New Hampshire home health care provider license: He-P 809, Medicare and Medicaid

One statute, three kinds of home care license

New Hampshire does not split home care into a “medical” license and a “non-medical” license the way many states do. RSA 151:2-b defines a home health care provider broadly. It is any organization, for-profit or nonprofit, that arranges or provides, directly or by contract, nursing, home health aide services, or other therapeutic and related services in people’s homes. The statute’s list of those services includes physical and occupational therapy, speech pathology, nutrition, medical social services, personal care and homemaker services. Case management agencies are named in the definition too.⁠² Operating one without a license is prohibited by RSA 151:2, I(b).⁠¹

The statute then carves out two limited licenses. A provider offering only homemaker services gets a license limited to homemaker services. A provider offering only personal care gets a license limited to personal care.⁠² DHHS licenses those limited agencies under a separate rule, He-P 822, as home care service provider agencies; see New Hampshire home care service provider agency license. He-P 809, the rule this guide covers, applies to everyone else, and it does not apply to an entity that holds another home health license and stays within it.⁠⁷

The statute excludes a few programs: agencies that only provide Older Americans Act Title III-C services, services authorized under RSA 161-I, nutrition-only programs, and volunteer hospices that do not provide home health services.⁠² He-P 809 also does not reach “other qualified agencies” certified under RSA 161-H. Medical equipment suppliers are outside it too, as long as they only deliver, set up and monitor equipment and teach the user how to run it.⁠⁷

A home health care provider license covers every service in the RSA 151:2-b list, so an HHCP can also provide personal care and homemaker services. But He-P 809 bars you from advertising or presenting the agency as offering services it is not licensed for. The fine for doing so is $500.⁠⁷

No certificate of need, but a Medicare problem

New Hampshire has no certificate-of-need review for home health. The only growth limit in RSA 151 is the moratorium in RSA 151:2, VI on new licenses and added capacity for nursing homes, skilled nursing facilities, intermediate care facilities and rehabilitation facilities.⁠¹ Home health agencies are not on that list.

The bigger constraint is federal. On May 13, 2026, CMS started a nationwide six-month moratorium on Medicare enrollment of new home health agencies and new branches or practice locations. Applications that reached the Medicare contractor before that date continue. CMS can extend the moratorium in six-month increments.⁠¹³ As of October 13, 2026, the Federal Register had published no extension or end notice. During the moratorium, accreditation by a CMS-approved accrediting organization does not give a new agency deemed status for Medicare participation.⁠¹⁴ After the moratorium ends, CMS will assign new applicants to the “high” screening level if they apply within 6 months.⁠¹³

New Hampshire Medicaid ties itself to Medicare here. Under He-W 553.04, a home health care provider billing Medicaid for home health services must hold the He-P 809 license, be certified to participate in Medicare, and be enrolled as a New Hampshire Medicaid provider.⁠¹² So a new agency licensed in 2026 can serve private-pay and commercially insured patients. It cannot bill NH Medicaid for state-plan home health until it gets Medicare certification. The one exception in He-W 553.04 covers individual nurses, not agencies. Where no licensed and certified home health care provider serves the area, an independent licensed nurse enrolled in Medicaid may provide skilled nursing on a physician’s written orders.⁠¹² CMS’s moratorium notice leaves Medicaid moratoria to each state.⁠¹³

The licensing application asks about this up front. If you plan to become Medicare-certified, the August 2025 form tells you to call DHHS’s certification line at 1-800-852-3345 ext. 19049. For Medicaid enrollment, it points you to Provider Enrollment at [email protected] or 866-291-1674.⁠⁸

Certification also changes your state licensing later. Under RSA 151:5-b, a home health agency certified under Medicare (Title XVIII) or Medicaid (Title XIX) still files the license application and pays the fee. It is then deemed licensed and exempt from state licensing inspections under RSA 151:6-a, but only for the parts of the agency that are certified.⁠⁵ On the application form you mark whether you are a certified facility with deemed status.⁠⁸

Who must run the agency

He-P 809.15 requires two positions: an administrator and a director of patient services.⁠⁷

• Administrator. Any newly appointed administrator must have at least a bachelor’s degree in business or a health-related field, or be a registered nurse. The administrator must name an alternate in writing. One person may hold more than one position if they qualify for each and can actually carry out all the duties.⁠⁷
• Director of patient services. A new director needs at least 2 years’ experience supervising personnel or providing direct home health care. They must also be a New Hampshire-licensed or compact-state RN, or hold a bachelor’s degree in a health-related field. This person is responsible for the overall delivery of patient care.⁠⁷

DHHS denies an application if the applicant, licensee or administrator has a felony conviction anywhere, or a conviction for sexual assault, another violent crime, assault, fraud, theft, abuse, neglect or exploitation. The same applies to a finding by DHHS or another state agency for assault, fraud, theft, abuse, neglect or exploitation, or if DHHS finds the person otherwise threatens patient safety. A waiver can be requested.⁠⁷ A license revoked by any DHHS unit within the past 5 years is also a ground for denial.⁠⁷

If you change administrators later, you must tell DHHS in writing at least 5 days ahead, or as soon as practicable after a death or other emergency. Send the new administrator’s resume, licenses, a New Hampshire criminal records check and a BEAS registry check. DHHS then decides whether the person qualifies.⁠⁷ Employing an unqualified administrator without a waiver carries a $500 fine.⁠⁷

Before you file: town sign-offs and background checks

Local approvals come first. He-P 809.04 requires written approvals for your office, dated no more than 90 days before you submit, from four local officials:⁠⁷

1. Health officer

   Confirms you meet local health requirements.

2. Building official

   Confirms you meet state and local building codes.

3. Zoning officer

   Confirms local zoning allows the use.

4. Fire chief

   Confirms you comply with the state fire code, Saf-C 6000, and local fire ordinances for a business.

If a town has no such official, the board of selectmen or the mayor signs instead.⁠⁷ DHHS’s local approval form is optional. Towns may use their own forms, a certificate of occupancy or an email, and if a town has no ordinances for this type of business, the approval should say so.⁠¹⁰ The 90-day window matters: if a zoning sign-off is four months old by the time you mail the package, the application is incomplete.

Because home health care happens in patients’ homes, the paperwork for an HHCP is lighter than for residential facilities. The August 2025 form does not require a floor plan or a water test for He-P 809 applicants.⁠⁸ DHHS’s December 2025 training deck says there is no separate life safety inspection for home health.⁠⁹

Criminal records checks. RSA 151:2-d requires the initial application to include criminal records check results for the applicant, the licensee (if different) and the administrator.⁠⁶ The application form adds a check on the business entity itself. You may use any vendor, but the results must cover New Hampshire.⁠⁸ DHHS’s December 2025 training deck explains how to check an entity: use the New Hampshire State Police online portal with the entity name in the last-name field and a date of birth that makes the “person” between 18 and 100 years old.⁠⁹ For the administrator, you also need a Bureau of Adult and Aging Services (BAAS) registry check, a resume and licenses, and a signed non-conviction statement.⁠⁸⁠⁹

Secretary of State paperwork. If it applies to your business, include your Certificate of Authority (corporation), Certificate of Formation (LLC) or Certificate of Trade Name.⁠⁷

He-P 809.04(a)(1) still tells a new HHCP applicant to certify that a notice of the application ran in a local newspaper in at least 2 separate issues, no less than 10 business days before filing, and, within 15 miles of a critical access hospital, that the hospital’s chief executive officer got written notice by registered mail in the same window.⁠⁷ The August 2025 application form carries neither certification. Its only critical access hospital affirmation applies to hospital applicants, and RSA 151:4-a, amended effective August 26, 2025, now covers proposed hospitals.⁠⁸⁠¹⁵ The published sources do not say whether the Health Facilities Administration still expects the newspaper or hospital notice from home health applicants. Ask the Licensing Unit, at the phone number or email below, before you file; running the newspaper notice costs little and satisfies the rule as written.

The application package and where it goes

The current form is titled “Application for Residential, Health Care, or Special Health Care Services” (August 2025 edition).⁠⁸ For a new HHCP it collects the following:

• Owner, licensee and agency details, plus a required agency email address. That email is DHHS’s main channel for emergency notices, so a change must be reported within 10 days.⁠⁸⁠⁷
• The name and address of every person with a direct or indirect ownership interest over 5%, and the officers or partners of the entity.⁠⁸
• Branch office locations, if any. The form’s branch section applies to He-P 809 agencies.⁠⁸
• A written description of the services you will provide, the health care involved, and who will provide it.⁠⁸
• Signatures. An owner signs for a private business. Two officers sign for a corporation, and two authorized individuals for an association or partnership.⁠⁸⁠³ The signers affirm that they know RSA 151 and its rules and that the premises comply. They also accept that false information is grounds for denial, revocation and a fine.⁠⁸
• The $250 fee, by check or money order payable to “Treasurer, State of New Hampshire.”⁠⁸⁠⁷ If the license is denied, the fee is refunded. Agencies run by federal, state or local government do not pay it.⁠³
• The attachments described above: local approvals, criminal records checks, BAAS check, administrator credentials and Secretary of State documents.⁠⁸

Mail or hand-deliver the package to the DHHS Health Facilities Administration, 129 Pleasant Street, Concord, NH 03301.⁠⁷ The Health Facilities Licensing Unit’s phone number is (603) 271-9039 and its email is [email protected].⁠¹⁰

Your application becomes public. RSA 151:4, VI makes every initial application available for inspection and copying as soon as it is filed, and DHHS posts it online.⁠³⁠⁸ In 2026, the Initial Applications page listed filings from several new home health and home care agencies.⁠¹¹ Leave out anything you would not want competitors to read, such as personal information that is not required.

From filing to license

The December 2025 deck describes the review steps:⁠⁹

1. Completeness review

   DHHS emails you to say whether the application is complete. If something is missing, you have 30 days to send it, and DHHS will extend that if you are waiting on a town, a background check or another agency and you tell them. If you go silent, DHHS sends a certified letter giving you 10 days. After that, it closes the file.

2. Assignment and consult

   For a complete application, DHHS assigns a clinical inspector and has 30 days to act, starting with a consult.

3. Clinical inspection

   He-P 809 requires an inspection before any initial license.⁠⁷ Have New Hampshire criminal records check results ready for all current staff.⁠⁷ DHHS can deny the application if you are not in full compliance after the first inspection and up to 2 follow-up inspections. It also denies if you do not respond within 3 months of being told the application is complete and an inspection needs to be scheduled.⁠⁷

4. Report and license

   Once inspectors find full compliance with RSA 151 and He-P 809, they have 5 days to issue a final report. The license is then issued within 5 days and emailed to you.⁠⁹

Operating, or continuing to operate after DHHS has told you a license is needed, costs $2,000 under the rule’s fine schedule. Each day of a violation counts as a separate violation.⁠⁷

What surveyors check: policies and patient records

Most of the clinical inspection is a review of your written policies and records under He-P 809.14 through 809.20. Before the consult, have these ready:

• Policies. You need policies on patient rights that follow the Home Care Clients’ Bill of Rights in RSA 151:21-b, all the policies He-P 809 requires, and a firearms safety policy for the licensed premises. Policies must be reviewed every 2 years.⁠⁷ You must also define in writing the scope and type of services you provide.⁠⁷
• Contracts. Services you arrange through others need a written agreement. It must name the services and staff qualifications, require your authorization, and state that your agency keeps professional responsibility for the care.⁠⁷
• Admission packet. At admission, give the patient your rights policy, the Bill of Rights, your complaint procedure, your list of services and the services contractors provide, both orally and in writing. Get a signed acknowledgment, consent and the patient’s legal directives.⁠⁷
• Assessments. A professional in the relevant discipline assesses each patient before care starts, at least every 90 days, and after any significant change. Patients who get only personal care are assessed at the start and every 6 months by an RN, an LPN or the director of patient services. An assessment by an LPN or a non-RN director must be co-signed by an RN or physician before the care plan is written. Homemaker-only patients need no assessment or care plan.⁠⁷
• Care plans and orders. Write the care plan within 3 business days of admission, or before services start if that is later. An interdisciplinary team that includes the patient reviews it every 90 days, or every 6 months for personal-care-only patients. Licensed practitioner orders must be renewed at least once a year.⁠⁷
• Quality improvement. Keep a quality improvement committee that meets at least quarterly, keeps dated minutes and holds 2 years of records on site.⁠⁷
• Emergency plan. The plan must follow the incident command system and be approved by your local emergency management director or fire department. It must cover staff duties during an emergency in a patient’s home, and it is reviewed every year. Agencies within 10 miles of a nuclear power plant that are part of the state Radiological Emergency Response Plan must include its elements.⁠⁷
• Postings. Post your license, the last 12 months of inspection reports, the Bill of Rights, your patient rights policy, your complaint procedure with the DHHS address and 1-800-852-3345, and your fire and emergency plan.⁠⁷

After you open, report incidents to DHHS within 2 business days.⁠⁷ Any inspection citation needs a plan of correction within 21 days of the date on the letter that sends you the report.⁠⁷

Hiring and training rules

He-P 809.17 sets personnel requirements, and RSA 151:2-d adds statutory ones:

• Criminal records checks. Get a check from the New Hampshire Department of Safety for every applicant, volunteer and contractor who will give direct or personal care. Nurses and others licensed by the Board of Nursing are exempt.⁠⁷ Review the results before making a final offer, because no employee may start before that offer. The one exception lets you employ a licensed nursing assistant conditionally for up to 90 days under conditions set by the statute.⁠⁶ Staffing agencies that supply per diem workers must run the checks themselves.⁠⁶
• Registries. Do not employ anyone listed on the BEAS state registry unless BEAS grants a waiver. Board of Nursing licensees must appear on the Board’s nursing assistant registry or license lookup.⁠⁷
• Health screening. Before patient contact, staff need a physical exam or health screening and a 2-step TB test, both done within 12 months before hire.⁠⁷
• Age. Direct care staff must be at least 18. The exceptions are LNAs supervised by an RN and students in an established educational program supervised by an RN.⁠⁷
• Orientation and in-service training. Orientation comes before any patient contact. It covers patient rights, job duties, policies, infection control, emergency plans, mandatory abuse reporting and body mechanics. In-service training on rights, infection control and emergencies is required every year.⁠⁷
• Personal care training. A personal care service provider who will help with transfers, bathing, feeding or dressing needs at least 8 hours of training first. An LPN or RN must teach the clinical portion. LNAs count as already trained but still need orientation.⁠⁷ The agency supervises each personal care service provider every 6 months.⁠⁷
• Medication assistance. Before helping patients take their medications, personal care service providers must complete a medication assistance course taught by a licensed nurse, licensed practitioner or pharmacist.⁠⁷
• Non-conviction statement. All staff sign one when offered the job and again every year.⁠⁷

Keep employee files at the licensed premises.⁠⁷ Branch offices count as licensed premises, but drop sites and patients’ homes do not.⁠⁷ DHHS warns that if surveyors arrive and personnel records are kept off site, the records must be available within two hours, or the agency will be cited.⁠¹⁰

Renewal, branches and changes

Renewal. A license expires one year after it is issued, on the last day of the month before the month it was issued.⁠⁴⁠⁷ DHHS emails a reminder 150 days before expiration, and the renewal application is due 120 days before.⁠⁹ Renewal requires an inspection unless the agency is deemed licensed through Medicare or Medicaid certification.⁠⁷⁠⁵ If you miss the deadline and do not intend to close, you must file a new initial application and pay a $100 fine. Continuing to operate after the expiration date is a separate $2,000 fine.⁠⁷

Branch offices. You may open branch offices and drop sites, but no direct care may happen at a drop site. Before a branch opens, send DHHS its address, phone number and your license number, along with local approvals for the branch. DHHS then issues a revised license certificate.⁠⁷

Moving. Under RSA 151:5, an HHCP does not need a new license to move its office within the license year.⁠⁴ It still owes DHHS 30 days’ written notice, a letter with the new address and move date, and new local approvals for the new location.⁠⁷ Failing to give notice before a move carries a $1,000 fine.⁠⁷

Ownership changes. Licenses cannot be transferred.⁠⁴ You must give 30 days’ notice, and the new owner must obtain a new license before the change. The same applies to a change in license classification.⁠⁷ DHHS defines a change of ownership as a transfer of more than 50% controlling interest. The buyer must file a complete initial application at least 30 days before closing. If you close before DHHS approves, the agency is operating unlicensed.⁠⁹ A restructuring that does not move controlling interest is not a change of ownership.⁠⁷

Closing. Give DHHS 60 days’ written notice with a closure plan for transferring or discharging patients.⁠⁷

Founders weighing a narrower business can compare the home care service provider agency license for personal care and homemaker agencies. Those planning a facility instead should see the assisted living residence license or the adult day program license. For every care license in the state, see New Hampshire.

Sources

1. 1
   New Hampshire General Court, RSA 151:2, Licenses required; moratorium Checked 12 Oct 2026 · Back to text ↑
2. 2
   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 ↑
3. 3
   New Hampshire General Court, RSA 151:4, Application for license Checked 12 Oct 2026 · Back to text ↑
4. 4
   New Hampshire General Court, RSA 151:5, Licenses (term and fees) Checked 12 Oct 2026 · Back to text ↑
5. 5
   New Hampshire General Court, RSA 151:5-b, Deemed licensed Checked 12 Oct 2026 · Back to text ↑
6. 6
   New Hampshire General Court, RSA 151:2-d, Criminal record check required Checked 12 Oct 2026 · Back to text ↑
7. 7
   New Hampshire Department of Health and Human Services, He-P 809, Home Health Care Providers Checked 12 Oct 2026 · Back to text ↑
8. 8
   New Hampshire Department of Health and Human Services, Application for Residential, Health Care, or Special Health Care Services (August 2025) Checked 12 Oct 2026 · Back to text ↑
9. 9
   New Hampshire Department of Health and Human Services, Initial and Renewal Applications and Other Administrative Changes (December 10, 2025) Checked 12 Oct 2026 · Back to text ↑
10. 10
    New Hampshire Department of Health and Human Services, Health Facilities Administration Checked 12 Oct 2026 · Back to text ↑
11. 11
    New Hampshire Department of Health and Human Services, Initial Applications Filed with Health Facilities Administration Checked 12 Oct 2026 · Back to text ↑
12. 12
    New Hampshire General Court, Office of Legislative Services, He-W 553, Home Health Services (in Chapter He-W 500) 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 (2026-09717) Checked 12 Oct 2026 · Back to text ↑
14. 14
    Centers for Medicare & Medicaid Services, QSO-26-11-HHA/Hospice Checked 12 Oct 2026 · Back to text ↑
15. 15
    New Hampshire General Court, RSA 151:4-a, Requirements for licensure near critical access hospitals Checked 12 Oct 2026 · Back to text ↑

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