Maine home health care services license: DLC rules, fees and the Medicare question

One license, two names: HHA or Home Health Care Services

Maine does not split home health into skilled and non-skilled licenses. Under 22 M.R.S. §2143, no home health care provider may provide home health services without a written license from DHHS. That rule has applied since July 1, 1984.⁠¹ What changes is what DLC calls you afterward. The Medical Facilities Unit page says every agency must be state-licensed, but certification is optional. “Home Health Agencies are both licensed by the state and federally certified. Home Health Care Services are only licensed by the state.”⁠³

The two groups use different paperwork:

• Certified, or planning to certify. Use the paper Form 090102, Application for Home Health Care Services Agency.⁠³⁠⁴
• State-licensed only, with no plan to certify. Use the online Home Health Service Provider Application in the state’s Regulatory Licensing and Permitting portal. Renewals, status checks, change notices and license copies are handled there too.⁠³⁠⁷ The waiver request form for this group is a separate PDF.⁠³

Choose your route before you file, because it affects which revenue you can reach (see the Medicare and MaineCare section below). A Medicare-certified agency that meets all federal certification requirements is “deemed” to meet state licensure requirements under Ch. 119.⁠² DLC also runs the Medicare certification surveys for CMS under the Section 1864 agreement, so the same unit handles both steps.⁠³

Does your business need this license?

The statutory definition is broad. A “home health care provider” is any business, public or private, for-profit or not, that provides “acute, restorative, rehabilitative, maintenance, preventive or health promotion services” through nursing or another therapeutic service. The examples listed include physical therapy, home health aides, nurse assistants, medical social work, nutritionist services and personal care services, provided “either directly or through contractual agreement, in a client’s place of residence.” Speech pathology has been included since October 1, 1991.⁠¹

The definition does not cover a sole practitioner providing private duty nursing or other in-home services. It also does not cover municipal health promotion, or federally qualified health centers and rural health clinics doing case management or health education in the home.⁠¹ Section 2147 adds a list of exclusions:⁠¹

• Hospices staffed substantially by volunteers
• Family, friends and neighbors
• Sole practitioners otherwise licensed by the state, services provided directly by physicians, and services provided directly by certified nurse practitioners
• Elderly nutrition programs and chore services
• Pharmacies and medical supply companies that furnish only supplies
• Anyone “contracting or arranging” for services delivered by licensed or excluded home health providers
• Hospitals, nursing facilities and other chapter 405 facilities serving their own residents, or serving 6 or fewer clients at a time at home under a department-approved plan of care when the local licensed agencies cannot serve them or agree to the plan
• Licensed residential care facilities serving their own residents
• Registered nurse educators, and community paramedicine services delivering episodic care

The contracting exclusion is narrower in practice than it sounds. Ch. 119 exempts only agencies “whose employees do not directly provide home health care services” in the home.⁠² If your own staff make visits, you need the license.

Unlicensed operation is a civil violation with a $100 forfeiture, and each day counts as a separate violation (22 M.R.S. §2150).⁠¹

Licenses founders confuse with this one

• Personal care agency (PCA). A PCA employs direct care workers who help with daily living and household tasks. Its license comes under 10-144 C.M.R. Ch. 129. The statute says a PCA “does not include a home health care provider licensed under chapter 419.”⁠⁹ A PCA “may not advertise that they are a home health agency” or offer health services that require a licensed medical professional. Its initial fee is $500.⁠¹⁰ If you want to provide non-medical care without RN-delegated aide services, see the Maine personal care agency guide.
• Home and Community Support Services agency. This DLC license, under 10-144 C.M.R. Ch. 108 (effective December 3, 2025), covers agencies serving adults with intellectual disabilities, autism spectrum disorder, a related condition or acquired brain injury.⁠¹¹
• Facility-based care. Residential care facilities serving their own residents are excluded from ch. 419.⁠¹ If you plan to house clients, the relevant licenses are the residential care facility and assisted living facility licenses.

There is no certificate of need. Maine’s CON definition of “health care facility” lists hospitals, psychiatric hospitals, nursing facilities, kidney disease treatment centers, rehabilitation facilities, ambulatory surgical facilities and certain imaging, cardiac and cancer centers. Home health agencies are not on the list.⁠⁸

Medicare and MaineCare: decide this first

Rule Ch. 119 lets you open as a state-licensed-only agency, and the license is not frozen. The payer rules limit what that agency can bill.

MaineCare requires Medicare certification. Under MaineCare Benefits Manual Chapter II, Section 40, a home health agency must hold a Ch. 119 license to be reimbursed. It must also “have in effect a current Medicare certification to participate” under 42 CFR Part 484. Section 40 defines a Home Health Agency as an organization “certified under Title XVIII of the Social Security Act.”⁠¹² A state-licensed-only agency therefore cannot bill MaineCare’s home health benefit. Since January 1, 2023, every provider of Section 40 services has also had to use Maine DHHS Electronic Visit Verification.⁠¹²

Medicare enrollment is frozen. Effective May 13, 2026, CMS stopped enrolling new home health agencies, branches and practice locations in Medicare nationwide. Only applications that a Medicare contractor received before that date go forward.⁠¹³ CMS’s survey memo to state agencies adds the following:⁠¹⁴

• Initial enrollment applications filed during the moratorium are denied and must be filed again after it ends.
• Accreditation from a CMS-approved organization will not produce deemed status for a new agency while the moratorium lasts.

The moratorium runs six months and can be extended in six-month steps. CMS also left it to each state to decide whether to impose a Medicaid home health moratorium.⁠¹³ A Federal Register search on October 12, 2026 found no extension notice after the May 15 announcement, so the first period ends around mid-November 2026. Check again before you set an opening date.

Buying a recently enrolled agency does not get around the freeze. An agency that goes through a non-exempt change in majority ownership within 36 months of its initial Medicare enrollment must enroll as new, and the moratorium blocks that enrollment.⁠¹³

In practice, a Maine agency licensed during the moratorium can serve private-pay and other non-Medicare clients. Medicare and MaineCare Section 40 revenue has to wait until CMS lifts the freeze and the agency is certified. The sources reviewed do not show whether MaineCare enrolls state-licensed-only agencies under a different benefit section; ask MaineCare provider enrollment which section covers the services you plan to bill before you rely on any Medicaid revenue.

Where the agency must be and who must run it

Location. “All licensed providers of home health care services must be located in the State of Maine, with a commercial address.” Services must be delivered in Maine. The only exceptions are licensed providers on the Maine/New Hampshire and Maine/Canada borders.⁠² A home office in another state does not qualify.

Branches and subunits. A branch shares administration and supervision with the parent office and is covered by the parent’s license. A subunit serves a separate area that the parent cannot manage day to day, and it needs its own license.⁠² Form 090102 asks you to list the counties you serve and every location, marked as a branch or a drop site.⁠⁴

Administrator. The administrator must be a licensed physician, a registered nurse, or someone with training and experience in health services administration. Any of them needs at least one year of supervisory or administrative experience in home health care or a related health program.⁠²

Director of Nurses. This must be a registered nurse licensed in Maine, with one year of clinical experience and at least two years of supervisory or administrative experience in home health care.⁠² This is often the hardest position to fill for a new agency, and DLC needs the name on the application.⁠²

Suitability. DLC judges whether the applicant is suitable to run an agency. It looks at your record of lawful conduct (including criminal convictions) and your financial ability, such as tax withholding history, credit rating and ability to finance working capital. It also weighs management experience, health care experience and your record on client rights.⁠²

Physician owners. DLC checks whether ordering physicians have a financial interest in the agency, and you must submit a list of any who do. A physician with a significant ownership or financial interest may not set or review a plan of care or certify the need for services.⁠²

Staffing, supervision and training rules

Ch. 119 sets the clinical staffing rules:⁠²

• Staff RNs need one year of home health clinical experience, or one year of nursing within the past three years. LPNs have a parallel one-year requirement and work under RN direction.
• Aides must be CNAs or home health aides listed on the Maine Registry of Certified Nursing Assistants. You must confirm the registry listing before hiring.
• Aide training. Aides need on-the-job instruction plus at least 12 hours of in-service training a year (prorated in the first year). Their orientation must be taught by an RN.
• RN coverage. You need at least one RN available for every 25 full-time-equivalent aides or CNAs. The RN must be on duty or on call whenever aides are in clients’ homes.
• Aide supervision. The RN must make a supervisory visit to the client’s residence at least every 30 days, and alternate visits may be by telephone. Where the client receives therapy but not skilled nursing, the therapist may supervise the aide. Rule 7.D.4 is internally inconsistent: one sentence says aides are supervised “not less than once every fourteen (24) calendar days,” while the next sets the 30-day residence visit. The published text does not say which governs, so ask DLC which interval it cites in surveys, and plan on the shorter one.
• Therapists and social workers must hold current Maine licenses. Contracted services need a written agreement that applies Ch. 119 standards to the contractor’s staff.

Background checks. The statute requires a comprehensive background check for direct access personnel under 22 M.R.S. §1717, subject to the employment bars in §1812-G.⁠¹ The rule bars hiring anyone listed on the CNA registry for abuse, neglect or misappropriation, and anyone convicted of such a crime in a health care setting. It also bars anyone with a conviction in the past 10 years for a crime punishable by three or more years.⁠² You must also have written policies prohibiting abuse, neglect and misappropriation of client property.⁠¹

Policies DLC expects to see

Ch. 119 requires a written policy and procedure manual with patient care protocols. It also requires the following:⁠²

• A statement of goals and services
• An organizational chart showing lines of authority down to client care, including subunits
• Job descriptions for the administrator and every position
• A staff orientation program, including your abuse-reporting protocol
• Bylaws, if you have a governing or advisory board

The clinical rules you will be surveyed against include these:⁠²

• Respond to every referral within 24 hours.
• Start each plan of care within three business days of admission. The plan is written by the RN (or the therapist, for therapy-only clients) after a home visit.
• Get verbal physician orders signed within 30 days.
• Give written notice of discharge or transfer at least 14 days ahead, with appeal rights.
• Before care begins, give clients a written statement of their rights, the Long Term Care Ombudsman number, and the toll-free home health hotline.
• Run a quality assurance program with a clinical record review at least quarterly and an agency-wide review at least annually.
• Keep business records, contracts and advertisements for five years. Keep clinical records for at least five years.
• Have direct-care staff wear ID badges showing the agency name, first name, credential initials and job title.

DLC’s Home Health and Hospice Hotline is 1-800-621-8222.⁠¹⁵ If you offer community support services, mental health agency licensing standards apply as a condition of full licensure.⁠²

Filing order

1. Pick your model and counties

   Decide whether you will seek Medicare certification, because that decides whether you file Form 090102 or the online application.⁠³ Also decide which counties you will serve, because the application asks for them.⁠⁴

2. Secure a Maine commercial address

   You need the address and a lease (if leased) before you file. Leased space requires a copy of the lease showing who maintains the property.⁠²

3. Get a municipal letter

   A local official must confirm you comply with zoning and building codes, plus a certificate of occupancy where appropriate. There is no state fire-safety inspection for this license.⁠²⁠⁴ If applicable, also get a CLIA number and a Department of Environmental Protection number.⁠²

4. Hire your administrator and Director of Nurses

   Both names go on the application.⁠²

5. Request the preliminary conference

   Book it with DLC at least 45 days before the initial survey.⁠²

6. File the application

   First-time applicants must include a financial feasibility plan with a two-year projection of operating and non-operating expenses and evidence of financing, and a marketing plan covering the market area, size, growth, potential clients and competitors.⁠⁴ Corporate applications must be signed by two officers or the administrator.⁠² Paper filings are paid by check or money order to “Treasurer, State of Maine”; credit cards are not accepted.⁠⁴

7. Receive a provisional license and survey visit

   A new agency gets a provisional license for 3 to 12 months. DLC makes a site monitoring visit to confirm you can meet the rules that apply only once you have clients.⁠¹⁠²

8. Correct deficiencies

   DLC sends any statement of deficiencies within 15 days of the inspection. Your plan of correction is due within 10 working days.⁠²

9. Get the full license

   By statute it may not run longer than 24 months.⁠¹ Post it where the business is run.⁠²

DLC’s Medical Facilities - Acute Care program is at 41 Anthony Avenue, 11 State House Station, Augusta, ME 04333-0011. Phone (207) 287-9300, toll-free 1-800-791-4080, email [email protected].⁠⁴

Fees as published

The June 13, 2024 memo moved renewal licenses from one year to two years, effective July 1, 2024, and set the fee at $600 for the two-year period. The earlier fee was $300 a year.⁠⁵ Rule Ch. 119 was last amended in January 2005 and has not caught up: it still calls for “an annual fee of $300.00” and 12-month full licenses.⁠² The rule’s full license is 12 months and the statute allows up to 24 months (22 M.R.S. §2144(3))⁠¹⁠², and the sources reviewed do not state how long the first full license after a provisional period runs or what fees the online state-only application charges. Ask DLC both questions before you file.

Renewal, changes and sale

• Renewal reminders. DLC stopped sending renewal postcards and reminder calls in 2020, so track your own expiration date.⁠⁶
• Renewal window. File at least 20 days before expiration. Filing later can be cited and require a plan of correction. DLC will not renew more than 30 days early.⁠⁶
• Changes. Report changes in writing, including ownership, services, address, administrator, branches or subunits, and deeming status.⁠² State-only agencies file changes through the online portal.⁠³⁠⁷
• Sale or change of control. A license cannot be transferred, and it “shall be immediately void if ownership or control of the provider changes.”⁠¹ Give DLC at least 30 days’ written notice before a transfer. The new owner must apply and pay the fee, and may get a provisional license.⁠² Form 090102 includes a notice that a buyer can become liable for the seller’s debts to DHHS.⁠⁴
• Survey frequency. DLC surveys at least every two years, but skips the state survey in any year with a Medicare certification survey. Surveys become annual after a change of ownership, a complaint survey with deficiencies, a conditional license, or a failed Medicare Condition of Participation in the past 24 months. Surveys may be unannounced, and complaint investigations always are.⁠²

Changes in 2024-2026

• July 1, 2024: Renewal licenses moved to a two-year term at $600.⁠⁵
• 2025: PL 2025, c. 567 created 22 M.R.S. §2145-A. A home health provider that is both licensed and Medicare-certified may now serve a Maine resident for up to 90 days on orders from a physician licensed in another state. The physician must have examined the patient in person, and the agency must verify and keep proof of the physician’s license.⁠¹ State-licensed-only agencies cannot use this provision.
• December 3, 2025: Ch. 108 took effect for Home and Community Support Services agencies, a separate license.⁠¹¹
• May 13, 2026: CMS’s nationwide Medicare enrollment moratorium for new home health agencies began.⁠¹³

Sources

1. 1
   Maine Legislature, Office of the Revisor of Statutes, 22 M.R.S. ch. 419, Home Health Services Checked 12 Oct 2026 · Back to text ↑
2. 2
   Maine Department of Health and Human Services, 10-144 C.M.R. Ch. 119, Regulations Governing the Licensing and Functioning of Home Health Care Services Checked 12 Oct 2026 · Back to text ↑
3. 3
   Maine DHHS, Division of Licensing and Certification, Medical Facilities: Home Health Agencies/Home Health Care Services Checked 12 Oct 2026 · Back to text ↑
4. 4
   Maine DHHS, Division of Licensing and Certification, Application for Home Health Care Services Agency, Form 090102 (rev. 6/2024) Checked 12 Oct 2026 · Back to text ↑
5. 5
   Maine DHHS, Division of Licensing and Certification, Memo: Two-year license period for home health providers (June 13, 2024) Checked 12 Oct 2026 · Back to text ↑
6. 6
   Maine DHHS, Division of Licensing and Certification, Memo: Change in reminder process for license renewals (January 28, 2021) Checked 12 Oct 2026 · Back to text ↑
7. 7
   State of Maine, Regulatory Licensing and Permitting, Medical Facilities Program online licensing (Home Health Care Services Agency) Checked 12 Oct 2026 · Back to text ↑
8. 8
   Maine Legislature, Office of the Revisor of Statutes, 22 M.R.S. §328, Certificate of need definitions Checked 12 Oct 2026 · Back to text ↑
9. 9
   Maine Legislature, Office of the Revisor of Statutes, 22 M.R.S. §1717, Regulation of personal care agencies Checked 12 Oct 2026 · Back to text ↑
10. 10
    Maine Department of Health and Human Services, 10-144 C.M.R. Ch. 129, Personal Care Agency Licensing Rule (adopted August 20, 2024) Checked 12 Oct 2026 · Back to text ↑
11. 11
    Maine DHHS, Division of Licensing and Certification, Home and Community Support Services Program Checked 12 Oct 2026 · Back to text ↑
12. 12
    Maine Department of Health and Human Services, MaineCare Benefits Manual, Chapter II, Section 40, Home Health Services Checked 12 Oct 2026 · Back to text ↑
13. 13
    Federal Register (Centers for Medicare & Medicaid Services), Announcement of Nationwide Temporary Moratoria on Enrollment of Home Health Agencies (HHAs) Checked 12 Oct 2026 · Back to text ↑
14. 14
    Centers for Medicare & Medicaid Services, QSO-26-11-HHA/Hospice: Nationwide moratoria on HHA and hospice enrollment Checked 12 Oct 2026 · Back to text ↑
15. 15
    Maine Department of Health and Human Services, Division of Licensing and Certification Checked 12 Oct 2026 · Back to text ↑

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