Oregon home health agency license: OHA rules, the 60-mile limit and Medicare

What Oregon counts as a home health agency

ORS 443.015 bars anyone from establishing a home health agency, or providing home health services for compensation, without first getting a license from OHA. The license is renewed every year and cannot be transferred.⁠¹ The statute defines a home health agency as a public or private agency that provides coordinated home health services on a home-visiting basis. Home health services are items and services that the agency, or others under arrangement with it, furnish during visits to the patient’s home, so that the patient can stay at home.⁠¹

Licensure has a minimum service mix. ORS 443.065 requires a licensed agency to be “primarily engaged in providing skilled nursing services and at least one other service.”⁠¹ When OHA reviews an application, it checks that your agency provides skilled nursing plus at least one of the following:⁠²

• physical therapy
• occupational therapy
• speech therapy
• medical social services
• home health aide services

You may add other therapeutic services on top of that pair, such as in-home care or palliative care, but they never count as the required second service.⁠² Every patient needs an order or plan of care from a physician, naturopathic physician, physician associate or nurse practitioner.⁠¹ The rules add a caution: CMS will not pay for services that only a naturopathic physician ordered.⁠²

The definition has two exclusions. It does not cover visiting nurse or home health services run by and for people who rely on prayer alone for healing. It also does not cover home health work that a local health department does outside a program formally designated and funded as a home health agency.⁠¹ A licensed hospital may run home health services without a separate governing body or administrative staff. It must still meet the home health statutes and pay the home health license fee.⁠¹⁠²

The in-home care line

Personal care with no curative or rehabilitative element is in-home care. A company that provides only that kind of care needs an in-home care agency license, also issued by OHA, and not this one. See the Oregon in-home care agency license guide. A licensed home health agency may provide the same personal care without a second license (ORS 443.090), but it must follow every in-home care law and rule except the licensing requirement. That includes ORS 443.305 to 443.355 and OAR 333-536.⁠¹⁠² If you plan to do this, OHA wants its attestation form (OHA 8953) returned with your home health application. On that form your administrator swears that your in-home care policies, personnel records and training meet the in-home care rules.⁠⁷

If your clients need a place to live rather than visits at home, you are looking at a different license from a different department. See assisted living and residential care facilities or adult foster homes.

The federal rulebook is also the state rulebook

Since January 13, 2022, OAR 333-027-0001 has required every licensed home health agency to comply with the Medicare Conditions of Participation in 42 CFR Part 484, which Oregon adopts by reference. The latest amendment took effect February 1, 2026.⁠² Oregon’s own rules in OAR 333-027-0000 to -0190 apply on top of the federal ones.⁠² When OHA reviews a license application, it assesses compliance with 42 CFR Part 484 “for purposes of state licensure.”⁠²

In practice, a private-pay or Medicaid-only start-up in Oregon has to build the same governance, patient-rights, assessment, care-planning, quality and personnel systems as a Medicare-certified agency. Your policy manual and staffing plan should be written against both sets of rules from the start.

No certificate of need is involved. ORS 442.315 requires one only for new hospitals and new skilled nursing or intermediate care services or facilities.⁠⁹

The 60-mile service area

Oregon caps how far an agency may reach. Your geographic service area may not extend more than 60 miles from the licensed office.⁠² Branch offices count as part of the parent agency and do not get their own license.⁠² OAR 333-027-0046 lets OHA allow branches only if all three conditions are met:⁠²

• every branch operates under the same Medicare certification number as the parent
• every branch offers the same level and range of care as the parent
• every branch is within 60 miles of the parent

OHA may waive the geographic limit under its general waiver rule. The rule’s example is a parent agency that proposes to serve an underserved area or population and can show it can manage and control the services.⁠² A waiver request must be in writing. It must name the rule, explain the special circumstances and the alternatives you considered, and describe the possible effect on different populations and how you would mitigate it. You may not act on a waiver until OHA approves it in writing.⁠² The application form asks directly whether you operate within the 60-mile radius and, if not, whether you hold a waiver.⁠³

Pick your office location with this radius in mind. If you move 30 miles or more, you must apply for a new license (OAR 333-027-0010). The geographic service area rule says an agency that moves its physical location must apply for a new license, so ask OHA before any shorter move. After any move, every patient you serve must be within 60 miles of the new address.⁠²

Leadership and the professional policy committee

Oregon’s statute sets several organizational requirements that you need to fill before you apply.

• Governing body. You need an organized governing body. If the agency is part of a larger organization, you need a clearly defined local body that is responsible for it.⁠¹ The governing body carries full legal and fiscal responsibility. It hires a qualified administrator, monitors the administrator’s performance, and makes sure a quality assessment and performance improvement (QAPI) program is in place.⁠² You must document QAPI activities at least quarterly.⁠²
• Professional policy-making committee. ORS 443.065 requires your policies to be set by a committee that includes one or more physicians or naturopathic physicians, one or more registered nurses, and two consumers. The statute requires that at least two of the professional members be neither owners nor employees of the agency.⁠¹ It also requires the agency to maintain clinical and financial records on all patients and to have an overall plan and budget in effect.⁠¹ Each year the committee must put in writing and review your policies on scope of services, admission and discharge, personnel safety, behavior flagging, medical supervision, plans of treatment, emergency care, clinical records, personnel qualifications and QAPI.⁠² OHA checks for this committee as part of its application review.⁠²
• Administrator. OHA’s initial-licensure instructions ask for the administrator’s résumé. The résumé must show one of two backgrounds. The first is an Oregon-licensed physician or registered nurse with education, experience and knowledge in community health service systems. The second is a person with related education and experience who also has at least one year of administrative experience in home health care or a related community health program.⁠⁴ The administrator must name a qualified alternate in writing. The clinical manager may fill that role.⁠²
• Clinical manager. You must employ a clinical manager who oversees all patient care and personnel and is available during all operating hours.⁠² The clinical manager must be a licensed physician, physical therapist, speech-language pathologist, occupational therapist, audiologist, social worker or registered nurse.⁠²
• No outsourcing of control. You may contract out services, but you may not delegate administrative or supervisory functions to another agency, person or organization. Every contract must say that only your agency accepts patients and must spell out who is responsible for the plan of care, visit scheduling and discharge planning.⁠²

Staff rules specific to Oregon

ORS 443.004 bars a home health agency from employing anyone convicted of the crimes it lists. The list includes many violent, sexual, theft and fraud offenses, and any conviction for delivering or manufacturing a controlled substance within the last 10 years.⁠¹ HB 4115 (Oregon Laws 2026, chapter 59) took effect June 5, 2026. It renumbered ORS 443.004 but kept both the home health background check requirement and the hiring ban.⁠¹³ For convictions that are not on the list, your written policy must set out a “weighing test” that considers the nature of the offense and how it relates to the job. A new hire may start before the check is finished only if they have no patient contact and no access to patient data, and are actively supervised.⁠²

Two safety rules in force since May 1, 2026

OHA adopted OAR 333-027-0115 and 333-027-0125 effective February 1, 2026. Both require compliance starting May 1, 2026.⁠² New agencies have to meet them from their first day.

1. Workforce violence prevention program

   At intake you must assess each home for threats or history of violence, pets that cannot be secured, pests, and whether the patient will lock up weapons before visits. For patients referred by a hospital, you must ask the hospital for any known history of violence in the past 12 months. You share what you learn with assigned staff. You also need annual personnel safety training consistent with NIOSH and OSHA materials for home health workers, quarterly safety assessments with field staff, and a way for staff to run safety checks (an app, two-way messaging or regular check-ins). Your policies must let staff chart away from the patient’s home and bring an escort when a setting raises safety concerns.⁠²

2. Potential threat flagging system

   You need written protocols for creating, reviewing and removing electronic health record flags and visual flags. Electronic health record flags must be reviewed at least every 12 months. Staff who can set flags must be trained to avoid bias. Patients or their representatives must have a way to ask for a flag to be removed. A flag alone may never be used to deny services, restrict care or punish a patient.⁠²

Applying: the packet and the order of steps

OHA’s Health Facility Licensing and Certification Program posts the home health forms on its program page. The application packet’s own checklist points to the application, the in-home care attestation and the owner/administrator background check request, and the application names the program page as the home for the rules and forms.⁠³⁠⁵ OHA’s initial-licensure letter (revised January 19, 2023) says the process has no set timeframe. Timing depends on whether your application is complete, whether OHA needs more information, and its workload.⁠⁴

1. Set up the entity, office and leadership

   Choose your office address with the 60-mile radius in mind. Recruit the governing body, administrator, alternate, clinical manager and the policy committee, including its two consumers and two outside members.⁠¹⁠²

2. Write policies and forms

   OHA asks for a sample of your policies and procedures with their forms, and does not return them.⁠⁴ The 2023 letter asks for samples covering OAR 333-027-0060, “0080 Patients’ Rights” and “0090 Plan of Treatment,” but those rule titles are out of date: in the rule as published on October 12, 2026, 0080 covers advance directives and there is no 0090.⁠²⁠⁴ The application checklist (revised 08/2024) lists the current set: OAR 333-027-0001 (compliance with federal law), 0060 (administration) and 0080 (advance directives, covering patients’ rights of treatment).⁠³ Write the full manual against 42 CFR Part 484 and division 27 anyway, because OHA reviews both.⁠²

3. Complete the application

   The form asks for your legal and DBA names, your administrator and owner, and whether you are accredited. It also asks which services you will provide (skilled nursing, aide, PT, OT, speech therapy, medical social services, palliative care, in-home care) and whether each discipline is staffed by employees, contractors or both. You also list branches and their distance from the parent office.⁠³ The administrator signs under penalty of perjury.⁠³

4. Background check forms

   The owner or administrator must submit background information for a criminal records check.⁠² On OHA’s request form, you need fingerprints through Fieldprint if any of these is true: your primary residence is outside Oregon, you hold an out-of-state driver’s license or ID, or you spent more than 60 consecutive days outside Oregon in the last five years. You must list every past charge, arrest or conviction with an explanation.⁠⁶ Any owner with patient contact or access to patient data files the same form.⁠³

5. Pay and mail

   Mail a check or money order for the $4,000 new-license fee, payable to “Oregon Health Authority,” along with the administrator’s résumé and your policies.⁠³⁠⁴ The application form (revised 08/2024) gives the payment address as HFLC, PO Box 14260, Portland, OR 97293. The phone number is 971-673-0540, option 5.⁠³ For questions, the 2023 letter asks applicants to email [email protected], attention HHA Team.⁠⁴

6. Pre-licensure survey

   OHA must inspect the agency in person before issuing a license.⁠¹⁠² Surveyors may interview patients, families and staff, watch care being given, and review and copy records.⁠² Instead of its own survey, OHA may accept CMS certification or a survey done in the last three years by an approved accrediting organization. You must then invite OHA to the exit interview and provide the accreditation documents, including evidence of corrective actions.⁠¹⁠²

7. License issued

   OHA approves the application in writing. The license covers only the agency and persons named and must be posted where the public can see it.⁠² You may advertise or provide only the services listed on it.⁠²

Fees

The legislature sets these amounts in ORS 443.035, so they change only by statute.⁠¹ Fees are not prorated and are not refunded.⁠² If OHA decides a nationwide criminal records check is needed, the agency pays for it, up to what OHA itself is charged.⁠²

Renewal, inspections and changes

Every license expires on December 31.⁠² Your renewal application and fee are due at least 30 days before the license expires, and the application form lists December 1 as the due date.⁠²⁠³ To renew, you must attest that the agency served patients during the past calendar year. OHA may also ask for an annual statistical report.⁠²

OHA inspects every agency on site at least once every three years, and accreditation can stand in for that inspection under the same conditions as at licensure.⁠¹⁠² If your deemed status changes, your administrator must tell OHA within 30 calendar days.⁠² Complaint investigations are unannounced. If a complaint alleges an immediate threat to a patient, OHA starts the investigation within two working days.⁠²

You must tell OHA in writing within 30 days of any change in ownership, organizational structure or other information on your last application.⁠² The form says changes to your service area or administrator, adding or removing a service, and adding or removing a branch all need Public Health Division approval in advance.⁠³ Before you add a service, you must get OHA’s written approval. To get it, you show that the governing body approved the service and the related policy changes.⁠² If you drop a service, notify OHA within 30 days.⁠²

Medicare enrollment and the 2026 freeze

Oregon requires a license before Medicare participation. OHA’s letter says you may seek Medicare certification once you are licensed and caring for patients.⁠⁴⁠⁸ OHA’s Medicare information sheet says the initial certification survey has to be done by a CMS-approved accrediting organization. The letter (revised 01/19/2023) says to obtain and file the CMS-855 enrollment application through National Government Services, which it names as the CMS-designated intermediary for Oregon home health agencies; confirm the current contractor before you file. You also need working OASIS data transmission to the state before the survey can happen.⁠⁸

In 2026 a federal freeze blocks that path. On May 13, 2026, CMS put a nationwide moratorium on Medicare enrollment of new home health agencies. It covers initial applications, new branch or practice locations, and non-exempt changes in majority ownership. Applications filed while it is in force are denied.⁠¹⁰⁠¹² Only applications that the Medicare contractor received before the effective date continue.⁠¹¹⁠¹² CMS also told state survey agencies that accreditation will not give a new agency deemed status during the moratorium.⁠¹² The moratorium lasts six months and can be extended in six-month increments.⁠¹⁰ As of October 12, 2026, the CMS moratoria page (last updated August 27, 2026) showed no extension. The notice says CMS will publish any extension in the Federal Register, and that period ends November 13, 2026, so check for a notice before you plan a Medicare filing date.⁠¹¹

The federal notice leaves Medicaid enrollment moratoria to each state.⁠¹¹ Oregon’s Medicaid rule defines a “Medicaid Home Health Provider” as a licensed home health agency that is certified for Medicare and enrolled with the Division as a Medicaid provider (OAR 410-127-0020), so the Medicare freeze likely blocks that route too.⁠¹⁴ The official sources reviewed show no Oregon Medicaid moratorium of its own. Ask the OHA Provider Enrollment Unit whether a licensed, non-Medicare-certified agency can enroll for Oregon Health Plan payment, and whether any state moratorium applies.

A new Oregon agency licensed during the freeze can serve private-pay and other non-Medicare patients, but it must still meet 42 CFR Part 484 as a condition of its state license.⁠²

Enforcement and closing down

OHA may deny, suspend or revoke a license, or impose civil penalties, for violations of ORS 443.004, the home health statutes or the rules.⁠¹ Civil penalties are capped at $1,000 per violation and $2,000 in total. Each day a violation continues counts as a separate violation.⁠¹⁠² After a survey that finds deficiencies, you have 10 business days to return a signed plan of correction. You must fix all deficiencies within 60 days of the exit conference unless OHA grants an extension.⁠² Operating without a license and refusing to cooperate with a survey are violations in their own right.⁠²

If you close, you must notify patients and OHA at least 14 calendar days in advance and tell OHA where the clinical records will go.⁠² You must keep clinical records for seven years after each patient’s last discharge.⁠²

Sources

1. 1
   Oregon State Legislature, ORS chapter 443, Residential Care; Adult Foster Homes; Hospice Programs (ORS 443.004 to 443.105) Checked 12 Oct 2026 · Back to text ↑
2. 2
   Oregon Secretary of State, Oregon Administrative Rules, OAR chapter 333, division 27, Home Health Agencies Checked 12 Oct 2026 · Back to text ↑
3. 3
   Oregon Health Authority, Health Facility Licensing and Certification Program, Home Health Agency License Application Checked 12 Oct 2026 · Back to text ↑
4. 4
   Oregon Health Authority, Health Care Regulation and Quality Improvement, Request for initial home health agency licensure (Initial Letter HHA) Checked 12 Oct 2026 · Back to text ↑
5. 5
   Oregon Health Authority, Health Facility Licensing and Certification Checked 12 Oct 2026 · Back to text ↑
6. 6
   Oregon Health Authority, Home Health Agency Owner/Administrator Background Check Request Checked 12 Oct 2026 · Back to text ↑
7. 7
   Oregon Health Authority, In-Home Care services provided under the Home Health Agency license (attestation, OHA 8953) Checked 12 Oct 2026 · Back to text ↑
8. 8
   Oregon Health Authority, Health Care Regulation and Quality Improvement, Certification Information HHA (Medicare) Checked 12 Oct 2026 · Back to text ↑
9. 9
   Oregon State Legislature, ORS chapter 442, Health Planning (ORS 442.315, certificate of need) Checked 12 Oct 2026 · Back to text ↑
10. 10
    Centers for Medicare & Medicaid Services, Provider Enrollment Moratoria Checked 12 Oct 2026 · Back to text ↑
11. 11
    Federal Register, Announcement of Nationwide Temporary Moratoria on Enrollment of Home Health Agencies (HHAs), 2026-09717 Checked 12 Oct 2026 · Back to text ↑
12. 12
    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 ↑
13. 13
    Oregon State Legislature, Oregon Laws 2026, chapter 59 (HB 4115), criminal records checks Checked 12 Oct 2026 · Back to text ↑
14. 14
    Oregon Secretary of State, Oregon Administrative Rules, OAR chapter 410, division 127, Home Health Care Services (OAR 410-127-0020) Checked 12 Oct 2026 · Back to text ↑

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