Starting a non-medical home care agency in New Hampshire: the HCSPA license

How New Hampshire classifies non-medical home care

New Hampshire has no separate homemaker, companion or “private duty” registration of the kind used in some states. Its statute defines a “home health care provider” broadly. The definition covers nursing, home health aide and therapy services, and it also covers personal care services and homemaker services.⁠¹ A provider that offers only homemaker services, or only personal care services, “shall be issued a license limiting their services” to that category.⁠¹ Rule He-P 822 is how DHHS issues those limited licenses. It calls the business a home care service provider agency (HCSPA), meaning an organization that provides personal care or homemaker services through its employees to people in their homes.⁠⁴

Every HCSPA license carries one of two classifications.⁠⁴

The classification printed on your license is a hard limit. RSA 151:2, III bars licensed facilities from advertising services they are not licensed for.⁠² Under He-P 822.13 the fine is $500 for advertising beyond your license and $1,000 for admitting a client whose needs exceed what your license allows.⁠⁴ To move from homemaker to personal care, you file a new application, get a new license and pass an inspection before you start the new services.⁠⁴

Licenses a founder might confuse with this one

• Home health care provider (He-P 809). You need this license if your agency arranges or provides nursing, home health aide or therapy services.⁠¹ He-P 809 licensees fall outside He-P 822 altogether.⁠⁴ The sources used for this guide do not cover that license; ask the Health Facilities Administration about it.
• Individual home care service provider (He-P 820). A self-employed person who is not employed by a licensed agency, and who solicits and provides personal care or homemaker services for pay to non-family clients, must register with DHHS.⁠¹⁠² The fee for a registered individual is $25 (as published on 2026-10-12).⁠³ Once you employ caregivers, you are an agency and need the HCSPA license.⁠⁴
• Other exclusions. He-P 822 does not apply to agencies certified as “other qualified agencies” for personal care under RSA 161-H, to businesses that deliver only meals, or to home medical equipment suppliers whose work stops at delivery, setup, monitoring and teaching the client how to use the equipment.⁠⁴ The statute also excludes agencies that provide only Older Americans Act Title III-C services, those authorized under RSA 161-I, nutrition-only programs, and volunteer hospices.⁠¹
• Residential and day settings. Care given in a facility instead of the client’s home falls under different licenses. See the assisted living residence license and the adult day program license.

What you need before you file

He-P 822.04 lists the items for an initial application.⁠⁴ The August 2025 DHHS application form adds some detail to that list.⁠⁵

1. The application form

   The current form is the “Application for Residential, Health Care, or Special Health Care Services” (August 2025).⁠⁵ The form has no HCSPA checkbox: tick “New facility/Initial application”, and list any branch offices in the section reserved for He-P 809, 819, 822 and 823 agencies. You must also give a facility email address. The form marks it as required, and He-P 822.08(o) says email is the agency’s primary channel for emergency notices.⁠⁴⁠⁵ The owner signs for a privately owned business; a corporation needs signatures from 2 officers.⁠⁵⁠⁷

2. Secretary of State paperwork

   Attach your certificate of authority (corporation), certificate of formation (LLC) or trade name certificate, as applicable.⁠⁴⁠⁵

3. Administrator file

   Include the administrator’s resume, any professional licenses, the non-conviction attestation, a check of the adult protective services registry (the form calls it BAAS, for the Bureau of Adult and Aging Services; the rule still calls it BEAS) and a criminal records check.⁠⁵

4. Criminal records checks for the owner and the entity

   RSA 151:2-d requires checks on the applicant, the licensee and the administrator with the initial application.⁠⁸ The form also asks for a check on the business entity (DBA) and says you may use any vendor, as long as New Hampshire results are included.⁠⁵

5. Four local approvals

   Your town’s health officer, building official, zoning officer and fire chief must each confirm in writing that your office complies with local health rules, building codes, zoning and the state fire code (Saf-C 6000). Each approval must be dated no more than 90 days before you submit.⁠⁴ If your town lacks one of these officials, the board of selectmen or the mayor signs instead.⁠⁴ DHHS calls its own local approval form a suggested form. Towns may use their own forms, a certificate of occupancy or an email.⁠⁶ If the office is still under construction, submit approvals based on the plans, then again when the work is finished.⁠⁴

6. The fee

   Pay by check or money order made out to “Treasurer, State of New Hampshire”.⁠⁵

The form exempts He-P 822 agencies from the floor plan and the water-supply documents.⁠⁵ The rule text is less clear on water: He-P 822.04(a)(6) asks for a private water supply test or a public water bill.⁠⁴ Because an HCSPA office is usually a business address on public water, a water bill is the simplest thing to attach if the office has one; ask the Health Facilities Administration if you are unsure.

The 2019 rule text also asks applicants to certify that they published a notice of intent in a local newspaper in 2 issues at least 10 business days before filing, and to notify any critical access hospital within 15 miles.⁠⁴ Neither certification appears on the August 2025 form for this license type, and RSA 151:4-a now applies the critical access hospital notice only to proposed hospitals.⁠⁵⁠⁹ The official sources do not settle whether the Health Facilities Administration still collects the newspaper notice from new HCSPAs. The rule text, which remains the published He-P 822 on the DHHS site, still lists it, so ask the Health Facilities Administration at (603) 271-9039 before you file and publish the notice if it says the rule applies.

Mail or hand-deliver the packet to the Health Facilities Administration, 129 Pleasant Street, Concord, NH 03301.⁠⁴ Once filed, your application is a public record. RSA 151:4, VI makes initial applications available for inspection and copying, and DHHS posts them on its initial applications web page.⁠⁵⁠⁷

Fees, and a conflict in the published figures

RSA 151:5, XII sets the annual fee for personal care providers at $25 for fewer than 10 clients and $250 for 10 or more.⁠³ He-P 822.04 and the August 2025 application form use the same figures for all HCSPAs, including homemaker-only agencies.⁠⁴⁠⁵ The FAQ on the Health Facilities Administration web page lists $100 for the 10-or-more tier.⁠⁶ The statute controls, and the form that goes with the check says $250, so plan for $250 if you expect 10 or more clients (figures as published on 2026-10-12). DHHS refunds the fee if it denies the license.⁠⁷ A fee can’t be moved to another application.⁠⁴

Who DHHS will not license

Without a waiver, DHHS must deny the application if the applicant, licensee or administrator:⁠⁴

• has a felony conviction in any state;
• has a conviction for sexual assault, another violent crime, assault, fraud, theft, abuse, neglect or exploitation;
• has an administrative finding in any state of assault, fraud, theft, abuse, neglect or exploitation; or
• otherwise poses a threat to clients.

Caregivers are screened against the same list (see the staffing section below).⁠⁴

Inspection and the first license

DHHS considers the application complete once it has every item on the He-P 822.04 list. If anything is missing, it tells you in writing.⁠⁴ An on-site inspection follows, and at that visit you must have criminal records check results for all current personnel.⁠⁴ DHHS issues the license only if the inspection finds you in full compliance with RSA 151 and He-P 822.⁠⁴ If you are still out of compliance after the first inspection and up to 2 follow-up visits, DHHS denies the application. It also denies applications when it hears nothing from the applicant for 3 months after telling them the application is complete and an inspection needs to be scheduled.⁠⁴

No state processing time is published in He-P 822 or on the application form.

Because the inspection checks for full compliance, your written policies, emergency plan and personnel files need to be in place before the inspector arrives. The next sections cover what those include.

Required staff and their qualifications

He-P 822.15 requires two positions.⁠⁴

The administrator must name an alternate in writing. One person may hold both positions if they meet the qualifications for each and can handle both jobs.⁠⁴ If the administrator changes, notify DHHS at least 5 business days ahead. Send the new administrator’s resume, licenses, criminal records check and registry check. DHHS then decides whether they qualify.⁠⁴ Employing an unqualified administrator without a waiver carries a $500 fine.⁠⁴

Screening, health checks and training for caregivers

Background screening. For every employee, volunteer and contractor who will give direct care or personal care, you must:

• obtain a New Hampshire Department of Safety criminal records check (nurses licensed by the NH Board of Nursing are exempt);
• verify their qualifications; and
• confirm they are not listed on the BEAS registry.⁠⁴

The same disqualifying offenses that apply to owners apply to staff. DHHS must grant a waiver if it finds that the person does not pose a threat.⁠⁴ Under RSA 151:2-d, you review the criminal history before making a final offer, and nobody starts work before that offer.⁠⁸ Every staff member signs a non-conviction statement when they accept the job and again each year.⁠⁴

Age and health. Direct care staff must be at least 18. The exceptions are licensed nursing assistants (LNAs) supervised by an RN and students in an RN-supervised educational program.⁠⁴ Before contact with clients or food, each worker needs a physical exam or health screening and 2-step TB testing, both done within the 12 months before hire. A worker may start once the first TB step is negative.⁠⁴

Orientation and annual in-service. Before meeting any client, staff must be oriented on:⁠⁴

• client rights and the complaint procedure;
• the duties of their job;
• your policies;
• infection control;
• your fire, evacuation and emergency plans;
• mandatory reporting under RSA 161-F:46-48 and RSA 169-C:29-31; and
• body mechanics.

Rights, infection control, emergency procedures and mandatory reporting must be reviewed every year.⁠⁴

The 8-hour personal care training. Before helping clients with transfers, feeding, bathing or dressing, a personal care worker must complete at least 8 hours of training run by the director of client services or a trained designee.⁠⁴ The training must cover:⁠⁴

• the caregiver’s role;
• communicating with clients;
• personal and home safety;
• personal care skills: bathing and grooming, toileting and hygiene products, moving and transferring clients, nutrition and feeding, assistive devices, fall prevention and medication reminders; and
• recordkeeping.

LNAs count as having had this training but still need the orientation.⁠⁴

Ongoing supervision. The director of client services or a designee must observe each personal care worker every quarter and complete an annual evaluation. The rule also requires supervision every 6 months.⁠⁴

What personal care staff may and may not do

He-P 822.17(l) spells out the personal care tasks:⁠⁴

• sponge bathing and setting bath water temperature;
• shampooing, skin care with preventive products and filing nails;
• helping with oral hygiene, and shaving with an electric razor only;
• dressing;
• weight-bearing transfer help (non-weight-bearing help case by case);
• toileting and incontinence care;
• inserting and cleaning dentures and hearing aids;
• feeding by mouth, case by case.

Some tasks are allowed only case by case, after the director of client services has trained the individual worker:⁠⁴

• applying a stoma bag on a long-term, well-healed ostomy;
• emptying or changing urinary drainage bags; and
• putting on some braces, splints and prostheses.

Medication help is narrow. Unlicensed staff may remind and prompt clients, put the pill planner within reach and open containers while the client is present.⁠⁴ Anything more is medication administration. That happens only if a nurse delegates it under Board of Nursing rule Nur 404 and RSA 326-B.⁠⁴ Homemakers may do none of the personal care tasks.⁠⁴

Client paperwork the inspector will check

• Admission packet. At admission, give the client, orally and in writing, the Home Care Clients’ Bill of Rights (RSA 151:21-b), your complaint procedure and the list of services. Get a signed acknowledgment and signed consent for care.⁠⁴ Give clients a list of your charges at admission, and give 30 days’ written notice before any price increase. The notice rule has limited exceptions for Medicaid and Choices for Independence clients.⁠⁴
• Assessment and service plan (personal care clients). An RN, LPN, the director of client services or a designee assesses each client before services start, every 6 months and after any significant change. The assessment covers diagnoses and mental status, equipment, functional limits, diet and safety precautions.⁠⁴ The service plan is due within 3 business days of admission, or before services start if that is later.⁠⁴
• Visit notes. Each visit is documented with the date and time, the services given, any observed changes and the worker’s signature.⁠⁴
• Retention. Keep client records locked or electronically secured at the main or branch office for at least 4 years after discharge. For minors, keep them until one year after age 18, and never less than 4 years after discharge.⁠⁴

Written programs: policies, quality, infection control and emergencies

He-P 822 requires these written programs:⁠⁴

• Policies. Written policies cover client rights, every policy He-P 822 calls for and firearms safety on the premises. Review them every 2 years.
• Quality improvement. A quality improvement committee meets at least every 6 months, keeps dated minutes and keeps its records on site for 2 years.
• Infection control. The program covers hand washing, universal precautions, clients with infectious disease and disposal of infectious waste.
• Emergency plan. The plan is modeled on the Incident Command System and approved by your local emergency management director or fire department. It covers utility outages and how staff respond to an emergency in a client’s home. Review it every year. If your office is within 10 miles of a nuclear power plant and part of the state’s Radiological Emergency Response Plan, the plan must include that plan’s required elements.

You must also post these in a public area of your office:⁠⁴

• your license;
• inspection reports from the past 12 months;
• the clients’ bill of rights;
• your complaint procedure, with the DHHS address and 1-800-852-3345; and
• your fire and emergency plan.

Report reportable incidents to DHHS within 48 business hours and follow up in writing within 5 business days.⁠⁴

Renewal, branch offices and changes

• Renewal. A license expires on the last day of the month it was issued, one year later. File the renewal application at least 120 days before that date.⁠⁴ Renewal requires another inspection.⁠⁴ If you miss the deadline, you start over with an initial application and face a fine. He-P 822.13 sets $100 for a late renewal application.⁠⁴
• Branch offices. You may open branches. Tell DHHS in writing before you operate one, and submit the four local approvals for the branch. DHHS then issues a revised license certificate.⁠⁴ Branch records must be available at the main office during inspections.⁠⁴
• Moving the main office. Statute lets home care licensees move their office within the license year without a new license.⁠³ You still need to give DHHS 30 days’ written notice and submit new local approvals. The fine for moving without notice is $1,000.⁠⁴
• Ownership and closure. A change of ownership needs 30 days’ notice and a new application. If you close, give DHHS 45 days’ notice and a closure plan for clients.⁠⁴

Operating without a license after DHHS has told you one is needed carries a $2,000 fine under He-P 822.13.⁠⁴

Getting paid through Medicaid: Choices for Independence

New Hampshire’s Choices for Independence (CFI) Medicaid waiver, under rule He-E 801, covers homemaker, personal care and in-home care services when they come from agencies licensed under He-P 822 (or under He-P 809 for home health).⁠¹⁰ An HCSPA license is therefore the entry ticket for a non-medical agency that wants to serve CFI participants. Enrollment is a separate step: He-E 801.32(a) requires every CFI provider to be enrolled in New Hampshire Medicaid as a CFI provider and to meet the licensing rules for the service.⁠¹⁰ The DHHS application form tells agencies planning to be Medicaid providers to notify the Provider Enrollment Unit at [email protected] or 866-291-1674.⁠⁵ The sources do not publish enrollment steps, fees or timelines for He-P 822 agencies, so ask that unit what it requires.

Sources

1. 1
   New Hampshire General Court, RSA 151:2-b, Home Health Care Provider and Individual Home Care Service Provider Checked 12 Oct 2026 · Back to text ↑
2. 2
   New Hampshire General Court, RSA 151:2, License or Registration Required Checked 12 Oct 2026 · Back to text ↑
3. 3
   New Hampshire General Court, RSA 151:5, Licenses Checked 12 Oct 2026 · Back to text ↑
4. 4
   New Hampshire Department of Health and Human Services, He-P 822, Home Care Service Provider Agencies (HCSPA) Checked 12 Oct 2026 · Back to text ↑
5. 5
   New Hampshire Department of Health and Human Services, Health Facilities Administration, Application for Residential, Health Care, or Special Health Care Services (August 2025) Checked 12 Oct 2026 · Back to text ↑
6. 6
   New Hampshire Department of Health and Human Services, Health Facilities Administration (FAQs) Checked 12 Oct 2026 · Back to text ↑
7. 7
   New Hampshire General Court, RSA 151:4, Application for License Checked 12 Oct 2026 · Back to text ↑
8. 8
   New Hampshire General Court, RSA 151:2-d, Criminal Record Check Required Checked 12 Oct 2026 · Back to text ↑
9. 9
   New Hampshire General Court, RSA 151:4-a, Requirements for Licensure Near Critical Access Hospitals Checked 12 Oct 2026 · Back to text ↑
10. 10
    New Hampshire General Court, Administrative Rules, He-E 801, Choices for Independence Program (Chapter He-E 800) Checked 12 Oct 2026 · Back to text ↑

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