Oklahoma home care agency license: one OSDH license for skilled and personal care

One license for skilled and personal care

Most states issue separate licenses for skilled home health and for non-medical personal care. Oklahoma uses one. Under the Home Care Act, a “home care agency” is any sole proprietorship, partnership, association, corporation or other organization that “administers, offers or provides home care services, for a fee or pursuant to a contract for such services, to clients in their place of residence” ⁠¹. “Home care services” means “skilled or personal care services” delivered in the client’s home for a fee ⁠¹. Both kinds of service fall under the same license.

• Skilled care is work done on a regular basis by a trained respiratory therapist or technician, or by a person licensed in Oklahoma, “including but not limited to” an LPN, RN, physical therapist, occupational therapist, speech therapist or social worker ⁠¹.
• Personal care means “assistance with dressing, bathing, ambulation, exercise or other personal needs” ⁠¹.

OSDH’s own summary of the program lists the home care agency as: state license required, Medicare certification optional, certificate of need none ⁠¹³. You do not need a need determination. You also do not need to be Medicare certified to hold the license and serve private-pay clients.

The license also covers companionship. An agency that holds a valid home care license “may provide companion or sitter services in addition to home care services under an existing license” ⁠¹. If you will never give hands-on help, Oklahoma has a separate, cheaper Companion/Sitter Service Agency license under 63 O.S. § 1-1972. That license costs $1,000 to apply and $500 to renew, and it is covered in the Oklahoma companion/sitter agency guide ⁠¹. Once a worker helps a client bathe or dress, you need the home care license.

Who needs the license, and who is exempt

The rule is short: “No home care agency … shall operate without first obtaining a license” ⁠¹. Section 1-1972(E) makes it unlawful for an unlicensed agency to advertise or provide personal care or home care services. It is also unlawful to use the titles “home care agency,” “home health agency” or “senior care agency” without the license ⁠¹. On conviction, the agency faces a fine of $500 to $5,000 per offense, up to six months in county jail, or both ⁠¹. OSDH’s applicant letter warns that serving clients before the license is issued “carries an administrative penalty of up to $10,000.00” ⁠³.

The Act also protects licensed agencies on the referral side. Hospitals, skilled nursing facilities, assisted living facilities, residential care homes, home care agencies, adult day centers, hospices, physicians, APRNs, PAs and state agency employees may refer clients for personal care or companion services only to licensed agencies ⁠¹.

Section 1-1962(D) exempts the following ⁠¹:

• one person acting alone who serves a relative, neighbor or friend;
• maid-only services;
• religious nursing services that rely on prayer alone for healing;
• licensed hospices and nurse-midwives;
• contractors serving people with developmental disabilities under the OHCA waiver or OKDHS contracts, but only for those contracted direct-care services;
• providers supporting CD-PASS self-directed participants (they are still subject to the criminal history check), and individuals who only provide Medicaid home- and community-based personal care under an OHCA contract;
• VA-approved medical foster homes serving three or fewer veterans;
• certified nurse aides.

The definition of home care agency also excludes PACE organizations and intermediary services organizations working for CD-PASS participants ⁠¹.

Nurse registries do not escape the license. OAC 310:662-3-4(h) says a nurse registry that provides home care services “shall function and be licensed as a home care agency” ⁠².

Line up the administrator and the supervising nurse first

The administrator certificate is the step that takes longest. The application asks for a copy of it, and OSDH will not issue or renew a license without proof that the administrator completed the required training ⁠¹⁠³. Acting as a home care agency administrator without OSDH certification is a misdemeanor ⁠¹.

There are two ways to qualify. Both end with the Oklahoma Home Care Administrator Preparedness and Assessment Program (OHCAPA) exam ⁠¹⁰:

1. Preparedness program route. Complete a Department-approved OHCAPA course, which OSDH describes as “a 160 hour course” open to people with or without home health experience, then pass the exam ⁠¹⁰.
2. Deeming route. Skip the course and go straight to the exam if you meet one of these criteria ⁠¹⁰:
   • a bachelor’s degree or higher, plus one year of full-time home care experience in the last two years;
   • an associate degree in a health field, plus that year;
   • a 30-credit-hour Certificate of Achievement in Healthcare Administration from an accredited Oklahoma institution, plus that year;
   • an Oklahoma RN license, plus that year;
   • a passing score on the National Association for Home Care Executive Certification exam.

The deeming application costs $80. Once OSDH has acknowledged that you meet a deeming criterion, a provisional certificate ($80) lets you act as administrator for no more than six months ⁠¹⁰. After passing the OHCAPA, you have six months to apply for the full certificate. That application costs $140 and needs an OSBI criminal arrest check dated within the previous 60 days (fees as published on 2026-10-12) ⁠¹⁰.

Certificates expire every July 31. The administrator needs 12 hours of continuing education each year, with no more than 6 hours from home study, but none before the first renewal. The renewal fee is $55, and OSDH’s registry page lists penalties of $25 for a renewal filed August 31 to September 30 and $50 for one filed October 1 to 31 ⁠¹⁰⁠¹¹. By statute the annual certification fee cannot exceed $200 ⁠¹. The administrator’s certificate must be posted where people can see it at each licensed office ⁠².

Supervising nurse or physician. If the agency provides skilled care, it must employ a physician or a qualified supervising registered nurse. A personal-care-only agency may employ or contract with a supervising physician or RN. That person must be available to advise staff whenever personal care is provided and may work on call ⁠². Either way, you must designate a physician or RN alternate in writing ⁠². The application asks for license verification for both the supervisor and the alternate ⁠⁴.

The office, the money and the insurance

An Oklahoma office open to the public. Every agency must operate “from a place of business which is accessible to the public and physically located in Oklahoma.” Staff providing services must be supervised by personnel at that location ⁠². The license is issued only for the premises named on the application and must be posted there ⁠¹. OSDH’s form instructions add that an agency cannot be located in a home ⁠⁴. You may not move the license to another address without telling OSDH, and the rules require 30 days’ notice before a relocation ⁠². Each additional office is a branch, which needs its own form (ODH-758) and a $25 fee ⁠²⁠⁷.

Financial solvency. The rules require “resources sufficient to ensure the agency’s ability to provide adequate home care services” and an annual operating budget that covers operating costs at all times ⁠². OSDH accepts a bank statement, letter of credit or line of credit. The funds must be in the operating entity’s name, or in the DBA name if you use one ⁠³. Neither the rule nor the guidance letter sets a dollar minimum.

Insurance. You need liability coverage of at least $100,000 per occurrence and $300,000 aggregate, kept in force at all times, plus proof of workers’ compensation (the form asks for it; the insurance rule itself names only the liability limits) ⁠²⁠⁴.

Business registration. The form requires proof that your entity and any DBA are registered with the Oklahoma Secretary of State and that the names match exactly ⁠⁴.

What the application packet contains

You apply on ODH Form 757. The same form is used for initial, renewal, change-of-ownership and change-of-information filings ⁠⁴⁠⁷. For an initial license, OSDH lists these attachments ⁠³⁠⁴:

The form also asks which counties you will serve (you may choose the entire state), your office hours and after-hours number, and any accreditation. For each service line, you mark whether it is provided by employees or contractors. The listed lines include nursing, therapies, home health aide, personal care, pharmaceutical infusion, sitter/companion and Medicaid ADvantage waiver services ⁠⁴.

The person who signs certifies that they are at least 21, “of reputable and responsible character,” and in sound physical and mental health ⁠⁴. OSDH may deny the application if the agency fails the minimum standards, or if the applicant or any affiliated person has a conviction listed in § 1-1950.1(F) ⁠¹. The rules also require you to disclose your owners’ prior health care operations and their compliance history in Oklahoma and other states. That history includes any suspension, receivership, penalty or sanction ⁠².

Mail the packet and fee to OSDH Financial Management, Receipting Unit, PO Box 268823, Oklahoma City, OK 73126-8823. Questions go to the Home Services Division at (405) 426-8470 ⁠⁴.

From filing to license

1. File at least 30 days before you plan to open

   The rule requires the initial application at least 30 days before operations begin ⁠⁸. If OSDH tells you the application is incomplete and you do not fix it within 30 days, it is dismissed. You then have to file again and pay the fee again ⁠⁸.

2. Wait in the queue

   OSDH processes complete applications “in the order that they are received,” and then queues the agency for an initial licensure survey ⁠³. OSDH does not publish a processing time.

3. Pass the on-site survey

   The survey checks whether you meet the minimum standards. OSDH says plainly: “Your agency must be ready for business at the time of the initial survey” ⁠³. Have your policies, personnel files, client rights statement and clinical record system in place.

4. Receive a 12-month initial license, then move to the July 31 cycle

   The first license runs 12 months. The next renewal is prorated so that it expires on July 31, at $125 per quarter or part of a quarter for the parent agency and $6.25 per quarter for each branch ⁠²⁠⁴.

The accreditation alternative. Section 1-1963 lets OSDH license an agency that is Medicare- or Medicaid-certified, or accredited by The Joint Commission, CHAP or ACHC. An agency licensed this way “will not be subject to an inspection or examination by the Department unless necessary to investigate complaints” ⁠¹. Form 757 asks you to report deemed status and its expiration date ⁠⁴.

Operating standards the surveyor checks

Most of these rules come from OAC 310:662 Subchapters 3 and 5 ⁠²:

• Governing body and disclosure. An organized governing body is legally responsible for the agency, and ownership must be “fully disclosed” to OSDH.
• Personnel policies. These must cover hiring, orientation, job descriptions, evaluations and discipline. They must also include TB screening under the CDC’s 2019 health care guidance, and an annual flu vaccination program that offers the vaccine on site at no charge and documents each vaccination or signed declination.
• Client rights. Each client gets a written statement of rights and responsibilities before or at admission, explained verbally. It must include unit charges, and any change in fees or billing must be given to the client orally and in writing within 30 calendar days of when the agency learns of it. It must also explain how to complain to OSDH.
• Assessment before service. A physician, RN or qualified therapist does the first assessment in the client’s home, before or when services start. You may not assess for skilled care or provide it until you have an order. The rule says “physician’s order,” while the 2021 statute speaks of a “healthcare provider,” meaning a physician, PA or qualifying APRN ⁠¹⁠². Personal care may start without an order ⁠¹.
• Plans of care. For personal-care-only clients, the RN or physician writes the plan at the first assessment, and the RN reviews it at least every six months. For skilled clients, you send orders to the physician for signature within 10 days, and clinical records are reviewed for each 62-day period.
• Supervisory visits. An RN visits at least every 60 days when aide or personal care is combined with skilled care. In therapy-only cases, a therapist may make that visit instead. When a client receives only aide or personal care, a physician or licensed nurse visits at least every six months.
• Quality program. A governing-body-approved assessment program must include client satisfaction surveys and sample clinical record reviews, with written reports to the administrator and governing body at least every three months ⁠².
• Records and conduct. Clinical records are kept at least five years after the client was last seen. The agency must not solicit, coerce or harass prospective clients. Contracted services require written agreements. Agency staff may not serve as a client’s guardian unless they are related to the client ⁠¹.

Aides, personal care workers and background checks

Oklahoma gives you three ways to staff hands-on care:

• Certified home health aides. No one may work as a home health aide for more than four months unless they are a licensed health professional or certified and listed on OSDH’s home health aide registry ⁠¹.
• Agency-trained personal care workers. Under § 1-1962(D)(9), an employee who provides only personal care for a licensed agency does not need aide certification if four conditions are met ⁠¹:
  • they have no disqualifying convictions;
  • an RN trains them continuously for each client’s needs;
  • an RN supervises them on site at least every three months, or sooner after a surgery, hospital stay or other significant change;
  • they pass a written, RN-designed competency plan covering observation and documentation, a safe environment, emergencies, bathing, grooming and toileting, meals and food safety, client rights, and infection control.
• Supportive home assistants. These workers give “standby assistance” (verbal prompting with only incidental hands-on help) to ambulatory clients alongside companion or homemaker services ⁠¹.

A certified nurse aide may help a medically stable client take routine medications themselves. For oral medications, an RN, a relative or the nursing staff of the licensed agency must first fill the medication planner ⁠¹.

Background screening runs through OK-SCREEN, OSDH’s portal for registry checks, fingerprint authorization and employment eligibility decisions ⁠³⁠¹². As published on 2026-10-12, the provider pays $19 per initial fingerprint or monitored-employee enrollment, and the applicant pays a one-time $10 ⁠¹². The statute requires aide certification and registry placement but does not state training hours, and this guide did not confirm the hour count in OSDH’s aide curriculum. Ask the Home Services Division at (405) 426-8470 for the current aide training and competency requirements before you hire ⁠¹.

Fees and renewal at a glance

The statute caps the initial fee at $3,000 “not to exceed the reasonable costs incurred by the Department” ⁠¹. OSDH has set it at $1,000.

Renewal. Every license expires July 31. OSDH asks for the renewal Form 757 and fee by June 30 ⁠⁵; the rule requires filing at least 30 days before expiration ⁠⁸. You must include your Secretary of State trade name report, the administrator’s current certificate, license verification for the supervising and alternate RN or physician, and your certificate of insurance ⁠⁵.

Buying an agency. An Oklahoma license cannot be transferred except to affiliated persons, parent companies, subsidiaries or entities with an ongoing organizational relationship ⁠¹. A buyer files a new application with the $500 fee (plus $25 per branch) at least 30 days before the change takes effect, together with the executed sales agreement ⁠². A name change in the articles of incorporation, or a sale of stock, does not trigger this rule ⁠².

Enforcement. OSDH’s Home Services Division surveys agencies on site, investigates complaints and visits clients at home ⁠⁶. Administrative penalties run up to $100 per violation per day, with a maximum of $10,000 for a related series of violations ⁠¹.

Medicare and SoonerCare in 2026

The license lets you serve private-pay clients. Most skilled home health revenue, though, comes from Medicare and SoonerCare, and the state license does not open either one.

Medicare. OSDH’s guidance sets the order of steps ⁠³:

1. Get the state license.
2. File CMS-855A with the Medicare Administrative Contractor (MAC). OSDH notes that Palmetto serves most home care agencies in the region, and the MAC “will not process your application until after you have a state license number.”
3. Serve skilled patients. You must have provided skilled care to at least 10 patients before the initial Medicare survey, and at least 7 must be receiving skilled care when the surveyor arrives.
4. Get surveyed. Most new agencies enter through The Joint Commission, CHAP or ACHC. If OSDH does the survey as the state survey agency, it may take place 150 days after OSDH receives the MAC’s approval letter, provided CMS finds no access-to-care issues.

If you do any lab testing, even finger-stick glucose checks, you also need a CLIA certificate of waiver ⁠³.

That path is closed for now. Effective May 13, 2026, CMS stopped enrolling new home health agencies, branches and practice locations in Medicare nationwide, for an initial six months that CMS may extend in six-month steps ⁠¹⁶. CMS’s memo to state survey agencies says initial applications filed during the moratorium are denied. It also says accreditation “will not serve as the basis for Medicare participation through deemed status” until the moratorium ends ⁠¹⁷. As of October 12, 2026, no extension notice had appeared in the Federal Register; CMS says it will publish any extension there ⁠¹⁶. Ask CMS or your Medicare contractor before mid-November 2026 whether the freeze continues. Applications the Medicare contractor received before May 13, 2026 are still processed ⁠¹⁷.

SoonerCare. OHCA’s rule for home health providers requires that every eligible provider “must be Medicare certified, or have deemed status with Medicare, and have a current contract with the Oklahoma Health Care Authority” ⁠¹⁴. While the Medicare freeze lasts, a newly licensed agency cannot meet that condition. The same Medicare requirement applies to OHCA’s newer paid family caregiver program. In 2025 the Legislature added SoonerCare-recognized family caregivers to the statutory definition of skilled care ⁠¹. OHCA’s rule, revised September 1, 2026, lets a licensed, OHCA-contracted home health agency employ these “complex caregivers” if they are at least 18, pass background and abuse registry checks, and complete 80 hours of training ⁠¹⁵. The agency must also meet the Medicare-certification requirement in 317:30-5-545 and hold the OSDH home care agency license ⁠¹⁵. Rule 317:30-5-545 also requires providers that were not in Medicaid before January 1, 1998 to meet the capitalization requirements of 42 C.F.R. § 489.28 ⁠¹⁴.

Rule changes in progress

In 2026, OSDH opened a rule-change consultation on Chapter 662 ⁠⁶. According to its Rule Impact Statement (prepared August 25, 2026, revised September 21, 2026), the changes are meant to “provide clear requirements for transfer of ownership” and to update OSDH’s mailing address in the client rights statement ⁠⁹. The same document shows change-of-ownership filings rising from 8 in 2025 to 41 through September 2026 ⁠⁹. The draft keeps the $1,000 initial fee and the $500 change-of-ownership fee ⁠⁸⁠⁹. Check the Home Services Division page for the final rule before you file ⁠⁶.

Sources

1. 1
   Oklahoma Legislature, Oklahoma Statutes Title 63, Home Care Act, 63 O.S. §§ 1-1960 to 1-1973 Checked 12 Oct 2026 · Back to text ↑
2. 2
   Oklahoma Secretary of State, Office of Administrative Rules, OAC 310:662, Home Care Agencies Checked 12 Oct 2026 · Back to text ↑
3. 3
   Oklahoma State Department of Health, Medical Facilities Service, Home Care Application Guidance (letter to applicants) Checked 12 Oct 2026 · Back to text ↑
4. 4
   Oklahoma State Department of Health, ODH Form 757, Application for License to Operate a Home Care Agency (12/2020) Checked 12 Oct 2026 · Back to text ↑
5. 5
   Oklahoma State Department of Health, Medical Facilities Service, Home Care License Renewal Letter Checked 12 Oct 2026 · Back to text ↑
6. 6
   Oklahoma State Department of Health, Home Services Division Checked 12 Oct 2026 · Back to text ↑
7. 7
   Oklahoma State Department of Health, Home Services Division Licensure Applications and Forms Checked 12 Oct 2026 · Back to text ↑
8. 8
   Oklahoma State Department of Health, Chapter 662 Section Changes (2026 rule change consultation) Checked 12 Oct 2026 · Back to text ↑
9. 9
   Oklahoma State Department of Health, Rule Impact Statement, Chapter 662 (2026) Checked 12 Oct 2026 · Back to text ↑
10. 10
    Oklahoma State Department of Health, Home Care Administrator Registry Checked 12 Oct 2026 · Back to text ↑
11. 11
    Oklahoma State Department of Health, OAC 310:664, Home Care Administrator Certification (OSDH posted copy) Checked 12 Oct 2026 · Back to text ↑
12. 12
    Oklahoma State Department of Health, Oklahoma National Background Check Program Checked 12 Oct 2026 · Back to text ↑
13. 13
    Oklahoma State Department of Health, Long Term Care Programs in Oklahoma Checked 12 Oct 2026 · Back to text ↑
14. 14
    Oklahoma Health Care Authority, OAC 317:30-5-545, Home health agencies: eligible providers Checked 12 Oct 2026 · Back to text ↑
15. 15
    Oklahoma Health Care Authority, OAC 317:30-5-551, Paid family caregiver: eligible providers Checked 12 Oct 2026 · Back to text ↑
16. 16
    Centers for Medicare & Medicaid Services, Federal Register, Announcement of Nationwide Temporary Moratoria on Enrollment of Home Health Agencies (HHAs), 2026-09717 Checked 12 Oct 2026 · Back to text ↑
17. 17
    Centers for Medicare & Medicaid Services, QSO-26-11-HHA & Hospice: Six-Month National Moratoria on Hospice and HHA Enrollment Checked 12 Oct 2026 · Back to text ↑

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