New York certified home health agency (CHHA): PHHPC approval and public need

CHHA or LHCSA: which approval you are actually after

New York has two home care approvals, and both go through PHHPC with a public need review. DOH’s position is simple: an organization must be licensed or certified as a home care agency to provide or arrange home care services in the state.⁠¹⁸

The licensed home care services agency (LHCSA) is the general license. DOH describes LHCSAs as serving people who pay out of pocket or have private insurance.⁠¹⁹ A LHCSA that is not certified under PHL 3608 cannot participate as a Medicare or Medicaid home health agency. The exception is Medicaid payment through a contract with a state agency, a Medicaid managed care plan or a managed long term care plan.⁠⁴ That route, and the county need test for LHCSAs, are covered in the New York LHCSA license guide.

The certified home health agency (CHHA) is the federally certified tier. PHL 3602(3) defines it as a home care services agency holding a certificate of approval under Article 36. It must be qualified to participate as a home health agency under Titles XVIII (Medicare) and XIX (Medicaid) of the Social Security Act.⁠¹ DOH’s provider profiles describe CHHAs as providing part-time, intermittent, skilled services.⁠¹⁷ The same definition also covers hospitals and nursing homes with Article 28 operating certificates that are authorized to run a long term home health care program.⁠¹ This guide is about a new, freestanding CHHA.

Every CHHA must provide, directly or by contract, at least these services:⁠¹

• nursing services;
• home health aide services, prescribed by a physician (or a nurse practitioner where State law allows) under a plan of treatment and supervised by a registered nurse;
• medical supplies, equipment and appliances suitable for use in the home; and
• at least one more service, such as physical therapy, occupational therapy, speech pathology, nutrition or medical social services.

DOH also approves special needs CHHAs. These serve a defined population and fall into two groups: people who would otherwise need an Office of Mental Health or OPWDD facility or program, and up to ten “pilot program” agencies.⁠¹⁷⁠⁷ See the need exceptions below.

The public need test comes first

PHL 3606 bars PHHPC from approving a CHHA unless it is satisfied, among other things, as to “the public need for the existence of the certified home health agency at the time and place and under the circumstances proposed”.⁠² New York Business Express lists the Document of Public Need as “always required” and gives “failure to demonstrate public need” as the common reason for denial.⁠¹⁵ The method is set out in 10 NYCRR 760.5. The online text of that rule carries an effective date of July 2, 2012.⁠⁷

How the formula works

• Planning areas are counties. Each county is a separate CHHA planning area unless two or more contiguous counties have been combined.⁠⁷
• Need comes from statewide use rates. DOH ranks every county’s CHHA cases per 1,000 residents in 12 age and sex groups. It drops high outliers and averages the 10 highest rates in each group, then applies those rates to the planning area’s population. Need estimates must be recalculated at least once every three years.⁠⁷
• Unmet need is need minus projected capacity. Projected need is compared with the case capacity of approved CHHAs in the county, projected five years into the future.⁠⁷
• New agencies are rationed by size. The number of new agencies a county can take is capped at its unmet need divided by the “standard agency case capacity” for its population density category. The density bands run up to areas above 5,000 people per square mile.⁠⁷ If too little unmet need remains for a full agency, PHHPC may still approve one if it finds the need will not otherwise be met and is enough to sustain an efficiently operated agency.⁠⁷

The council or the commissioner can propose to disapprove an application on need alone, before the character, competence and financial reviews are done. If that happens, you can request a hearing.⁠⁷

Section 760.5 requires DOH to recalculate need estimates at least every three years, but no county-by-county CHHA need estimate was found on DOH’s CON or home care pages as of October 12, 2026. Ask the CON unit ([email protected]) for the figures and the standard agency case capacity that apply to your county before you prepare the need section.⁠⁷⁠¹⁶

DOH’s posted regulatory agenda, written for the 2020 rulemaking cycle, listed an amendment to 760.5 “to update the need methodology used to estimate the need for CHHAs.”⁠²³ As of October 12, 2026, the rule text still shows the 2012 effective date.⁠⁷

Ways around a “need met” finding

Section 760.5(e) lets PHHPC recognize need even where the formula shows none, in two situations:⁠⁷

• OMH or OPWDD populations. You propose to serve patients who would otherwise need care in a facility or program licensed by the Office of Mental Health or OPWDD, and that office documents how many eligible people live in your planning area.
• Special pilot program agency. You show how serving a defined population directly will improve continuity of care, access, cost effectiveness and efficiency. You also show you can meet that population’s needs better than existing agencies, and you agree to file an annual report. The rule caps pilot agencies at 10 statewide. DOH limits each one’s case capacity and service area, and its capacity may not exceed 10% of the planning area’s projected need.

Agencies approved under either exception are exempt from the minimum case capacity and whole-county service conditions described next.⁠⁷

What a new CHHA must agree to

An initial applicant meets public need only if it commits to all of the following under 760.5(h):⁠⁷

1. Serve the entire planning area

   Exceptions are possible for geographic barriers or travel time, or for a program focused on underserved parts of a county. Even then, you must serve the whole alternate area DOH designates.

2. Take hospital patients on alternate care status

   who could safely receive care at home.

3. Serve hard-to-reach groups

   These are people who have trouble getting CHHA care because of minority status, age, medical history, case complexity or payment source.

4. Provide charity care

   worth at least 2% of projected total annual operating costs each fiscal year. The figure is 3-1/3% for public agencies. Part 763 repeats this as a continuing operating duty, measured against actual operating costs.⁠¹⁰

5. Reach a minimum case capacity

   within three years of the certificate’s issue date. The target is the standard agency case capacity for your density category, or the remaining need if that is smaller.

Where need exists, applicants get priority if they will reduce hospital and nursing home use in the area, provide more than the minimum charity care, or add three or more of social work, occupational therapy, physical therapy, speech-language pathology and nutrition.⁠⁷

Who is reviewed and what the application contains

PHHPC also judges “the character, competence, and standing in the community” of the incorporators, directors and sponsors, plus the agency’s financial resources and future revenue. Tax status and for-profit status may not be used as criteria.⁠²

Under 10 NYCRR 760.2, the application must be signed by the chief executive officer of a corporate applicant (with a certified board resolution), a general partner or the proprietor.⁠⁵ It must address:

• Public need, as above.
• Character, experience, competence and standing. This covers incorporators, directors, controlling persons, officers, principal stockholders, sponsors and partners, and those of any parent or health-related subsidiary.⁠⁵
• Disclosure of every health care, adult care or mental health facility, program or agency these people have controlled or operated anywhere in the United States, with addresses and dates. If any was fined, or had a certificate, license or certification suspended or revoked, you must describe the violation, the enforcing body and the corrective steps taken.⁠⁵
• Financial resources and sources of future revenue, and your ability to comply with federal and state rules.⁠⁵

Required attachments include any assumed-name certificate. Partnerships must file full partnership agreements containing the state’s prescribed clause: every change in partnership membership needs prior written council approval.⁠⁵

DOH checks inspection reports, complaint investigations and patient care reviews for every affiliated facility. That includes facilities outside New York that would need DOH, social services or mental hygiene approval if they were in New York. If a violation occurred, reviewers look at whether the operator acted as a reasonably prudent operator would to correct it and prevent a repeat.⁠⁶

Business Express groups the DOH-155 submission into a project description, financial information, personal background information and the document of public need. It asks for operator, management, related-facility, legal, capital and financing, and equipment information.⁠¹⁵ DOH’s CON program, which covers home care agencies, takes submissions through the NYS Electronic CON system (NYSE-CON).⁠¹⁶

The DOH-155 packet itself could not be retrieved from the official sites, so the schedule-level contents above come from 10 NYCRR 760.2 and the Business Express listing. Ask the CON unit ([email protected]) which DOH-155 schedules and how many copies apply before you assemble the filing.⁠⁵⁠¹⁵⁠¹⁶

The approval sequence

1. File the establishment application with PHHPC through DOH

   Pay the $2,000 application fee (PHL 3606(4)(a)). Business Express lists it as non-refundable (as published on 2026-10-12). If construction is also part of the project, PHL 3606-a fees apply instead, and Business Express notes an additional construction fee on approved proposals.⁠²⁠¹⁵

2. Health systems agency review

   PHHPC sends the application to the regional health systems agency, if there is one, and waits a reasonable time for its recommendation. PHHPC cannot act against that agency’s advice without first offering it a public hearing.⁠²

3. Answer DOH questions within 30 days

   Late answers, without an extension, count as abandonment. Extensions are discretionary and capped at 30 days. Refusing an authorization DOH requests to verify information is also treated as withdrawal.⁠⁶

4. PHHPC decision

   You are told in writing when the application is scheduled. If PHHPC proposes disapproval, you may request a public hearing.⁠² Business Express listed an average processing time of 171 days (checked October 12, 2026).⁠¹⁵

5. Open within one year

   You must get the certificate of approval and start operating within one year of PHHPC approval or contingent approval. Otherwise the approval is cancelled automatically.⁠⁸

6. Certificate of approval

   The commissioner issues it to an agency that is qualified for Medicare and Medicaid and complies with Article 36 and its regulations.⁠³ The certificate has no fixed term. It stays in effect until revised, annulled, revoked or surrendered, and must be posted.⁠¹⁵

The federal side: Medicare is part of the definition

Because a CHHA must be qualified under Titles XVIII and XIX, Medicare certification is part of what makes the agency a CHHA, not an optional extra.⁠¹⁠³

That collides with federal policy in 2026. CMS imposed a six-month nationwide moratorium on Medicare enrollment of new home health agencies, branches and practice locations, effective May 13, 2026. It applies unless the contractor received your enrollment application before that date, and CMS can extend it in six-month increments.⁠²⁰ During the moratorium, CMS denies initial applications. Accreditation by a CMS-approved accrediting organization does not give deemed status, and there are no individual exceptions.⁠²¹ For six months after the moratorium lifts, new applicants are placed in the “high” screening level.⁠²⁰ CMS left Medicaid moratoria to each state.⁠²⁰

CMS’s moratoria page (last modified August 27, 2026) says the moratorium stays in effect for six months and may be extended in six-month increments if CMS deems it necessary. No extension notice had been published as of October 12, 2026. The initial period would end about November 13, 2026, so ask CMS or your Medicare contractor whether it was extended before you schedule an opening.⁠²⁰⁠²¹

CMS also requires new home health agencies to hold “initial reserve operating funds” at the time of application and until three months after billing privileges are granted. The amount covers three months of operation and may not count Medicare receivables. The same rule applies to a change of ownership that produces a new provider number.⁠²² Plan this alongside the finance review that PHHPC runs under PHL 3606.⁠²

Operating standards DOH will survey against (Part 763)

Part 763 sets the minimum standards for CHHAs. These are the provisions that most shape a new agency’s staffing and policies.

Governance and leadership

The governing authority must adopt the budget and provide for annual fiscal audits. It may not allow fee-splitting with referral sources. It must provide an office big enough for efficient operation and prompt phone contact, and keep a written emergency plan that all employees are oriented to.⁠¹⁰ It must also:

• appoint an administrator for day-to-day management;
• employ a director of patient services, full or part time, who directs and supervises patient care, with that person or a qualified alternate available during all operating hours;⁠¹⁰
• appoint a group of professional personnel: one or more physicians, registered nurses, and representatives of each therapy service you offer. At least one member must be neither an owner nor a paid employee. The group meets at least quarterly, reviews policies, samples active and closed clinical records, and joins an annual program evaluation that includes consumers.⁠¹⁰
• run a complaint procedure with a written response within 15 days and a governing-authority appeal decided within 30 days.⁠¹⁰

Management contracts need the commissioner’s prior written consent, and the request is due at least 60 days before the contract’s start date. The governing authority must keep direct authority to hire and fire the administrator and control of the books and records.⁠¹⁰

Staff and clinical rules

• Personnel screening. Staff must meet the qualifications in 10 NYCRR 700.2. Aides must be entered in the home care worker registry, and criminal history checks run as Part 402 requires. Before patient contact, each worker needs a health assessment, rubella immunity documentation, measles immunity documentation (for staff born on or after January 1, 1957), a TB assessment and test, and influenza vaccination or masking in flu season. Health is reassessed at least annually.⁠¹¹
• In-service hours. Home health aides need 12 hours a year, personal care aides 6, and advanced home health aides 18, including medication management, infection control and injection safety.⁠¹¹
• Annual evaluations must include at least one observed home visit for anyone who provides care in the home.⁠¹¹
• Aide supervision. Aides are supervised by an RN or LPN, or by a therapist for therapy-extension tasks. An RN must visit advanced home health aides in the home at least every two weeks.⁠¹²
• Admission timing. The first patient visit must be made within 24 hours of accepting a community referral or a return home from an institution, unless the patient’s practitioner orders otherwise or the patient or family refuses in writing. An RN conducts the assessment, except where physical therapy or speech-language pathology is the only service prescribed and the agency has the therapist do it.⁠¹³
• Plan of care. It must be developed within 10 days of admission and reviewed at least every 60 days.⁠¹⁴

DOH surveys CHHAs and investigates complaints. After a statement of deficiencies, the agency has 10 days to submit a plan of correction.⁠¹⁷

Ownership changes, enforcement and losing the certificate

• Stock transfers. Any transfer of 10% or more of a corporate operator’s stock or voting rights needs prior council approval. So does any transfer that gives one person control of more than 10%.⁠⁹
• Partnership changes need prior written approval, as the clause required in your partnership agreement states.⁠⁵
• Revocation, suspension or limitation requires a hearing. DOH must serve charges at least 21 days before the hearing, and the agency answers at least 8 days before. Where public health or safety is in imminent danger, DOH may suspend or limit the certificate without a hearing for up to 30 days. Court review under CPLR Article 78 must be sought within 60 days.⁠³
• Limiting a CHHA on need grounds. The commissioner must first weigh public need and alternative services, and publish a newspaper notice at least 30 days before making the finding.⁠³

Where this leaves a founder in 2026

A new freestanding CHHA in New York has to clear three gates in order: a county need finding under a formula whose rule text carries a 2012 effective date, a PHHPC review of everyone with control over the agency, and federal Medicare enrollment, which is closed to new home health agencies while the May 2026 moratorium lasts.⁠⁷⁠²⁠²⁰ The alternative that does not depend on Medicare enrollment is the LHCSA license. It has its own county need test and cannot bill Medicare.⁠⁴ For residential settings, see the assisted living residence and family-type home for adults guides, or the New York state overview.

Sources

1. 1
   New York State Senate, Public Health Law 3602, Definitions Checked 12 Oct 2026 · Back to text ↑
2. 2
   New York State Senate, Public Health Law 3606, Establishment of certified home health agencies Checked 12 Oct 2026 · Back to text ↑
3. 3
   New York State Senate, Public Health Law 3608, Certification of home care services agencies Checked 12 Oct 2026 · Back to text ↑
4. 4
   New York State Senate, Public Health Law 3605, Licensure of home care services agencies Checked 12 Oct 2026 · Back to text ↑
5. 5
   New York State Department of Health, 10 NYCRR 760.2, Applications for establishment Checked 12 Oct 2026 · Back to text ↑
6. 6
   New York State Department of Health, 10 NYCRR 760.3, Requirements for approval Checked 12 Oct 2026 · Back to text ↑
7. 7
   New York State Department of Health, 10 NYCRR 760.5, Determinations of public need Checked 12 Oct 2026 · Back to text ↑
8. 8
   New York State Department of Health, 10 NYCRR 760.8, Failure to implement an application Checked 12 Oct 2026 · Back to text ↑
9. 9
   New York State Department of Health, 10 NYCRR 760.14, Transfers of stock Checked 12 Oct 2026 · Back to text ↑
10. 10
    New York State Department of Health, 10 NYCRR 763.11, Governing authority Checked 12 Oct 2026 · Back to text ↑
11. 11
    New York State Department of Health, 10 NYCRR 763.13, Personnel Checked 12 Oct 2026 · Back to text ↑
12. 12
    New York State Department of Health, 10 NYCRR 763.4, Policies and procedures of service delivery Checked 12 Oct 2026 · Back to text ↑
13. 13
    New York State Department of Health, 10 NYCRR 763.5, Patient referral, admission and discharge Checked 12 Oct 2026 · Back to text ↑
14. 14
    New York State Department of Health, 10 NYCRR 763.6, Patient assessment and plan of care Checked 12 Oct 2026 · Back to text ↑
15. 15
    New York Business Express, Certified Home Health Agency (CHHA) Operating Certificate (DOH-155) Checked 12 Oct 2026 · Back to text ↑
16. 16
    New York State Department of Health, Certificate of Need (CON) Checked 12 Oct 2026 · Back to text ↑
17. 17
    New York State Department of Health, NYS Health Profiles, About Certified Home Health Agencies (CHHAs) Checked 12 Oct 2026 · Back to text ↑
18. 18
    New York State Department of Health, Home Care and Hospice Checked 12 Oct 2026 · Back to text ↑
19. 19
    New York State Department of Health, Home Care: Information for Health Care Providers Checked 12 Oct 2026 · Back to text ↑
20. 20
    Centers for Medicare & Medicaid Services, Federal Register, Announcement of Nationwide Temporary Moratoria on the Enrollment of New Home Health Agencies and Hospices Checked 12 Oct 2026 · Back to text ↑
21. 21
    Centers for Medicare & Medicaid Services, QSO-26-11: Nationwide moratoria on HHA and hospice enrollment Checked 12 Oct 2026 · Back to text ↑
22. 22
    Electronic Code of Federal Regulations, 42 CFR 489.28, Special capitalization requirements for HHAs Checked 12 Oct 2026 · Back to text ↑
23. 23
    New York State Department of Health, Regulatory Agenda Checked 12 Oct 2026 · Back to text ↑

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