Ohio skilled home health services license: opening a nursing and therapy agency
Since October 1, 2022, an Ohio business that sends its employees to give skilled nursing, physical, occupational or speech therapy, or medical social services in patients' homes needs a skilled home health services license from the Ohio Department of Health (ODH). To get the license you must show Medicare certification, national accreditation, Department of Aging certification, or sign an attestation that you meet the Medicare conditions of participation. As published on 2026-10-12, the fee is $250, and an agency that was not operating by September 30, 2021 must also file a $50,000 surety bond.
Contents11 sections
Key takeaways
- Ohio has required a skilled home health services license only since October 1, 2022. It covers employees who give skilled nursing, physical, occupational or speech therapy, or medical social services in a patient's home.512
- ODH's licensing rules set no separate clinical standards for this license. You qualify by showing Medicare certification, accreditation (ACHC, CHAP, the Joint Commission or another CMS-approved body), Ohio Department of Aging certification, or a notarized attestation that you meet the Medicare conditions of participation.613
- As published on 2026-10-12, the fee is $250 (non-refundable), with the same fee to renew every three years. An agency that was not operating on or just before September 30, 2021 also files a $50,000 surety bond.168
- A skilled license also covers nonmedical services such as aide and personal care work, so you do not need a second ODH license for them.613
- Ohio Medicaid pays for home health services only from Medicare-certified agencies that also hold the ODH license (rule effective September 3, 2026). Accredited agencies without Medicare certification can still bill Medicaid for private duty nursing.2021
Quick facts
| Agency | Ohio Department of Health, Home Health Agency Licensure |
|---|---|
| Law | ORC Chapter 3740; OAC Chapter 3701-60 |
| Who needs it | Agencies or self-employed providers giving skilled nursing, PT, OT, speech therapy or medical social services at home |
| Qualifying basis | Medicare certification, accreditation, ODA certification, or notarized Medicare CoP attestation |
| Application fee | $250, non-refundable (as published on 2026-10-12) |
| Surety bond | $50,000 if not operating on or before Sept. 30, 2021 |
| License term | 3 years; $250 renewal, filed at least 90 days before expiration |
| Certificate of need | Not part of the ODH home health license |
Fee and bond figures are as published by ODH and in ORC 3740.03 and 3740.05 on 2026-10-12. The ODH rules in Chapter 3701-60 took effect January 27, 2023. Medicaid rules 5160-12-03 and 5160-12-03.1 were checked in their versions effective September 3, 2026.
What the license covers in Ohio
House Bill 110 created Revised Code Chapter 3740, effective September 30, 2021. The licensing requirement started one year later 5. ODH’s rule fixes the date: since October 1, 2022, no home health agency may give skilled home health services through its employees, or present itself or its staff as a provider of those services, without a current skilled home health services license 125.
Under ORC 3740.01(S), “skilled home health services” covers five services given in a patient’s home 4:
- skilled nursing care;
- physical therapy;
- occupational therapy;
- speech-language pathology;
- medical social services, meaning services from a social worker licensed under ORC Chapter 4757 who works under the direction of the patient’s attending physician.
The ODH director can add more services by rule 4. Home health aide services are listed in the same definition of a home health agency, but Ohio classes them as nonmedical. They are hands-on bathing, help with dressing, ambulation and toileting, catheter care (not insertion), and meal preparation and feeding 4. An agency that only provides those, or personal care, needs the nonmedical home health services license. It does not need this one. A skilled licensee can provide nonmedical services under the same license, without a second ODH license 613.
Operating or advertising skilled services without the license is a second-degree misdemeanor on the first offense and a first-degree misdemeanor for each later offense 9.
Agencies, nonagency providers and who falls outside
The license applies to two kinds of business 5:
- Home health agencies. A “home health agency” is a person or government entity whose primary function is giving those services at the patient’s residence 4.
- Nonagency providers. A nurse or therapist who gives direct care on a self-employed basis and employs no one, directly or by contract, is a nonagency provider. A nonagency provider needs a skilled license too 54.
The statute leaves out several groups. A self-employed person who cares for no more than two people who are not immediate family is not a nonagency provider. Neither are family caregivers, volunteers, or people giving self-directed services 4. The home health agency definition also excludes these settings, which have their own licensing routes 4:
- nursing homes;
- residential care facilities;
- hospice and pediatric respite or transition programs;
- providers certified by the Department of Developmental Disabilities;
- residential facilities licensed under ORC 5119.34 or 5123.19;
- shared living providers.
Nursing care given inside a residential care facility falls under that facility’s license (see the residential care facility guide). It is not covered by this one.
Choose your qualifying route first
The decision that shapes the whole project is which of four routes you use to qualify. ORC 3740.03(A)(1)(a) and OAC 3701-60-03(A)(3) require evidence of exactly one of them 613:
| Route | What ODH wants with the application |
|---|---|
| Medicare-certified | Your Medicare provider number (form question 12) 3 |
| Accredited by ACHC, CHAP, the Joint Commission, or another CMS-approved body ODH recognizes | Name of the accrediting body and a copy of your current accreditation inspection report 133 |
| Certified by the Ohio Department of Aging under ORC 173.391 for community-based long-term care services | Proof of the certification 63 |
| Not certified or accredited, but meets the Medicare conditions of participation | A notarized attestation signed by the owner or someone with signature authority 13 |
The first three routes depend on an outside body. A new agency that does not yet hold any of those can qualify only through the attestation. That route is still not a light one. You are swearing that the agency already meets the federal home health conditions of participation in 42 CFR Part 484. ORC 3740.10 tells ODH to set by rule the documentation and conditions for this route 25. The rule itself asks only for the notarized attestation 13, but form question 15 asks you to “provide proof” that you meet the conditions 3. Neither the statute, the rule nor the form says what that proof is. Ask ODH’s licensure program ((614) 466-7713) what it expects to see before you file.
Before you sign, it helps to know what Part 484 demands. Two federal examples:
- Clinical manager. Federal rules require a clinical manager, and 42 CFR 484.115(c) says that person must be a licensed physician, physical therapist, speech-language pathologist, occupational therapist, audiologist, social worker or registered nurse 24.
- Home health aide training. Aides must complete at least 75 hours of classroom and supervised practical training. At least 16 hours of classroom training must come before at least 16 hours of supervised practical training, and each aide needs at least 12 hours of in-service training every 12 months 23.
The licensing rules I checked (3701-60-01 to 3701-60-10) cover applications, enforcement and background checks. They set no staffing ratios or training hours for skilled licensees, and the clinical standard is the federal one you qualify under 1311.
The $50,000 bond and the September 30, 2021 cutoff
As published on 2026-10-12, an applicant that was not operating on or immediately before September 30, 2021 must file a surety bond of $50,000 from a company licensed to do business in Ohio 16. An applicant that was operating instead submits proof that it was 3. ODH publishes a skilled bond form on the skilled application page 2. The nonmedical license has a separate $20,000 bond. Because a skilled licensee needs no nonmedical license, it files only the $50,000 bond 61.
The sources use different words for what counts as operating. The statute and ODH’s licensure page say “providing direct care” 61. The rule and the application form say “providing skilled home health services” 133. An agency that gave only personal care before that date should ask ODH which test applies before relying on it. The sources do not say whether nonmedical direct care before that date exempts a skilled applicant from the $50,000 bond, so ask ODH in writing before you decide to skip it.
How Ohio Medicaid and Medicare fit with the license
The ODH license lets you operate. Who will pay you depends on other approvals, and Ohio Medicaid ties them to the license.
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Medicaid home health services. Under OAC 5160-12-03, in the version effective September 3, 2026, Medicaid home health services come only from Medicare-certified home health agencies. Those agencies must be certified by CMS, licensed by ODH under chapter 3701-60, and meet 42 CFR Part 484 20. Ohio Medicaid defines home health services as home health nursing, home health aide services and skilled therapies 19. They are covered only on a part-time or intermittent basis: no more than eight combined hours a day, and no more than 14 combined hours a week of nursing and aide services, except where the rule or prior authorization allows more 19. A qualifying physician, advanced practice nurse or physician assistant must document a face-to-face encounter within 90 days before or 30 days after the start of care 19.
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Medicaid private duty nursing. OAC 5160-12-03.1, also effective September 3, 2026, opens private duty nursing to three kinds of provider 21:
- Medicare-certified agencies;
- non-agency nurses;
- “otherwise-accredited agencies.” These must keep ACHC, CHAP or Joint Commission accreditation covering home health, private duty nursing, personal care and support services, and must hold the ODH license under chapter 3701-60.
For an accredited agency that is not yet Medicare-certified, private duty nursing is the Medicaid route.
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Medicare enrollment capital. A new home health agency entering Medicare must keep “initial reserve operating funds.” The money must be on hand from the time it applies until three months after Medicare grants billing privileges, and it must cover the first three months of operation without counting Medicare receivables 22. CMS sets the amount from the cost per visit of comparable new agencies and your projected visits 22.
Department of Aging certification under ORC 173.391 covers community-based long-term care services. It qualifies you for the ODH license, but it is not Medicare certification, so on its own it does not meet the Medicaid home health rule above 620.
Preparing application HEA 0621
ODH’s skilled application form is HEA 0621, revised 03/2025. The same form is used for initial, change-of-ownership and renewal applications 3. A complete initial application under OAC 3701-60-03(A) includes 133:
- the completed form and the $250 non-refundable fee. By mail, pay with a cashier’s check or postal money order payable to “Treasurer, State of Ohio” 133;
- evidence for one qualifying route (see the table above);
- proof that you were operating before September 30, 2021, or the $50,000 bond;
- the name, address and phone number of the operating location. ODH defines this as where record keeping, central staffing and general business operations happen, and it can include branches under that location’s direct supervision 1311;
- the names and addresses of everyone with an ownership or controlling interest. The form asks for each person with 5% or more 133;
- the corporate name, officers and statutory agent, with titles, addresses and phone numbers 133;
- a list of the skilled services you provide or will provide, and a description of the geographic area you will serve 13;
- for an agency (not a nonagency provider), a copy of your criminal records check policy 13.
The form also asks two background questions about the owners and the administrator 3:
- whether any of them has been tied to another home health agency or nonagency provider, as an owner or employee, in the five years before the application;
- whether any of them has a criminal conviction, civil judgment or administrative ruling related to giving care.
You must explain any “yes” answer in writing. Any owner named on the form can sign. A signer who is not an owner must attach a notarized affidavit showing they are the owner’s authorized representative 3.
Unlike the nonmedical license, the skilled license does not require ODH to take the primary owner’s fingerprint card 61.
An agency based in another state must set up an administrative office in Ohio before it applies. Clinical records for all Ohio patients must be kept at that office 13.
Filing and ODH review
File electronically or by mail
ODH calls electronic filing the fastest option. Use the ODH gateway’s “CertLicensure” option and pay by credit card or electronic check. To file by mail, send the downloaded form, documents and payment to Ohio Department of Health, Revenue Processing #3506, P.O. Box 15278, Columbus, OH 43215 2. ODH’s licensure program takes questions at (614) 466-7713 3.
Answer follow-up requests within 14 days
ODH may ask for more information. You must send it within 14 days of the date the request was mailed, or the application is not complete 13.
Site visit
If you apply as a Medicare-certified agency, ODH’s review includes a site visit to check the Medicare conditions of participation. ODH skips it if you had such a visit in the previous five years 7. The statute does not require a licensing site visit for the other three routes 7.
Issuance
ODH issues the license once you have paid the fee and shown that you meet the ORC 3740.03 requirements 7. The statute, the rule and ODH’s application pages state no processing time for skilled applications, so ask the licensure program for its current turnaround.
Neither ORC Chapter 3740 nor OAC Chapter 3701-60 makes a certificate of need a condition of this license 613.
Screening the nurses, therapists and aides you hire
ORC 3740.11 and rules 3701-60-05 through 3701-60-10 apply to every home health agency, skilled or nonmedical, for each applicant in a direct-care position 10:
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Database review first. Before a criminal records check, the agency checks six databases. They are the federal System for Award Management, the HHS Office of Inspector General exclusion list, the Department of Developmental Disabilities abuse registry, the sex offender and child-victim database, the state prison inmate database, and the Ohio nurse aide registry 15.
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Ohio BCI fingerprint check. The chief administrator requests a check from the Bureau of Criminal Identification and Investigation for each direct-care applicant. Employees are checked again at least every five years 16. An applicant who cannot show five years of Ohio residence also needs an FBI check 16.
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Conditional employment. You may let someone start before the results arrive only if the following conditions are met 17:
- the database review is clean;
- the applicant gives you a completed fingerprint sheet before starting;
- you request the check within five business days.
If the results are not back within 60 days, the employment must end 17.
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Disqualifying offenses. Offenses fall into four tiers: permanent exclusion, then 10, 7 and 5 years 18.
The agency pays the BCI fee. It may pass the fee to the applicant only if it tells the applicant the amount when they apply, and only if Medicaid does not reimburse it 10.
After licensure: changes, renewal and enforcement
- Ten-day notices. Tell ODH in writing within 10 days of any change to information in your application 13. The form adds that this includes any change in accreditation status 3. That matters if accreditation is your qualifying route.
- Change of ownership. A new owner files form HEA 0621 marked “Change of Ownership” with the full set of initial application materials 3.
- Renewal. A license lasts three years. As published on 2026-10-12, renewal costs $250 8. A renewal is on time if it is filed at least 90 days before the license expires 13. On the renewal form, you complete boxes 1 and 2 and supply only the information that has changed 3. ODH may move your first renewal date so that it lines up with your Medicare certification, accreditation or ODA certification cycle 138.
- Enforcement. ODH may deny, suspend or revoke a license for any of three reasons: a material misrepresentation in the application, failure to renew on time, or no longer meeting Chapter 3740 or the rules. You can request a hearing under ORC Chapter 119. An applicant who was denied can also ask for informal dispute resolution with an ODH employee who was not involved in the review 14.
Recent and pending changes
- January 27, 2023: ODH’s chapter 3701-60 rules took effect. Their five-year review date is January 27, 2028 14.
- April 6 and October 3, 2023: ORC 3740.01 was amended by House Bill 558 and House Bill 33. The October 3, 2023 version is the one in effect 4.
- September 3, 2026: new versions of the Medicaid provider rules 5160-12-03 (home health) and 5160-12-03.1 (private duty nursing) took effect. Both keep ODH licensure under chapter 3701-60 as a condition 2021.
Rule 3701-60-02 still refers to “paragraph (Y)” of rule 3701-60-01 for the skilled services definition. In the current rule, that definition is paragraph (Z) 1211. Expect the reference to be corrected at the 2028 review. The statutory definition applies in the meantime.
Sources
- 1 Ohio Department of Health, Home Health Agency Licensure Checked 12 Oct 2026 · Back to text ↑
- 2 Ohio Department of Health, Skilled Home Health Services License Application Checked 12 Oct 2026 · Back to text ↑
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- 4 Ohio Legislative Service Commission, Ohio Revised Code 3740.01: definitions Checked 12 Oct 2026 · Back to text ↑
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- 9 Ohio Legislative Service Commission, Ohio Revised Code 3740.99: penalties Checked 12 Oct 2026 · Back to text ↑
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- 11 Ohio Legislative Service Commission, Ohio Admin. Code 3701-60-01: definitions Checked 12 Oct 2026 · Back to text ↑
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- 14 Ohio Legislative Service Commission, Ohio Admin. Code 3701-60-04: enforcement Checked 12 Oct 2026 · Back to text ↑
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- 25 Ohio Legislative Service Commission, Ohio Revised Code 3740.10: rules Checked 12 Oct 2026 · Back to text ↑
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Related guides
- Ohio nonmedical home health services license: opening a personal care agencyOhio · Non-medical home care agency
- Ohio residential care facility license: how ODH licenses assisted livingOhio · Assisted living facility
- Ohio Class Two residential facility license: the behavioral health route for 3-16 adultsOhio · Small residential care home
Ohio and neighboring states
Compare all 51| State | License | Who needs it | State fee |
|---|---|---|---|
| Ohio (this guide) | Skilled Home Health Services license | Sending your own nurses, therapists or aides into clients' homes | $250, non-refundable |
| Indiana | Home Health Agency (HHA) license | Sending your own nurses, therapists or aides into homes | $250 initial and $250 each annual renewal, nonrefundable |
| Kentucky | Home Health Agency License | Own nurses, therapists or aides into homes; license plus certificate of need | $500 initial and annual |
| Pennsylvania | Home Health Agency license | Skilled nursing plus at least one other home service | $250 per license |
Shortened from each state's guide and our 51-state table, as of each guide's last review. Fees are the state's own; local permits and background checks cost extra.