complaints in a year can be put on a six-month provisional license, among other grounds.⁠¹⁠³
• Closing. Give patients, their practitioners and HSS 30 days’ written notice, and get LDH approval for a records-custody plan.⁠³

Recent and pending changes

• 2021: Act 181 (effective June 11, 2021) allowed nurse practitioners, clinical nurse specialists and physician assistants to order home health services, and directed LDH to rewrite the minimum standards.⁠²⁠¹¹
• July 2022: LDH’s rewrite of Chapter 91 (LR 48:1827 and following) broadened administrator qualifications, updated definitions and patient-rights rules, and added the quarterly QAPI requirement.⁠³⁠¹¹
• May 13, 2026: CMS’s nationwide moratorium on Medicare enrollment of new home health agencies took effect, for an initial six months.⁠⁹⁠¹⁰
• Pending: any LDH certification rule under R.S. 40:2116.32(F)(1) that would reopen initial licensing. None was found as of October 12, 2026.⁠¹

For other care licenses in this state, see the guides to adult day health care, adult residential care and early learning centers, or the Louisiana state page.

Sources

1. 1
   Louisiana State Legislature, La. R.S. 40:2116.32: Licensing of home health agencies; applications; fees Checked 12 Oct 2026 · Back to text ↑
2. 2
   Louisiana State Legislature, La. R.S. 40:2116.31: Scope; purpose; definitions (Home Health Care Providers) Checked 12 Oct 2026 · Back to text ↑
3. 3
   Louisiana Department of Health, LAC 48:I, Chapter 91: Minimum Standards for Home Health Agencies (October 2022 edition) Checked 12 Oct 2026 · Back to text ↑
4. 4
   Louisiana Department of Health, Health Standards Section: Home Health Checked 12 Oct 2026 · Back to text ↑
5. 5
   Louisiana Department of Health, HSS Fee Schedule Checked 12 Oct 2026 · Back to text ↑
6. 6
   Louisiana Department of Health, HSS Change of Ownership Checked 12 Oct 2026 · Back to text ↑
7. 7
   Louisiana Department of Health, Health Standards Section: Facility Need Review Checked 12 Oct 2026 · Back to text ↑
8. 8
   Louisiana Department of Health, Louisiana Medicaid, Louisiana Medicaid Program Provider Manual, Chapter 23: Home Health Checked 12 Oct 2026 · Back to text ↑
9. 9
   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 ↑
10. 10
    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 ↑
11. 11
    Louisiana Department of Health, Bureau of Health Services Financing, Notice of Intent: Home Health Agencies Licensing Standards (Louisiana Register, April 2022) Checked 12 Oct 2026 · Back to text ↑
12. 12
    Louisiana State Legislature, La. R.S. 40:2120.2: Definitions (Home- and community-based service providers) Checked 12 Oct 2026 · Back to text ↑
13. 13
    Electronic Code of Federal Regulations, 42 CFR Part 484: Home Health Services (Medicare Conditions of Participation) Checked 12 Oct 2026 · Back to text ↑

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