Mississippi home health agency license: the CON moratorium and how agencies change hands

Why a new Mississippi agency cannot be licensed today

Two MSDH offices handle home health in Mississippi. The Division of Health Facilities Licensure and Certification issues the license and also certifies agencies for Medicare and Medicaid.⁠⁶ Health Planning and Resource Development runs the certificate of need (CON) program.⁠³ The licensing rule makes the CON the gate: every initial and renewal application must include “Evidence of Certificate of Need”.⁠¹ The State Health Plan says it directly: “The development or otherwise establishment of a home health agency requires CON.”⁠²

No new CONs are being issued. The CON Review Manual says MSDH is prohibited from issuing a CON to anyone proposing “the establishment or expansion of the currently approved territory” of a home health agency. The ban also covers contracting to set up a home office, sub-unit or branch inside a hospital, nursing home or other health care facility.⁠³ Effective April 17, 2026, the Legislature reaffirmed that keeping the moratorium “remains in the public interest.” Its findings were that licensed agencies already serve every region of the state, that no statewide shortage has been demonstrated, and that more providers in “utilization-driven reimbursement systems” may increase Medicaid spending.⁠²

The moratorium limits territory as well as the number of agencies. Your service area is the list of Mississippi counties printed on your license. To serve a county outside that list, the rule requires a CON and a separately licensed sub-unit.⁠¹ Because those CONs are also covered by the moratorium, an existing agency cannot simply apply to grow into new counties either.⁠³

Operating without a license is a misdemeanor. The fine is up to $500 per offense, and each day counts as a separate offense. MSDH may also seek an injunction after consulting the Attorney General.⁠¹

The CON moratorium and the license rule are separate. Chapter 46 still contains full operating standards, summarized below. They apply to every agency you might buy and to any new agency if the Legislature ever lifts the moratorium.

What counts as a home health agency in Mississippi

Chapter 46 defines a home health agency as an organization “primarily engaged” in providing care in the patient’s residence at the written direction of a physician, podiatrist, nurse practitioner, physician assistant or clinical nurse specialist. The care must include skilled nursing by or under the supervision of a Mississippi-licensed RN, plus at least one part-time or intermittent service from this list:⁠¹

• physical, occupational or speech therapy
• medical social services
• home health aide services
• other services the licensing agency approves
• medical supplies (other than drugs and biologicals) and medical appliances
• services of a medical resident in a hospital teaching program
• drugs and biologicals, as allowed by a Board of Pharmacy home health permit

Every agency must provide skilled nursing plus at least one other home health service. Agency staff must provide the skilled nursing directly. Other services can be bought under contract.⁠¹ “Part-time or intermittent” means visits anywhere from once every 60 days to a few hours a day several times a week. The rule says this “does not mean eight (8) hour shifts in the home.”⁠¹ A patient’s residence does not include a hospital, nursing home or other extended care facility. The one exception is outpatient therapy in a nursing home.⁠¹

The license states one of four classifications: private non-profit, proprietary, hospital-based or governmental. A hospital-based agency must be “a clearly definable separate department of a hospital.”⁠¹

Several other care businesses look similar but fall under different rules:

• Non-medical home care. The Health Facilities Licensure division’s list of licensed facility types includes home health agencies but no companion or personal-care-only agency category.⁠⁶ Chapter 46 itself applies only to agencies providing skilled nursing plus another home health service.⁠¹
• Residential care. If you want to house residents rather than visit them at home, look at the personal care home and assisted living license or the adult foster care facility license.

The routes that remain open

Scroll the table sideways to see every column.

Buying an agency: change of ownership

Under the license rule, a change of ownership is any transaction in which a person or entity acquires 50% or more of the agency. That includes gifts, purchases, leases and stock transactions. Converting from a partnership, sole proprietorship or corporation to another form of ownership also counts, and so does a change in IRS tax-exempt status. Inherited interests do not count.⁠¹ MSDH’s ownership regulation, printed with Form 802E, adds more examples. Adding, removing or substituting a partner creates a new partnership. A management agreement counts as a change when it “conveys a large measure of control.” A lease counts when the lessee operates without substantial control from the lessor.⁠⁴

Here is the order of filings:

1. Notice of intent to Health Planning

   File Form 802E with Health Planning and Resource Development at least 30 days before the proposed change, together with the $2,500 processing fee. Include the executed sales contract or lease and a certification signed by both purchaser and seller in front of a notary. Mail or hand-deliver the original to 143-B LeFleur’s Square, Jackson, MS 39211, and email a full copy to [email protected]. The form is posted on MSDH’s CON forms page.⁠⁴⁠³⁠¹⁰ Timing matters. Under the CON Review Manual, a change of ownership needs full CON review if the notice of intent is not filed at least 15 calendar days before the change.⁠³

2. New license application

   The license cannot be transferred. File a new application at least 30 days before the effective date of a change of ownership, name, location or services.⁠¹

3. Disclosure

   An initial application must list all stockholders, partners or owners; every officer and governing body member; and the people directly responsible for operations. It must also include “proof of financial ability for continuous operation” and an in-state agent for service of process if the owner lives outside Mississippi.⁠⁴

4. Closing

   Notify the licensing division in writing within 24 hours after the change, surrender the old license, and wait for the new one.⁠⁴

Before you sign, check the seller’s county list and whether the agency is Medicare-certified. You inherit the counties printed on the license and cannot add others.⁠¹ Federal rules can also block the Medicare side of the deal. Under the nationwide moratorium, an agency that goes through a non-exempt change in majority ownership within 36 months of its initial Medicare enrollment must re-enroll as new, and CMS will not enroll it while the moratorium is in effect.⁠⁸

Taking over counties from another agency

Despite the moratorium, MSDH may license an existing agency for a county transferred to it from another existing agency.⁠³ The fee is 0.25% of the capital expenditure stated in the notice, but never less than $2,500 or more than $12,500. File the form 30 calendar days before the transition. During that period the State Health Officer makes the final decision.⁠³ Form 829E asks for buyer and seller details, the counties being transferred, the purchase or lease cost and fair market value, and the executed agreement. Purchaser and seller both sign a notarized certification.⁠⁵ If MSDH denies the transfer, it follows the same procedure it uses to deny a six-month CON extension request.⁠³

If the moratorium is ever lifted

The State Health Plan sets out the review standards MSDH would use if the Legislature lifted the moratorium entirely or in part. Need is decided county by county. A county shows a possible need only if its home health visits per 1,000 residents aged 65 and over fall below the average for a ten-state region: Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina and Tennessee. County visits are now estimated from CMS fee-for-service Medicare data.⁠² Each county you propose must then show unmet need of at least 50 home health patients. All of these applications go through substantive review.⁠²

For each county, the application would need:⁠²

• letters of intent from physicians who would use the agency
• the types and monthly numbers of cases those physicians expect to refer in year one
• the physicians’ referrals to existing agencies over the past 12 months
• evidence that patients or providers tried and failed to get services
• projected operating statements for three years, with cost per licensed unit, per visit by category and per patient

The home office of a new agency must be located in one of its approved counties.⁠² For scale, MSDH’s latest home health report (2016) counted 56,051 patients and 2,024,397 visits, an average of 34 visits per patient.⁠²

Who you must hire

Chapter 46 sets qualifications for the two key positions. Both apply to any agency you buy, so check the seller’s staff against them.

Supervisory load is tied to census. The supervising nurse may also serve as administrator until the agency reaches 25 patients and may carry scheduled patient visits until it reaches 50. Above 50 patients, the supervising nurse does supervision full-time.⁠¹ Every branch office needs at least one full-time RN.⁠¹

Requirements for other staff:

• Background checks. Before a new direct-care employee’s first day, you must have on file the employee’s disciplinary status from any professional licensing board and proof that fingerprints were submitted. The person may work temporarily while results are pending, but the offer is voidable if the check finds a disqualifying record. Disqualifying felonies include drug possession or sale, murder, manslaughter, armed robbery, rape, sexual battery, child abuse, arson, grand larceny, burglary, aggravated assault and felonious abuse of a vulnerable adult. MSDH may charge up to $50 per fingerprint submission. Within two weeks of a clear result, you give the employee a notarized suitability letter, which other MSDH-licensed employers can rely on for two years.⁠¹
• Health screening. Every employee who has patient contact needs a screening by a physician, nurse practitioner or physician assistant before hire and every year after. Follow CDC or MSDH guidance on TB testing.⁠¹
• Home health aides. Aides need prior nurse’s aide or home health aide experience, or completion of a training program. An agency’s own program must be approved by MSDH, and outside programs must meet Medicare’s duration and subject requirements. Training must cover nine listed topics, including personal care, nutrition and special diets, aging, and what to report. An RN teaches the personal care portion. Aides must finish basic training before working in a home.⁠¹
• Continuing education. Full-time and part-time nurses and aides need at least 12 hours a year.⁠¹
• Insurance. Liability coverage is “strongly recommended,” not required.⁠¹

The office, plans and paperwork MSDH inspects

MSDH does not license a new agency until it has inspected it for compliance.⁠¹ Chapter 46 allows a provisional license before opening, once the agency meets minimum staffing. That license lasts until a regular license is issued or until June 30, whichever comes first.⁠¹

Before inspection, have the following ready:

• Office. It must be sized for your staff and patient volume, lit, heated and cooled, with storage for administrative records, clinical records and medical supplies, and with toilet rooms. The phone must be listed under the agency’s licensed name, which is also the only name you may use in advertising.⁠¹
• Emergency Operations Plan. Use the MSDH Office of Emergency Planning and Response template. The plan must cover nine areas, including at least two fire drills a year and continuity of operations. Exercise and review it every year. Evidence of OEPR review must be attached to every renewal application.⁠¹
• Medical waste management plan. It must follow MSDH’s adopted medical waste standards.⁠¹
• Governing body bylaws. These cover board selection, delegation, meeting frequency with minutes, personnel policies and an organizational chart.⁠¹
• Policy and procedure manual. It must cover 13 subjects, among them scope of services, admission and discharge, medication administration, after-hours on-call care, patients’ rights and handling of lab samples.⁠¹
• Annual operating budget. A budget committee with governing body and administrative members plans it and records the planning in minutes.⁠¹

Clinical rules that inspectors check include the following:

• Plans of treatment are reviewed by the care team at least every 60 days, with new orders written at the end of each 60-day period.⁠¹
• Aide services for skilled patients are evaluated at least every other week.⁠¹
• For patients who receive aide services only, an RN makes a supervisory visit at least every 60 days while the aide is giving care.⁠¹
• Clinical records are kept at least 5 years after discharge. If the agency closes, records must be stored for 7 years.⁠¹

Application contents, fees and renewal

Applications go to MSDH on its forms. Each initial and renewal application must include:⁠¹

• complete ownership information
• the counties you serve
• services you provide directly and those under arrangement
• numbers and types of personnel
• utilization statistics (renewals only)
• the licensee’s name
• evidence of CON
• locations of branches and sub-units
• the parent agency, if you are a sub-unit

You also designate in writing one person as the responsible party for dealing with MSDH.⁠¹

The license fee is “set by the Board.” It is paid by business check, money order or electronic means and is non-refundable.⁠¹ Chapter 46 states no dollar amount, and the MSDH fee schedule page was not available when checked on October 12, 2026, so no official figure is published in the sources reviewed. Ask the Division of Health Facilities Licensure and Certification at (601) 364-1100 for the initial and annual home health license fee before you budget.⁠¹⁠⁶

Every license expires on June 30 after it is issued. To renew, you file an application and fee, MSDH approves your annual report for the previous calendar year, and you include evidence of CON where applicable.⁠¹ You must also keep a daily census log of admissions and discharges.⁠¹ If MSDH plans to deny, suspend or revoke a license, it must give at least 30 days’ notice and a hearing. You can appeal its decision to chancery court within 30 days.⁠¹

Medicare and Medicaid

In Mississippi, Medicaid payment depends on Medicare. Title 23, Part 215 requires a home health agency to be “certified to participate as a home health agency under Medicare.” Medicaid covers up to 36 home health visits per state fiscal year, under a plan of care reviewed every 60 days.⁠⁷ Medicaid enrollment follows Part 200, Chapter 4. Part 215’s enrollment rule was revised effective August 1, 2026.⁠⁷

The federal side is also closed to new agencies at the moment. Effective May 13, 2026, CMS imposed a six-month nationwide moratorium on Medicare enrollment of new home health agencies, branches and practice locations. Applications that a Medicare contractor received before that date are still processed.⁠⁸ CMS’s survey memo adds three rules:⁠⁹

• Initial applications filed during the moratorium are denied.
• No individual exceptions are allowed.
• Accreditation will not give a new agency deemed status while the moratorium lasts.

A Federal Register search on October 12, 2026 found no extension notice, so the first six-month period runs to about mid-November 2026.⁠⁸ If you are buying an agency, the 36-month re-enrollment rule described in the change-of-ownership section above applies to its Medicare enrollment.⁠⁸

Other care licenses in Mississippi

MSDH also licenses child care. If you are weighing other care businesses in Mississippi, see the child care facility license for 6 or more children and the child care family home license for 5 or fewer.

Sources

1. 1
   Mississippi State Department of Health, 15 Miss. Admin. Code Pt. 16, Subpt. 1, Ch. 46: Minimum Standards of Operation for Home Health Agencies (January 2023) Checked 12 Oct 2026 · Back to text ↑
2. 2
   Mississippi State Department of Health, Office of Health Policy and Planning, Mississippi State Health Plan, Chapter 7: Home Health Care and CON criteria (sections 702-703) Checked 12 Oct 2026 · Back to text ↑
3. 3
   Mississippi State Department of Health, Mississippi Certificate of Need Review Manual (2023) Checked 12 Oct 2026 · Back to text ↑
4. 4
   Mississippi State Department of Health, Health Planning and Resource Development, Change of Ownership, Form No. 802E (revised 11/11/2023) Checked 12 Oct 2026 · Back to text ↑
5. 5
   Mississippi State Department of Health, Health Planning and Resource Development, Transfer County of a Home Health Agency, Form No. 829E (revised 11/11/2023) Checked 12 Oct 2026 · Back to text ↑
6. 6
   Mississippi State Department of Health, About the Health Facilities Licensure Division Checked 12 Oct 2026 · Back to text ↑
7. 7
   Mississippi Division of Medicaid (Mississippi Secretary of State, Administrative Code), Miss. Admin. Code Title 23, Part 215: Home Health Services Checked 12 Oct 2026 · Back to text ↑
8. 8
   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 ↑
9. 9
   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 ↑
10. 10
    Mississippi State Department of Health, Certificate of Need forms Checked 12 Oct 2026 · Back to text ↑

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