Nevada personal care agency license: opening a non-medical home care business

The 2025 move to NRS chapter 449B

In 2025 the Nevada Legislature lifted personal care agencies out of the general health facility chapter and gave them their own chapter, NRS 449B, titled “Agencies to Provide Personal Care Services and Related Entities” ⁠¹. The licensing duties, surety bond, background check and training rules that used to sit in NRS 449 (including the definition in NRS 449.0021 and the bond in NRS 449.065) now appear as NRS 449B.015, 449B.185, 449B.310 and so on ⁠¹.

The paperwork has not caught up. NAC 449, revised April 13, 2026, still defines an agency “as defined in NRS 449.0021” ⁠², and the HCQC licensing page still points applicants to NRS 449.0021 ⁠³. The HCQC application checklist cites “NRS 449.065” for the bond ⁠⁴. Expect to see both numbering systems in the documents you work from. Where this guide cites a statute, it uses the 449B number.

The agency also has a new statutory name. Chapter 449B gives licensing to the Health Care Purchasing and Compliance Division of the Nevada Health Authority ⁠¹, while the website and forms are still branded Health Care Quality and Compliance (HCQC) ⁠³.

Who needs the license, and who does not

NRS 449B.015 defines an “agency to provide personal care services in the home” as “any person, other than a natural person,” that provides in-home services to elderly persons or persons with disabilities ⁠¹. In practice: if you form an LLC, corporation or partnership to send caregivers into homes, you need the license. The licensing duty in NRS 449B.100 also names state and local governments and their agencies ⁠¹. The statute carves out only the four arrangements below.

The services are listed in NRS 449B.050: elimination of wastes from the body, dressing and undressing, bathing, grooming, preparing and eating meals, laundry, shopping, cleaning, transportation, and “any other minor needs related to the maintenance of personal hygiene” ⁠¹. Laundry, shopping and cleaning sit in the same list as bathing, and none of the exclusions carves out companion-only or housekeeping-only work, so this license is the route for an entity offering any of these services to elderly or disabled clients ⁠¹.

Four arrangements fall outside the definition in NRS 449B.015 ⁠¹:

• An independent contractor who provides the services “without the assistance of employees.” A sole caregiver who works for clients directly does not need an agency license, but the exclusion ends once that caregiver hires anyone.
• A family-and-friends group that hires or contracts with caregivers for one person, or one family living in the same residence, if the group’s organization is set out in a written document the Division can review.
• An intermediary service organization (ISO), which supports clients who direct their own care. ISOs hold a separate certificate under NRS 449B.500 to 449B.795.
• A temporary respite contractor of the Aging and Disability Services Division.

Neighboring licenses you might confuse it with

• Employment agency to provide nonmedical services. A business that refers or places caregivers who contract with clients needs a different license under NRS 449B.105, and that applies “regardless of whether the employment agency is located in this State” ⁠¹. HCQC warns applicants to compare the two definitions before applying ⁠³. The initial fee for that license is $1,400 ⁠². A holder of a personal care agency license does not need the employment agency license as well ⁠¹.
• Home health agency. Skilled home health care is licensed separately. See the Nevada home health agency license guide.
• Care in your own home. Taking one or two aged or disabled residents into your home is a home for individual residential care. Three or more residents needs a residential facility for groups license.
• ISO alongside an agency. You may run both, but NAC 449.39515 requires separate records and separate clients for each, and the services each one provides must be kept distinct ⁠².

What attendants may and may not do

A licensed agency may provide nonmedical help with activities of daily living. For clients with disabilities, it may also provide medical services authorized under NRS 629.091, through employees or contractors ⁠¹.

NAC 449.3978 lists the services an attendant must not provide ⁠²:

• insertion or irrigation of a catheter;
• irrigation of any body cavity, including ear irrigation, enemas and douches;
• dressings involving prescription medication or aseptic technique;
• injections, except as NAC 449.39775 allows;
• administering medication, including rectal suppositories, prescribed skin lotions and eye drops, except as NAC 449.39775 allows;
• physical assessments;
• specialized feeding techniques;
• digital rectal examinations;
• trimming or cutting toenails;
• massage;
• specialized range-of-motion services;
• medical case management, including going with a client to a doctor’s office to pass on or receive medical information;
• any task the State Board of Nursing treats as skilled nursing, except tasks within a certified nursing assistant’s scope.

Routine bowel and bladder care is allowed. The training rules expressly cover emptying and positioning an indwelling catheter drainage bag and emptying and changing a colostomy bag ⁠². NAC 449.39775 lets trained attendants perform certain tasks listed in NRS 449.0304, such as blood glucose testing and helping a client use a prescribed insulin auto-injector, if the attendant is trained before starting the task and annually after that ⁠². Insulin help also requires a physician, physician assistant or advanced practice registered nurse to have found the client’s condition stable and predictable, with a maintenance-level dose that needs no daily assessment ⁠². If your attendants will test blood glucose for clients who cannot do it themselves, HCQC’s inspection workbook says the agency needs a CLIA waiver ⁠⁵.

Your client disclosure must say in plain terms that managing unstable or unpredictable medical conditions is outside the scope of your license ⁠². Your business name, signs and listings also must not mislead the public about the services you offer (NRS 449B.475) ⁠¹. A name that suggests nursing or medical care deserves a second look.

Getting the business ready before you file

HCQC’s checklist for initial applications ⁠⁴ sets the order of work. Several items have to exist before you can upload anything.

1. Form the entity and get a Nevada state business license

   HCQC accepts only a copy of the license showing your Nevada business ID. It will not take receipts or screenshots from SilverFlume ⁠⁴. LLCs upload articles of organization and a fully executed operating agreement; corporations upload articles of incorporation and bylaws; partnerships upload the partnership agreement ⁠⁴.

2. Secure a Nevada office

   “All Licensed facilities must have a physical location in the State of Nevada” ⁠⁴. Upload a fully executed lease in the agency’s name showing that you may run the business at that address, or a recorded deed if you own the property ⁠⁴. The license is tied to that location. You may add satellite “work stations” only if the client, staff and operations records stay at the licensed address ⁠².

3. Get local approval

   Upload a city or county business license, conditional use verification or special use permit that shows your DBA name and physical address. HCQC will not accept payment receipts ⁠⁴.

4. Buy liability insurance

   The certificate must name the agency and its address as the insured and list the Health Care Purchasing and Compliance Division, 727 Fairview Drive, Suite E, Carson City, NV 89701 as certificate holder ⁠⁴. NAC 449.3972 requires proof of adequate liability coverage, checked at the initial application ⁠².

5. Obtain the surety bond

   See the next section.

6. Document owner experience

   Each owner supplies either a resume showing three years of owning the same type of facility or, if they lack that, a resume plus one letter of reference ⁠⁴.

7. Appoint an administrator

   Upload the administrator’s resume, high school diploma or equivalent (foreign diplomas evaluated through NACES), government ID proving age 18 or older, and an elder abuse, neglect and exploitation training certificate ⁠⁴.

The surety bond

NRS 449B.185 ties the bond to the number of people you employ ⁠¹:

The bond is payable to the Aging and Disability Services Division of the Department of Human Services. It indemnifies clients aged 60 or older whose property is damaged by the agency’s act or failure to act, as determined by the state’s Attorney for the Rights of Older Persons ⁠¹. HCQC wants the bond to carry your DBA name and full physical address, the owner’s signature and the bond company’s original seal ⁠⁴. HCQC’s checklist describes the middle tier as “7-24 employees” ⁠⁴, but the statute says “at least 7 but not more than 25” ⁠¹.

The bond must cover the whole license period. A surety can cancel with 30 days’ written notice, and your license is suspended by operation of law the moment you are no longer bonded. The Division gives at least 20 days’ notice before that happens ⁠¹. Instead of a bond, you may deposit bank obligations or federal or Nevada government securities of equal value with a Nevada bank, with the Administrator’s approval ⁠¹. Agencies run by the State of Nevada are exempt from the bond ⁠¹.

Background checks for owners and staff

Each applicant submits a full set of fingerprints to the Central Repository for Nevada Records of Criminal History for an FBI report ⁠¹. HCQC requires a check for every owner holding 10 percent or more ⁠⁴. Each owner signs a civil applicant fingerprint waiver, which is uploaded with the application ⁠⁶. The applicant pays the fingerprinting and state and federal check costs ⁠⁶.

Once licensed, you open an account with the Department of Public Safety to run employee checks ⁠⁶. Within 10 days after hiring an employee, accepting a temp worker or signing an independent contractor, NRS 449B.310 requires you to collect a signed statement about criminal convictions, confirm it, verify any required licenses and submit fingerprints ⁠¹. The check must be repeated at least every 5 years ⁠¹. You may recover up to one-half of the Central Repository’s fingerprint fee from the worker ⁠¹.

NRS 449B.440 lists the convictions for which the Division may deny, suspend or revoke a license. Some have no look-back limit, including murder, felony sexual offenses, felony domestic violence, child abuse, and abuse or exploitation of older or vulnerable persons. Others count only if within the preceding 7 years, including drug offenses, Medicaid or Medicare crimes, and fraud, theft or embezzlement ⁠¹. HCQC’s guidance says a worker found “Not Eligible” who does not challenge the result must be terminated immediately ⁠⁶.

Policies, client paperwork and supervision

HCQC surveys new agencies with its initial inspection workbook ⁠³, so build your manual around it. NAC 449.3974 requires written staff policies that, at a minimum ⁠²:

• describe attendants’ duties and the activities they may not do. Those must include accepting gifts or money from clients (other than money for the client’s groceries or medication), making personal long-distance calls on a client’s phone or while on duty, and becoming a client’s guardian or attorney-in-fact;
• set out client rights, ethics and confidentiality;
• cover infection prevention and control, emergency responses to medical and nonmedical situations, and coordination with other community agencies;
• describe your services, how you assign and supervise attendants, how client needs are documented, periodic staff evaluations, personnel records, and any special populations you serve.

NRS 449B.220 adds a written infection control plan. It must be updated every year, and a copy goes to every employee, contractor and client ⁠¹.

For each client ⁠²:

1. Screening and service plan

   The administrator or designee screens each prospective client and develops or accepts a service plan. The screening is documented, signed and dated.

2. Review before services start

   You confirm you have the resources to deliver the plan, then review the schedule with the client, along with the no-show procedure, your hiring and training policies, the grievance process and the list of prohibited services.

3. Disclosure statement

   The client signs a statement covering your services, attendant qualifications, charges, billing and rate increase policy, termination criteria, how to reach the administrator during service hours, the on-call policy, and grievance rights.

4. Rights notice

   The client receives a written description of their rights, including the phone number for complaints to the state. The client’s signed and dated receipt goes in the file.

5. Supervision

   The administrator or designee makes supervisory home visits or phone calls. Each one is documented and records whether the plan is followed and meeting the client’s needs and whether the attendant is adequately trained.

Grievances must be investigated personally by the administrator or designee, and the client must be told what was done or why nothing was done ⁠².

Administrator and attendant requirements

The administrator must be at least 18, hold a high school diploma or equivalent, understand NAC 449 and the governing statute, and be able to read, write, speak and understand English. The administrator names a designee who has access to all agency records when the administrator is absent ⁠².

Each attendant must be at least 18 ⁠². HCQC’s summary of training and documentation rules ⁠⁵:

The initial training topics include documenting services and time records, client rights and confidentiality, aging-related sensory and cognitive changes, communication skills, emergencies, adverse behaviors, nutrition, bowel and bladder care, skin care, fall prevention, infection control, transfers and body mechanics ⁠⁵. The agency must provide a copy of the personal care agency regulations to each attendant before that attendant serves clients ⁠⁵.

The agency pays for required training. NAC 449.39735 makes you cover course costs and travel and pay wages for training time and travel time. An employee who does not finish a course is the exception ⁠². The agency also pays for elder abuse training ⁠¹.

The agency must name a primary and a backup infection control person. Each completes at least 15 hours of infection control training from APIC, the CDC, the WHO or SHEA ⁠². HCQC’s workbook says this is due within 3 months of appointment and annually after that ⁠⁵.

Cultural competency timing differs between two official documents. The NAC 449 text on the Legislature’s site (revised 4/13/2026) still reads “within 30 business days” of hire and at least once a year ⁠². HCQC’s workbook, which lists NAC 449.011931 “and R004-24” as the personal care agency requirement, describes a 2-hour approved course within 90 days of hire and every two years ⁠⁵. Before you write your training policy, ask HCQC at (702) 486-6515 ⁠³ which schedule it will cite at survey and which courses it has approved.

Under NRS 449B.280, the training is required for anyone with direct client contact at least once a week on average and for the people who supervise them. It must use a course approved by the Nevada Health Authority. If you ask the Authority to approve your own course, it must decide within 10 business days ⁠¹.

Filing the application and getting licensed

Applications go through HCQC’s online licensing system at myhealthfacilitylicense.nv.gov, which also handles later changes of administrator, location, name or ownership ⁠³⁠⁴. By statute the application states whether a natural-person applicant is 21 or older, your principal place of business, the services you will offer and the person in charge. You must also show evidence of reputable character for each member of the entity and for the person in charge, and evidence that you can comply with the rules ⁠¹.

The applicant, or for an entity the person in charge, must complete elder abuse training before the license is issued. Training completed within the year before you apply counts if you include proof ⁠¹.

The Division issues the license when it finds full compliance with NRS 449B and “substantial compliance” with the Board’s regulations. The license belongs to the named licensee and cannot be transferred ⁠¹. A change of ownership is a new application with a bill of sale and a governing-body letter ⁠⁴. The HCQC pages reviewed on 2026-10-12 state no processing time. An application stays valid for 1 year. If you have not met the licensing requirements within that year, you start over and pay the fee again ⁠².

Fees

The fee table is in NAC 449.013 ⁠². Your other costs at application are owner fingerprinting ⁠⁶, the bond premium, insurance, and local business license fees.

Renewal, inspections and enforcement

Every license expires on December 31 after it is issued and renews for one year ⁠¹. The renewal application must say whether you hold a state business license and, if you do, give the business ID number ⁠¹. It must also include statements that you have complied with the background check rules and that the licensee, administrator and employees have completed their annual elder abuse training ⁠¹. Renewal is blocked if you owe a debt that has been assigned to the State Controller for collection ⁠¹. The bond must be renewed with the license ⁠¹.

The Division may inspect at any time, with or without notice. A person designated by the Aging and Disability Services Division investigates complaints ⁠¹. If you fall short of the regulations but are fixing the problems, the Division may replace your license with a provisional license ⁠¹.

Operating without a license is a misdemeanor. The Division can serve a cease-and-desist order, and you then have 30 days to stop or apply ⁠¹. A court can impose civil penalties of up to $10,000 for a first offense and $10,000 to $25,000 for later offenses, and the Division can bill you for the actual cost of its investigation ⁠¹.

Getting paid through Nevada Medicaid

Nevada Medicaid pays for personal care through two models: the provider agency model, billed as provider type 30, and the self-directed model, which runs through intermediary service organizations under provider type 83 ⁠⁷. Covered services are hands-on help or instruction with activities of daily living, plus light housekeeping, laundry, meal preparation and essential shopping ⁠⁷.

All Medicaid personal care requires prior authorization. A Medicaid-certified physical or occupational therapist performs the functional assessment, and the authorization goes to the agency the recipient chooses ⁠⁷. If a recipient is classed as “At Risk,” the agency must be willing and able to start services within 24 hours ⁠⁷. Reassessment requests are due 60 to 90 days before an authorization expires, and transfers need at least 10 business days’ notice ⁠⁷. Visits must be recorded through electronic visit verification, as the 21st Century Cures Act requires ⁠⁷. Nevada Medicaid’s Services Manual chapter 3500 contains the full program policy ⁠⁷.

Sources

1. 1
   Nevada Legislature, NRS Chapter 449B: Agencies to Provide Personal Care Services and Related Entities (rev. 4/15/2026) Checked 12 Oct 2026 · Back to text ↑
2. 2
   Nevada Legislature, NAC Chapter 449: Medical Facilities and Other Related Entities (rev. 4/13/2026), including NAC 449.013 and 449.396 to 449.3982 Checked 12 Oct 2026 · Back to text ↑
3. 3
   Nevada Health Authority, Health Care Quality and Compliance, Agency to Provide Personal Care Services in the Home (Personal Care Agency) Checked 12 Oct 2026 · Back to text ↑
4. 4
   Nevada Health Authority, Health Care Quality and Compliance, Licensing Checklist for Personal Care Services (PCS) Checked 12 Oct 2026 · Back to text ↑
5. 5
   Nevada Health Authority, Health Care Quality and Compliance, Agencies to Provide Personal Care Services in the Home Workbook (12.2024) Checked 12 Oct 2026 · Back to text ↑
6. 6
   Nevada Health Authority, Health Care Quality and Compliance, Background Check Requirements Checked 12 Oct 2026 · Back to text ↑
7. 7
   Nevada Medicaid, Personal Care Services: Provider Types 30 and 83 Billing Guide (updated 08/11/2026) Checked 12 Oct 2026 · Back to text ↑

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