New York licensed home care services agency (LHCSA): the license, the need test and the CON

One license, no non-medical tier

Many states let a companion or homemaker business register cheaply while hands-on care needs a full license. New York does not split it that way. Public Health Law (PHL) 3602 defines “home care services” as one or more of five things: services of a home care services agency, home health aide services, personal care services, homemaker services, and housekeeper or chore services.⁠¹ The Department of Health (DOH) says any organization that provides or arranges home care services must be licensed or certified as a home care agency.⁠³

The statute and the rule are narrower about what forces a license. Under PHL 3605(1), the license is required for an agency that provides nursing, home health aide or personal care services.⁠² Under 10 NYCRR 765-2.1(a), no agency may provide nursing, advanced home health aide, home health aide or personal care services in people’s homes without PHHPC approval and a DOH license.⁠⁴ Personal care is defined broadly: help with personal hygiene, dressing, feeding and household tasks essential to the patient’s health, under a plan of care supervised by a registered nurse.⁠¹ Once a worker bathes, dresses or feeds a client, you are a licensed home care services agency, whatever you call the job. The initial application makes this explicit. You must sign that you are not supplying anyone who delivers hands-on personal care, “regardless of the title of the workers.”⁠¹⁰

The gray area is a business that offers only housekeeping, chores or companionship with no hands-on help. “Housekeeper or chore services” means light household work that does not need a trained homemaker.⁠¹ Homemaker and housekeeper are services you can list on a LHCSA license.⁠¹⁰ But the licensure trigger in PHL 3605(1) and 765-2.1 names nursing, aide and personal care.⁠²⁠⁴ If your model is strictly non-hands-on, describe it in writing and get DOH’s answer before you open (contacts are below). The state’s broad statement on its home care page is the one you would be measured against.⁠³

DOH looks at who controls the care when it decides whether an organization needs a license: who makes admission and discharge decisions, who provides or arranges care, who sets care standards and policies, who sets charges, and whether the staff are employees.⁠⁴ A referral or staffing model that matches aides with clients does not escape licensure just because it avoids the word “agency.”

Who is exempt

The rule exempts these:⁠⁴

• certified home health agencies, long term home health care programs, AIDS home care programs, and hospices caring for their own patients;
• agencies serving people only through a program another state agency runs or regulates;
• nurses’ registries licensed under General Business Law article 11;
• individual licensed nurses practicing alone;
• Article 28 dialysis facilities treating patients at home.

LHCSA or CHHA

A certified home health agency (CHHA) is a different approval. It must qualify for Medicare and Medicaid and provide at least nursing, home health aide services, medical supplies and equipment, and one more therapeutic service.⁠¹ DOH describes LHCSAs as serving people who pay out of pocket or through private insurance.⁠²¹ A LHCSA can still offer nursing and therapies if they are listed on its license.⁠¹⁰ For the Medicare-certified route, see DOH’s home care and hospice pages.⁠³ An assisted living program needs a home care license alongside its adult care facility certificate; that setup is covered in the assisted living residence guide.

The county need test decides where you can open

This is the fact that shapes every New York home care plan. Part B of Chapter 57 of the Laws of 2018 imposed a moratorium on new LHCSA licenses. The moratorium expired on March 31, 2020.⁠⁷ The same law amended PHL 3605(4). PHHPC may not approve a license unless it is satisfied about four things: public need for the agency “at the time and place and under the circumstances proposed”; the character, competence and standing of the people behind it; its financial resources; and anything else it considers pertinent.⁠²⁠⁶ Every application submitted on or after April 1, 2020 is reviewed under these standards.⁠⁶

DOH added 10 NYCRR 765-1.16 to implement the test:⁠⁹

• Planning area. Each county is its own planning area.
• Presumption. There is a rebuttable presumption of no need in a county where 5 or more LHCSAs are actively serving patients. The commissioner may move the target date for counting.
• Initial applicants must take hard cases. An initial applicant meets need only if it agrees to serve groups in the county that have trouble getting care because of minority status, age, medical history, case complexity, payment source or geography.
• Need can sink an application early. PHHPC or the commissioner may propose disapproval on need alone, before looking at anything else.

DOH counts an agency as “actively serving” a county when it has a plan of care in place and serves at least 25 patients there.⁠⁷ The test turns on agencies with 25 or more active patients, not on how many agencies are approved for the county.⁠⁸

These lists come from a survey DOH ran from June 15 to July 15, 2022.⁠⁸ As of October 12, 2026, the LHCSA page still links that report.⁠⁵ Before you pick counties, ask DOH whether a newer target date applies.

Rebutting “no need”

You can still apply in a no-need county, but the application must include a data-driven rebuttal for each such county. If the rebuttal is missing, DOH may not accept the application.⁠⁷ Section 765-1.16(d) lists the factors PHHPC weighs:⁠⁹

• demographics and health status of the people in the county;
• documented, unduplicated counts of patients on waiting lists who face long waits;
• the number and capacity of existing agencies;
• the quality of existing agencies;
• workforce availability;
• resources you commit to training new workers, including an organized training program;
• cultural competency of existing agencies;
• subpopulations that need specialty services.

You may target a specific population within a county, but you must show it has “difficulty gaining access” to care.⁠⁷ If DOH disapproves on need, the fee is not refunded.⁠⁷

Programs exempt from the need test

A LHCSA under common ownership with an assisted living program (ALP), PACE program, Nurse Family Partnership (NFP) or continuing care retirement community (CCRC) skips the need review if it serves only that program’s residents or members.⁠⁹ DOH reads “common ownership” as identical ownership of the two legal entities. Such an agency gets a restricted license, and serving anyone outside the program needs a new NYSE-CON application.⁠⁷ An ALP-linked LHCSA may offer only nursing, home health aide and personal care. An NFP-linked one may offer only nursing.⁠¹⁰

Buying an agency instead of starting one

With most downstate counties presumed closed, many founders enter by acquisition. Under 765-1.16(c)(2), a change-of-ownership application for an agency actively serving at least 25 patients skips the need review. PHHPC judges only financial feasibility and the buyer’s character and competence, unless the buyer wants to add counties.⁠⁹ The 25 patients do not have to be in each county. The seller reports patient counts by county with the application.⁠⁷

The limits:

• The license does not transfer. The buyer files a full CON and receives a new license with a new number. The seller surrenders its license when the new one is issued.⁠⁷
• The seller must be live and registered. It must be actively serving at least one patient and comply with PHL 3605-b registration.⁠⁷
• Small agencies face the need test. In a multi-agency deal, each agency with fewer than 25 active patients is reviewed under the need methodology.⁠⁷
• Changing your own legal entity counts as a sale. It is a formal change of ownership with need and financial review.⁠⁷
• The seller’s paperwork. The seller must give a notarized attestation of patient counts by county, a commitment to surrender the license under 765-2.3(g), and a certified board resolution authorizing the sale.⁠¹⁰

One practical gain: the buyer may adopt the seller’s approved policy and procedure manual, which DOH says speeds up licensure.⁠⁷ Some smaller transfers of ownership interests use 90- or 120-day notices instead of a full CON. Any transfer that needs a full CON is subject to the 2020 rules.⁠⁷

What goes into the NYSE-CON application

You file electronically through the New York State Electronic Certificate of Need (NYSE-CON) system, which you reach through a Health Commerce System account.⁠⁷ The application form is a Word document with sections A to G. A new agency completes A, B, C, D, F and G; Section E is for changes of ownership.⁠¹⁰ DOH acknowledges an application only when every section is complete and every attachment is labeled.⁠¹⁰

Requirements founders often miss:

• A directly employed RN. At least one registered nurse must be employed directly by the agency to supervise aides. Nursing services beyond supervision may be direct or contracted.⁠¹⁰
• Services you can list. Nursing, home health aide, personal care aide, physical, occupational and respiratory therapy, speech-language pathology, audiology, medical social work, nutrition, homemaker, housekeeper, and medical supplies and equipment.⁠¹⁰
• Schedule 1 for every principal. In a business corporation, everyone holding 10% or more of the stock, plus every board officer and director, files a Schedule 1, signed individually.⁠¹⁰
• Track record. Disclosure covers every health care, adult care or mental health facility a principal has controlled anywhere in the US, along with any penalties or revocations.⁠⁹ Compliance reports (Schedule 2D) for out-of-state affiliated facilities must come from those states before you submit.⁠⁷
• Franchises and management companies. Franchise and management agreements are attached to the application. A management contract needs DOH’s prior approval.⁠¹⁰ Under 766.9, the operator must keep the power to hire and fire, control of the books, control of assets, and independent policy authority. Agreements are submitted 60 days before they take effect.⁠¹¹
• A quality assurance committee with a nurse on it. The application’s QA plan must include at least one nurse on the committee.⁠¹⁰

The working capital test

Section 765-1.2(b)(3) requires:⁠⁹

• working capital of at least two months of the agency’s estimated operating expenses;
• start-up funding that passes a reasonableness test;
• projections showing revenue at least equal to expenses over time.

DOH’s FAQ adds detail:⁠⁷

• Working capital must be greater than projected expenses for the first two months, and DOH judges whether those expenses are reasonable.
• A loan or grant counts only if it was awarded before or at the time of application.
• A CPA must help, and the applicant pays the CPA.

The form asks for one of three things: a CPA letter on letterhead with your entity’s balance sheet; personal financial statements on CPA letterhead from each member contributing equity; or the funding parent’s CPA letter and balance sheet.⁠¹⁰ An application without the financial documents may not be accepted.⁠⁷

Limits on your first service area

An initial application may request up to five counties. All must be in one DOH region, except that one may be in a neighboring region if it borders another county you requested.⁠⁷

Fee and costs DOH sets

The application fee is $2,000, set by PHL 3605(13).⁠² The same fee applies to a change of ownership or an expansion of a restricted license. Pay by check to the New York State Department of Health. It must reach the Bureau of Project Management (Corning Tower, Room 1842, Empire State Plaza, Albany, NY 12237) within 30 days of submission, with the NYSE-CON submission number on its face. The fee is not refundable once DOH acknowledges the application, including after a disapproval. DOH refunds only the fee, never attorney or consultant costs.⁠⁷

DOH publishes no licensing fee beyond the application fee. Your other state-set costs are the CPA review DOH requires, and late registration fees if you miss a deadline after licensure.⁠⁷⁠¹⁷

From submission to license, in order

1. Choose counties against the need report

   Pick up to five counties in one region. Draft a rebuttal for any county on the no-need list, or document your ALP, PACE, NFP or CCRC exemption.⁠⁷⁠⁸

2. Form the entity and line up the money

   Register the legal operator with the Department of State. Get the CPA working capital confirmation and build first- and third-year budgets.⁠¹⁰

3. Submit in NYSE-CON and mail the fee

   The check must arrive within 30 days.⁠⁷ Before acknowledgment, questions go to [email protected]; technical problems go to [email protected].⁠⁷

4. Answer DOH within 30 days

   Applications are reviewed in the order acknowledged. If you do not answer a DOH request within 30 days, or get an extension of up to 30 more days, the application is treated as abandoned.⁠⁷⁠⁹ After acknowledgment, questions go to [email protected].⁠⁷

5. Keep the plan fixed

   Before licensure, a significant change in patient capacity, service area, budget, services or principals is an amendment that needs PHHPC approval. An undisclosed change can void the approval.⁠⁹

6. PHHPC meeting

   PHHPC meets six times a year. NYSE-CON notifies you when you are on an agenda and again after contingent approval or disapproval.⁠⁷

7. Policy and procedure manual

   Only after contingent approval do you send the manual to the DOH home care regional office.⁠⁷⁠⁵ DOH wants it in hard copy, built on Parts 765, 766, 402 (criminal history checks) and 403 (worker registry).⁠²⁰

8. Pre-opening survey and license

   When the manual is accepted, the regional office schedules a pre-opening survey. After you pass, the Bureau of Home Care Licensure and Certification issues the license.⁠⁷ You may not serve anyone before then.⁠¹⁰

DOH gives no timeframe. Its FAQ says only that the process has many steps and that complete applications and quick responses shorten it.⁠⁷

Operating standards the survey checks

Part 766 sets the operating rules your manual must cover and the survey tests.

Governing authority (766.9). The operator is responsible for:⁠¹¹

• an office large enough to work from, with staff access to patient records and prompt phone contact;
• at least one RN directing all patient care;
• a written emergency plan;
• public information on services, counties served, charges and payment options;
• a complaint procedure with a written response within 15 days and a governing-body appeal decided within 30 days;
• a quality improvement committee, including a consumer, that meets at least four times a year to review policies and a sample of open and recently discharged cases;
• Health Provider Network accounts with 24/7 emergency contacts.

Supervision (766.5). Aides are supervised by an RN, or by a therapist for therapy-extension tasks. Supervisors make in-home visits to teach and check new tasks and to reassess when a patient’s condition changes.⁠¹² An advanced home health aide needs an RN who visits at least every two weeks.⁠¹²

Personnel (766.11). Before an aide starts, you must:⁠¹³

• confirm the aide meets the 10 NYCRR 700.2 qualifications;
• check the Home Care Registry and enter the aide’s information;
• verify identity, employment history or references;
• run a criminal history check under Part 402;
• complete a health assessment;
• record rubella and measles immunity and a TB test;
• document flu vaccination or masking during flu season.

Each year after that, staff need health and TB assessments. In-service education is at least 12 hours for home health aides, 6 for personal care aides and 18 for advanced aides. Each worker also needs a performance review that includes an in-home observation where it applies.

Aide training and the registry

New York trains aides through DOH-approved programs:

• Home health aide: 75 hours (59 classroom, 16 supervised practical), completed within 60 days.⁠¹⁴
• Personal care aide: at least 40 hours.⁠¹⁵

DOH has kept a registry of everyone who completes these programs since September 25, 2009.⁠¹⁴ Under PHL 3613, an agency must get a worker’s registry information before that worker starts providing care.⁠¹⁶ A home health aide stays certified while working for a licensed or certified agency that provides nurse supervision and 12 in-service hours a year. The certification lapses two years after the aide last worked for a New York agency.⁠¹⁴

Aide wages

PHL 3614-f sets a separate minimum wage for home care aides. For calendar year 2026 it is $19.65 an hour downstate (New York City, Nassau, Suffolk and Westchester) and $18.65 in the rest of the state. From January 1, 2027, it rises each year by a regional consumer price index, subject to a cap.⁠²² DOH can demand payroll data from Medicaid providers that employ aides.⁠²²

After licensure: registration and growth

Annual registration (PHL 3605-b). A LHCSA may not operate, provide services or bill anyone in any period it is not registered. Late registration costs $500 for each month or part of a month. DOH must start revocation after two missed registration periods, consecutive or not.⁠¹⁷ You register by filing the statistical report through the Universal Data Collection System on the Health Commerce System. For 2026 registration, the 2024 report was due December 31, 2025. An agency licensed during 2025 had to file the registration portion.⁠¹⁸ Registration status is posted publicly.⁠¹⁷

Adding counties, services or offices. DOH’s procedure, revised January 13, 2026, handles these by email to [email protected] rather than through PHHPC.⁠¹⁹ Its main conditions:

• You must have been licensed more than 12 months and be actively serving patients. DOH may waive the 12 months.⁠¹⁹
• You must be registered and have no overdue plans of correction.⁠¹⁹
• A new county can be approved only if fewer than five LHCSAs are actively serving it, unless you will serve only an ALP, PACE, NFP or CCRC there.⁠¹⁹
• Adding a service needs 90 days’ notice under 765-2.2(a).⁠¹⁹
• DOH may require a separate office for a distant county.⁠¹⁹

The need test therefore follows you after you open. You cannot license into five upstate counties and add Kings County later by amendment.

Medicaid and the 2025-2026 changes

• Medicaid contracting (PHL 3605-c). This section still bars a LHCSA from enrolling in or billing Medicaid without a DOH contract authorizing it.⁠²³ DOH’s LHCSA pages, checked October 12, 2026, do not describe an open contracting process.⁠⁵ If Medicaid revenue is in your plan, ask DOH how 3605-c applies to a newly licensed agency.
• CDPAP moved to one intermediary. Public Partnership LLC (PPL) is now the statewide fiscal intermediary for the Consumer Directed Personal Assistance Program, and every CDPAP recipient must use it.⁠²⁴
• Minimum Needs Requirements (from September 1, 2025). New Medicaid personal care and CDPAP recipients aged 21 or older must need at least limited help with physical maneuvering for more than two activities of daily living. For people with a dementia or Alzheimer’s diagnosis, the bar is supervision with more than one. The same rule applies to adults enrolling in managed long term care plans. People already receiving services on that date keep the old criteria.⁠²⁴ This narrows the pool of new Medicaid clients in every county.
• Aide wage schedule. The 2026 rates above are the last fixed step. CPI-based indexing starts January 1, 2027.⁠²²

What to ask DOH before you file

The official sources leave three points open. Get written answers before you spend on attorneys or CPAs:

• Need lists. Is the 2022 county no-need list still in force, or has the commissioner set a later target date? Ask [email protected].⁠⁷⁠⁹
• Non-hands-on services. Does a housekeeping or companion-only service with no personal care need a LHCSA license? The DOH home care page and PHL 3605(1) are worded differently.⁠²⁠³
• Medicaid. How does PHL 3605-c apply to Medicaid enrollment for your agency?⁠²³

General LHCSA licensing questions go to [email protected] or (518) 408-8784.⁠⁵⁠¹⁹

Sources

1. 1
   New York State Senate, Public Health Law section 3602: definitions Checked 12 Oct 2026 · Back to text ↑
2. 2
   New York State Senate, Public Health Law section 3605: licensure of home care services agencies Checked 12 Oct 2026 · Back to text ↑
3. 3
   New York State Department of Health, Home Care and Hospice Checked 12 Oct 2026 · Back to text ↑
4. 4
   New York State Department of Health, 10 NYCRR 765-2.1: issuance of a license Checked 12 Oct 2026 · Back to text ↑
5. 5
   New York State Department of Health, Licensed Home Care Services Agencies (LHCSAs) Checked 12 Oct 2026 · Back to text ↑
6. 6
   New York State Department of Health, DHCBS Dear Administrator Letter 22-14: Licensed Home Care Services Application Changes Checked 12 Oct 2026 · Back to text ↑
7. 7
   New York State Department of Health, Frequently Asked Questions: Licensed Home Care Services Agencies Application Requirements Checked 12 Oct 2026 · Back to text ↑
8. 8
   New York State Department of Health, LHCSA County Presumption of "No Need" Report Checked 12 Oct 2026 · Back to text ↑
9. 9
   New York State Department of Health, Adopted regulation: amendments to 10 NYCRR Part 765, including new section 765-1.16 (effective April 1, 2020) Checked 12 Oct 2026 · Back to text ↑
10. 10
    New York State Department of Health, Licensed Home Care Services Agency Application, Article 36 (LHCSA CON application) Checked 12 Oct 2026 · Back to text ↑
11. 11
    New York State Department of Health, 10 NYCRR 766.9: governing authority Checked 12 Oct 2026 · Back to text ↑
12. 12
    New York State Department of Health, 10 NYCRR 766.5: clinical supervision Checked 12 Oct 2026 · Back to text ↑
13. 13
    New York State Department of Health, 10 NYCRR 766.11: personnel Checked 12 Oct 2026 · Back to text ↑
14. 14
    New York State Department of Health, Home Health Aide Training Program FAQs Checked 12 Oct 2026 · Back to text ↑
15. 15
    New York State Department of Health, Guide to the Operation of a Personal Care Aide Training Program Checked 12 Oct 2026 · Back to text ↑
16. 16
    New York State Senate, Public Health Law section 3613: home care services workers Checked 12 Oct 2026 · Back to text ↑
17. 17
    New York State Senate, Public Health Law section 3605-b: registration of licensed home care services agencies Checked 12 Oct 2026 · Back to text ↑
18. 18
    New York State Department of Health, DAL DHCBS 25-13: 2024 LHCSA Statistical Report and registration Checked 12 Oct 2026 · Back to text ↑
19. 19
    New York State Department of Health, Policy and Procedure for LHCSA Administrative Approval of Licensure Amendments (revised January 13, 2026) Checked 12 Oct 2026 · Back to text ↑
20. 20
    New York State Department of Health, Guidance for Developing Policies and Procedures for a Licensed Home Care Services Agency Checked 12 Oct 2026 · Back to text ↑
21. 21
    New York State Department of Health, Home Care: Information for Health Care Providers Checked 12 Oct 2026 · Back to text ↑
22. 22
    New York State Senate, Public Health Law section 3614-f: home care minimum wage increase Checked 12 Oct 2026 · Back to text ↑
23. 23
    New York State Senate, Public Health Law section 3605-c: authorization to enroll and provide medical assistance Checked 12 Oct 2026 · Back to text ↑
24. 24
    New York State Department of Health, Consumer Directed Personal Assistance Program (CDPAP) Checked 12 Oct 2026 · Back to text ↑

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