Nevada home health agency license: the agency to provide nursing in the home

Is it a home health agency or a personal care agency?

Nevada law does not use the term “home health agency.” It licenses an agency to provide nursing in the home: any person or government body that, in the home and through employees or contractors, provides “skilled nursing and assistance and training in health and housekeeping skills.”⁠¹ The administrative code calls the same business a home health agency, so you will see both names on HCQC’s pages and forms.⁠²⁠⁵ The statute lists it as a medical facility (NRS 449.0151). That puts it in the same licensing system as hospitals and hospices, not with the residential homes.⁠¹

Two kinds of providers are excluded from the definition while they deliver their own services: providers of community-based living arrangement services and providers of supported living arrangement services.⁠¹

If your caregivers only help with bathing, dressing, meals and similar tasks and do no skilled nursing, you need a different license: Nevada’s agency to provide personal care services in the home. That license sits in NRS chapter 449B. See the Nevada personal care agency guide. Once you add nursing, you need the nursing-in-the-home license. Running the agency without one lets the Division ask a court for an injunction. The rule says it is enough to allege that you operated an agency without a license on a certain date and in a certain place.⁠²

Who licenses you after the 2025 reorganization

The 2025 Legislature redefined “Division” in NRS 449 to mean the Health Care Purchasing and Compliance Division of the Nevada Health Authority.⁠¹ The licensing website is still called Health Care Quality & Compliance (HCQC), and many forms still say Division of Public and Behavioral Health (DPBH). HCQC takes applications through CLICS, its online health licensing system, and its licensing team uses the address [email protected].⁠⁴ The home health page also lists the complaint line, 1-800-225-3414, and links to the CMS certification documents.⁠⁵

Some of the paperwork still carries the old names. The R071-26 fee regulation still tells applicants to pay “the Division of Public and Behavioral Health,” with that phrase bracketed for deletion.⁠³ Whatever the letterhead says, the requirements in this guide come from NRS 449 and NAC 449.

The federal rulebook applies even without Medicare

This is the most important thing to understand before you write a policy manual. Nevada’s own home health rules (NAC 449.749 to 449.800) take only a few pages. On December 29, 2022, regulation R048-22 added NAC 449.7935, which requires every licensed home health agency to follow 42 CFR 484.1 to 484.115, the federal Medicare conditions of participation. It also adopted CMS’s State Operations Manual Appendix B, the home health surveyor guidance issued February 21, 2020.⁠²

An agency that is not certified by CMS is excused from only three things:⁠²

• 42 CFR 484.45, which requires OASIS data to be sent to CMS. You still have to collect OASIS data and update it on the federal schedule, and give it to the Division on request.
• 42 CFR 484.50(c)(7)(i) and (ii).
• The 484.50(c)(8) requirement to follow the Medicare notice procedures in 42 CFR 405.1200 to 405.1204.

Wherever the federal rules mention a physician, Nevada also accepts a physician assistant or an advanced practice registered nurse.⁠²

So a private-pay agency in Nevada is surveyed against roughly the same standards as a Medicare agency. Under 42 CFR 484, that means you need:

• A governing body with full legal responsibility for the agency.⁠⁷
• An administrator who reports to the governing body. Anyone hired on or after January 13, 2018 must be a licensed physician or a registered nurse, or hold an undergraduate degree, and must have at least 1 year of supervisory or administrative experience in home health care or a related health care program.⁠⁷
• A clinical manager available during all operating hours. This must be a physician, RN, physical, occupational or speech therapist, audiologist or social worker.⁠⁷
• Skilled nursing plus at least one other therapeutic service. The other service can be therapy, medical social services or home health aide services, provided on a visiting basis.⁠⁷
• Comprehensive assessments, including OASIS, updated at least in the last 5 days of every 60-day period.⁠⁷

Your staff and records under the Nevada rules

The Nevada sections add these requirements on top of the federal rules:

• Written personnel policies covering wages and hours, leave and benefits, orientation and continuing education, performance reviews, job descriptions, employee records, and an employee health record kept under NAC chapter 441A.⁠²
• Licensed staff. Everyone who provides services must hold any license, registration or certification that state or federal law requires. A nutritionist must be a dietitian licensed under NRS chapter 640E.⁠²
• Home health aides. NAC 449.749 defines a home health aide as a “nursing assistant” under NRS 632.0166, the Nursing Practice Act.⁠² Under federal rules, aides must also complete at least 75 hours of training, with 16 classroom hours before 16 hours of supervised practical training. They must pass a competency evaluation done by an RN and receive 12 hours of in-service training every 12 months.⁠⁷ When patients also get skilled services, the aide’s work must be supervised in an assessment at least every 14 days.⁠⁷ Because the code defines the aide as a nursing assistant, Nevada’s nursing-assistant certification rule applies: anyone who practices as a nursing assistant must be certified by the Board of Nursing, except a trainee.⁠¹²
• A quarterly record-review committee. The committee must include an administrative representative, a physician, a registered nurse and a records clerk. Every quarter it reviews 10% of the records of patients served in each service area during the previous 3 months, and it keeps minutes for HCQC. Small branch offices may share one committee.⁠²
• Clinical records kept as NRS 629.051 requires. Each record must include hospital or nursing-facility admission and discharge dates, the transferring facility’s clinical summary, copies of any durable power of attorney for health care or life-sustaining-treatment declaration, and a record of the termination of services with its date, the reason and when the physician was notified.⁠²
• Orders. Orders taken by phone must be written down before they are carried out and signed by the physician, PA or APRN within 20 working days. Medication orders must state the drug, exact dose, frequency, duration and route. You also need a written policy on whether staff may give injectable narcotics.⁠²

Background checks start before you apply

Every applicant must send fingerprints to the Central Repository for Nevada Records of Criminal History for an FBI report. Each applicant must also authorize a search of Nevada’s child abuse and neglect registry and the registry of any other place they lived in the past 5 years.⁠¹ HCQC’s checklist asks for Department of Public Safety criminal background reports for the applicant or licensee, including all corporate officers. It also lists a mandatory background-check webinar.⁠⁶

Once you are open, within 10 days of hiring an employee, taking a temp-agency worker or signing an independent contractor, you must:⁠¹

• get a written statement about convictions for the crimes listed in NRS 449.174;
• get proof of any license or certificate the person needs;
• send the person’s fingerprints to the Central Repository;
• get the person’s authorization for the registry check.

If an owner or administrator has a record, they can ask the Division before applying whether it would disqualify them. The Division has to answer within 90 days, though it can later change that answer.⁠¹

The surety bond and insurance

Nevada requires home health agencies to file a surety bond. You file it under NRS 449.065 with your application and again at every renewal:⁠¹

The bond is payable to the Aging and Disability Services Division of the Department of Human Services. It covers claims by patients aged 60 or older whose property is damaged because the agency failed to protect it. If the bond lapses and no substitute is in place, your license is suspended automatically by law. NRS 449.067 lets you deposit a substitute with a bank or trust company in Nevada if the Administrator approves it.⁠¹ Agencies run by the State are exempt.⁠¹

Separately, NAC 449.758 requires proof that you are “adequately covered against liabilities resulting from claims incurred in the course of operation.” HCQC’s checklist asks for a certificate of insurance.⁠²⁠⁶ The rules do not set a minimum amount.

Location, zoning and what you do not need

The applicant must keep its home office in Nevada. An agency based only out of state cannot be licensed.⁠² Each license covers one person at one location and lists the agency name, its service area and the person responsible for operating it. You cannot transfer or sell the license with the business. Each branch on separate premises receives its own copy of the license.⁠²

The application must show that the office meets local zoning rules, or that you have applied for a variance or special-use permit.⁠¹ NAC 449.011 also asks for your business license, certificate of occupancy, any special-use permits and your lease.⁠²

Three things that apply to residential care in Nevada do not apply to a home health agency:

• No fire marshal inspection before licensing. NAC 449.0112 (last amended by R048-22) lets the Division license an agency to provide nursing in the home without a State Fire Marshal report.⁠² HCQC’s older checklist PDF still lists a fire marshal certificate, so ask your licensing contact whether they still want one.⁠⁶
• No certificate of need. Nevada’s only approval of this kind is for new construction by a health facility above the greater of $2,000,000 or an amount the Authority sets by regulation, in a county with fewer than 100,000 people or in a city or town under 25,000 inside a larger county. Renting an office does not trigger it.⁠⁸
• No bed counts. Capacity is not licensed. Your service area and list of services are, so adding a service later means applying for a new license (see the fee table).⁠²⁠³

What goes in the application packet

HCQC’s home health checklist covers initial and change-of-ownership applications. It warns that a packet missing any item is returned as incomplete.⁠⁶ It asks for:

• the application form, notarized, with original signatures;
• the fee (the checklist still shows the pre-2026 amounts);
• proof of zoning approval from the city or county, such as a business license, a conditional-use verification form or a special-use permit;
• a certificate of insurance and the original surety bond;
• your lease, partnership agreement, articles and bylaws or operating agreement;
• a 3-year business history, or resumes and 3 letters of reference for each applicant and corporate officer;
• a financial statement;
• the administrator’s resume, 3 letters of reference and professional license, if any;
• a form showing that employees and contractors comply with NRS 449.174;
• a medical labs attestation (NRS 652.080);
• Department of Public Safety background reports;
• an 8 x 11 photo of the office.

These items come from NRS 449.040 and NAC 449.011. If the applicant is a person, the application must state whether they are at least 21. It must describe the services and type of care “in specific terms,” name the person in charge, and show the applicant’s “reputable and responsible character.” That last part covers financial status and business activities in and outside Nevada over the past 3 years.⁠¹⁠² Ownership disclosure covers every owner who is a person, every holder of 10% or more who also holds a mortgage or note secured by the agency, and all officers, directors and partners.⁠²

The checklist cites NAC 449.773 for the administrator’s resume. That section no longer appears in NAC 449, and the administrator standards now come from 42 CFR 484.115 through NAC 449.7935.⁠²⁠⁶⁠⁷

An application stays open for 1 year. If you do not meet the licensing requirements within a year, you must file a new application and pay the fee again.⁠²

Fees as published

The State Board of Health raised these fees in approved regulation R071-26, filed July 1, 2026.⁠³ HCQC’s licensing page says the amendments apply to initial and change-of-ownership fees, license changes and renewals.⁠⁴ The online NAC 449.013 (revised April 13, 2026) and the checklist PDF still show the old amounts.⁠²⁠⁶ All of these fees are nonrefundable.⁠²

The Division can also bill you for a substantiated complaint investigation, at the hourly rate for its health facility surveyors.⁠² R071-26 also raised the maximum administrative penalty for not reporting accreditation news to $1,070. If you are accredited, you must send HCQC the accreditor’s notice within 7 calendar days, and tell HCQC within 7 days if you lose accreditation.⁠³

From filing to license

1. Check background issues early

   If an owner or the administrator has a criminal record, use the NRS 449.03008 pre-petition, which takes up to 90 days to answer, before you sign a lease.⁠¹

2. Secure the office and local approvals

   Get the business license and zoning or special-use approval from your city or county. The Division will not issue a license until the office meets zoning.⁠¹

3. Buy the bond and insurance

   The bond amount depends on how many employees you expect.⁠¹

4. Fingerprint the applicants and officers

   through the Central Repository and attend HCQC’s background-check webinar.⁠¹⁠⁶

5. File the full packet in CLICS

   and pay the fee. The 1-year clock for the application starts on the filing date.⁠²⁠⁴

6. Prepare for the prelicensure survey

   Once HCQC has a complete application, proof of identity and the fee, it investigates your premises, staff qualifications, operating methods and policies, and surveys the agency.⁠² The survey follows 42 CFR 484 and Appendix B, so have your written policies, clinical record forms, aide training program and governing-body documents ready.⁠²⁠⁷

7. Receive the license

   It is issued once the Division finds full compliance with NRS 449, substantial compliance with the regulations, and conforming zoning.⁠¹

HCQC does not publish a processing time for home health licenses.

Inspections and annual renewal

A Nevada license expires 1 year after it is issued. You renew it by reapplying and paying the renewal fee.⁠¹ Each renewal must state that the agency complies with the background-check laws (NRS 449.115 to 449.125 and 449.174), and you must renew the surety bond for the new license period.⁠¹

HCQC inspects licensed agencies periodically. If it finds deficiencies, it sends the administrator a report within 10 days of the exit conference. You then have 10 days to send back a plan of correction.⁠² HCQC offers home health agencies informal dispute resolution for deficiencies cited during recertification surveys.⁠⁵

Medicare and Nevada Medicaid in 2026

The state license lets you operate. It does not let you bill Medicare or Medicaid. CMS certification applications go through HCQC, which lists the CMS application documents on its home health page.⁠⁵

Nevada Medicaid enrolls home health agencies as Provider Type 29. Its enrollment checklist, updated May 18, 2023, requires the Nevada license and active Medicare enrollment, and Medicaid checks that the details match your Medicare record. Each owner with 5% or more must sign a Department of Public Safety fingerprint waiver.⁠⁹

That Medicare requirement matters more than usual this year. On May 13, 2026, CMS stopped enrolling new home health agencies, branches and practice locations in Medicare nationwide for six months. Only applications that a Medicare contractor had received before that date continue.⁠¹⁰ CMS’s survey memo says initial applications filed during the freeze will be denied and must be filed again once it lifts. It also says accreditation will not grant deemed status while the freeze is in place.⁠¹¹ The freeze can be extended six months at a time. As of October 12, 2026, no extension or lifting notice had appeared in the Federal Register.⁠¹⁰ CMS says it will announce any extension or lifting in the Federal Register and evaluates the question before the first six months end, about November 13, 2026, so ask HCQC or your Medicare contractor where the freeze stands before you file.

Until then, a newly licensed Nevada agency can serve private-pay clients, and other payers if their own rules allow. It cannot bill Medicare, and under Nevada Medicaid’s checklist it cannot enroll in Medicaid either.⁠⁹⁠¹⁰

Related Nevada licenses

• Agencies that only do non-medical personal care need the license in the Nevada personal care agency guide.
• Residential care is licensed separately: the residential facility for groups for assisted living, and the home for individual residential care for up to two residents.
• Day programs need the adult day care facility license.

Sources

1. 1
   Nevada Legislature, Nevada Revised Statutes, Chapter 449, Medical Facilities and Other Related Entities Checked 12 Oct 2026 · Back to text ↑
2. 2
   Nevada Legislature, Nevada Administrative Code, Chapter 449 (NAC 449.013, 449.0168, 449.011, 449.0112, 449.749 to 449.800) Checked 12 Oct 2026 · Back to text ↑
3. 3
   Nevada Legislative Counsel Bureau, Nevada Register, Approved Regulation of the State Board of Health, LCB File No. R071-26 (filed July 1, 2026) Checked 12 Oct 2026 · Back to text ↑
4. 4
   Nevada Health Authority, Health Care Quality and Compliance, Health Facilities - Licensing (application information and fee schedules) Checked 12 Oct 2026 · Back to text ↑
5. 5
   Nevada Health Authority, Health Care Quality and Compliance, Home Health Agency Checked 12 Oct 2026 · Back to text ↑
6. 6
   Nevada Division of Public and Behavioral Health, HCQC, Application Documents for Home Health Agencies (HHA or HBR), Initial/CHOW Checked 12 Oct 2026 · Back to text ↑
7. 7
   Electronic Code of Federal Regulations, 42 CFR Part 484, Home Health Services Checked 12 Oct 2026 · Back to text ↑
8. 8
   Nevada Legislature, Nevada Revised Statutes, Chapter 439A, Planning for the Provision of Health Care Checked 12 Oct 2026 · Back to text ↑
9. 9
   Nevada Medicaid, Provider Enrollment Checklist for Provider Type 29 (updated 05/18/2023) Checked 12 Oct 2026 · Back to text ↑
10. 10
    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 ↑
11. 11
    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 ↑
12. 12
    Nevada Legislature, Nevada Revised Statutes, Chapter 632, Nursing (NRS 632.0166, 632.285) Checked 12 Oct 2026 · Back to text ↑

Was this information accurate? Report an errorPrint or save as PDF