Rhode Island home care provider license: RIDOH licensure after the 2026 certificate-of-need change

Rhode Island has no unlicensed companion or homemaker tier. Any agency that sends homemakers or nursing assistants into clients' homes needs a Home Care Provider license from the Rhode Island Department of Health (RIDOH). Until June 12, 2026, a new agency also needed a certificate of need; the FY2027 budget (P.L. 2026, ch. 84) removed home care providers from the certificate-of-need law on that date, but RIDOH's rule and web page still describe the old step, so ask RIDOH which process it applies before you file.

Written by Editorial team Checked against 14 official sources Last reviewed 12 Oct 2026 Updated 11 Nov 2026 How we review

Contents12 sections

Key takeaways

Rhode Island licenses homemaker and personal care agencies as Home Care Providers. No companion-only exemption exists, and only a licensee may advertise as a "home care provider."⁠¹
Until June 12, 2026, a certificate of need was a precondition to initial licensure. The FY2027 budget (P.L. 2026, ch. 84, Article 12) struck "home-care provider" from the certificate-of-need statute effective on passage, June 12, 2026.⁠¹²⁠¹³
As checked on 2026-11-11, RIDOH's licensing rule, fee schedule and Home Care Providers page still describe a Letter of Intent and certificate-of-need application. Get RIDOH's answer in writing before you file either.⁠¹⁠²⁠³
As published on 2026-10-12, the annual license fee is $650.⁠³
A new agency has two years from initial licensure to become accredited by a nationally recognized accrediting body. It must also carry $10,000 per-loss employee bonding and $500,000 per-occurrence liability insurance.⁠¹
RI Medicaid stopped approving new enrollments for home care and personal care provider types 65 and 72 from July 1, 2026, to January 1, 2027.⁠⁹

Quick facts

Agency	RIDOH, Center for Health Facilities Regulation
Certificate of need	Removed from statute June 12, 2026 (P.L. 2026, ch. 84); RIDOH rule not yet updated
Annual license fee	$650 (as published on 2026-10-12)
License term	Calendar year; expires December 31
Accreditation	Within 2 years of initial licensure
Office	Must be located in Rhode Island

Fees from 216-RICR-10-05-2 (effective March 25, 2026), which still lists certificate-of-need fees for home care providers. Licensing standards from 216-RICR-40-10-17 (effective May 6, 2024). Certificate-of-need status checked against P.L. 2026, ch. 84 on November 11, 2026.

What the license covers in Rhode Island

Many states let a companion or housekeeping business run with no license, or with a light registration. Rhode Island does not. The state rule defines a “home care provider” as anyone who “provides, arranges to provide, offers to provide, or in any other way provides for the delivery of any direct health care services in the home requiring supervision by a Registered Nurse (RN),” and it then adds that the term “includes homemaker services” ⁠¹. A homemaker is “a trained non-professional worker who performs related housekeeping services in the home for the sick, disabled, dependent or infirm” ⁠¹. A cleaning-and-errands agency that serves frail or disabled clients is therefore inside the license, not outside it.

The rule also defines personal care services as services that “do not require the skills of a licensed nurse,” including bathing, dressing, grooming, hair and nail care, and help with walking ⁠¹. A home care provider can offer these through nursing assistants supervised by a registered nurse (see below). Under the same license you may also provide nursing service agency (staffing) services, as long as you follow RIDOH’s separate nursing service agency rule ⁠¹.

The one line the Home Care Provider license does not cross is ongoing skilled nursing. The definition “excludes the delivery of direct nursing care by a Registered (RN) or Licensed Practical (LPN) Nurse on an on-going basis” ⁠¹. If your business plan includes RN or LPN visits, or licensed therapists such as PT, OT or speech, you need a Home Nursing Care Provider license. That license can also include home care services ⁠¹.

Two other points from the rule:

Exemption. Organizations that provide volunteer RNs and LPNs to the public do not need a license ⁠¹. The rule contains no other carve-out for small or private-pay agencies.
Title protection. You may not use “home care provider,” “home health care provider” or “other similar term” in advertising unless you hold the license. Operating without one carries a fine of up to $5,000, up to one year in prison, or both, for each offense ⁠¹.

The certificate of need: repealed for home care on June 12, 2026

Until June 12, 2026, this was the step that set Rhode Island apart. The Certificate of Need Act listed “home-care provider” among the healthcare facilities it covered, and establishing a new facility counted as a “new institutional health service” that needed review ⁠⁵. A founder filed a Letter of Intent and then a certificate of need application with the Center for Health Systems Policy and Regulation, and the Health Services Council reviewed the proposal before the Director of Health decided ⁠²⁠⁴.

The FY2027 budget ended that for home care. Article 12, Section 10 of P.L. 2026, ch. 84 (2026-H 7127 Substitute A as amended) rewrites the definitions in § 23-15-2 and strikes “home nursing-care provider, home-care provider” from the list of covered facilities; hospice providers stay on it ⁠¹³. Section 20 says the article “shall take effect upon passage,” and the act was enacted on June 12, 2026 ⁠¹²⁠¹³. The budget adds no moratorium, need test or license cap for home care providers in place of the certificate of need ⁠¹³.

RIDOH’s own documents had not caught up when we checked on 2026-11-11:

The rule. 216-RICR-40-10-17 still says “A certificate of need is required as a precondition to the establishment and initial licensure of any home nursing care provider or home care provider” ⁠¹.
The web page. RIDOH’s Home Care Providers page, last updated January 15, 2025, still calls the Letter of Intent and certificate of need application “a prerequisite to licensure” ⁠².
The fee schedule. 216-RICR-10-05-2 (effective March 25, 2026) still lists certificate of need fees for home care providers ⁠³.

The statute now controls, but RIDOH decides what goes into your file. Before you prepare a Letter of Intent, ask the Center for Health Facilities Regulation in writing whether it still expects one, and how it will review a new application.

What remains in the rule is the licensing review itself. Under § 17.4.2(C), within 10 working days of receiving “an application for initial licensure” in acceptable form, RIDOH gives the public 30 days to comment when practicable, and it decides within 90 days of accepting the application. The decision follows the findings and recommendations of the Health Services Council unless RIDOH explains in writing why it departs from them ⁠¹.

Buying an existing licensed agency follows a different route. It goes through a Change in Effective Control application to the Health Services Council ⁠². RIDOH accepts complete applications for review within 10 working days, and the Council review may take up to 90 days ⁠⁶. The fee runs from $1,500 to $50,000 as published on 2026-10-12 ⁠³.

Fees as published on 2026-10-12

Home Care Provider fees, 216-RICR-10-05-2 (effective March 25, 2026)
Item	Fee
Change in owner, operator or lessee	$1,500 to $50,000
Annual license fee	$650

Source: ⁠³. The same schedule still lists certificate of need application fees for home care providers ($500 plus 0.25% of capital cost, or $750 plus 0.25% for expedited review), set before the June 12, 2026 repeal ⁠³⁠¹³. Fees are payable to the Rhode Island General Treasurer and are non-refundable ⁠¹. You do not pay a second license fee if you move offices during a calendar year that is already paid for ⁠¹.

Who can run the agency

The governing body (your board, members or owners) holds final responsibility for operations, finances and compliance. It must appoint an administrator, set the range of services and define the geographic area you will serve ⁠¹. The administrator must work full time ⁠¹ and must meet one of three tests ⁠¹:

be a licensed physician;
have training and experience in health service administration, plus at least one year of supervisory or administrative experience in home nursing care, home care or related health programs; or
be a registered nurse who meets the qualifications in 42 C.F.R. Part 484.

If the administrator is not a nurse, nursing services must be directed by a Rhode Island-licensed registered nurse who reports to the administrator ⁠¹.

With your license application you must file a notarized list of every direct and indirect owner, with ownership percentages. The list must include anyone holding a mortgage, note or other obligation secured by the agency’s assets, plus corporate officers and directors or partners, and it must be updated every year ⁠¹.

Insurance, accreditation and an in-state office

Three requirements in 216-RICR-40-10-17 shape your startup budget and timeline:

Bonding and liability. You must have written policies for “employee bonding insurance (theft and damage)” of at least $10,000 per loss, and liability insurance of at least $500,000 per occurrence ⁠¹.
Accreditation within two years. “Accreditation by a nationally recognized accrediting body must be achieved within two (2) years of the date on which the home care provider/home nursing care provider is initially licensed,” and you must keep it to stay licensed in good standing ⁠¹. The rule does not name any accrediting body, and § 17.5.1 treats an agency as meeting its quality-improvement requirements if it meets similar requirements of a national accrediting body “as approved by the Director” ⁠¹. Ask RIDOH, before you pick an accreditor, which organizations the Director has approved.
Office in Rhode Island. Each licensee must keep an office in Rhode Island, with space for staff, equipment, supplies and records ⁠¹. You may open branch offices under one license, but clinical records for branch patients must be kept at that branch, and the license must be posted at the central office ⁠¹.

Staff: homemakers, nursing assistants and supervisors

Homemakers must complete a basic training program of 20 hours of classroom instruction plus at least 5 hours of practical experience, and pass the program’s final exam before working ⁠¹. The curriculum must cover:

an orientation to the agency;
basic human needs, including dementia and terminal illness;
infection control;
emergency procedures; and
care of the home, from meal planning to disposal of medical waste ⁠¹.

The rule lists the homemaker’s duties: changing unoccupied beds, grocery shopping, general housekeeping, laundry and ironing, meal preparation, errands, and recording services. You may add other duties in your policies, but never nursing assistant duties ⁠¹.

Homemaker supervision. A Rhode Island-licensed nurse, or a person with a bachelor’s degree in social work, home economics, gerontology or a related field, must supervise homemaker services. That supervisor does the initial in-home assessment and reassesses at least every three months ⁠¹.

Nursing assistants. Hands-on personal care is nursing assistant work, and nursing assistants are governed by RIDOH’s nursing assistant rule (Subchapter 05, Part 22) ⁠¹. A registered nurse or another Rhode Island-licensed professional must:

do an initial in-home assessment before service begins, or within 48 hours if documented extraordinary circumstances prevent that;
supervise on site at least every three months; and
review the plan of care at least every three months ⁠¹.

Every employee. The rule requires the following for all staff:

Background check. Employees with routine patient contact without other employees present need a national fingerprint-based criminal records check through the Attorney General’s Bureau of Criminal Identification. The check must start before, or within one week of, employment, and the employee pays for it ⁠⁷.
Health screening. A pre-employment health screening under RIDOH’s health care worker immunization and testing rule, done before the person delivers services ⁠¹.
Training. Orientation and ongoing in-service training that covers infection control, HIPAA, and recognizing and reporting abuse, neglect, mistreatment and exploitation ⁠¹.
Evaluations. An annual evaluation, reviewed with the employee and signed within 45 days ⁠¹.
Personnel file. It must include an I-9 or equivalent, references checked before hire, criminal check results and training records ⁠¹.
ID badge. A photo badge showing first name, license status, fluency in other languages and position ⁠¹.
Employee status. Workers you supply on a temporary basis count as your employees, not independent contractors ⁠¹.

The license also requires you to provide homemaker, nursing assistant or other therapeutic services either directly or under a written contract with another RIDOH-licensed agency ⁠¹. Any contract must set out who does what and document that the contractor’s staff meet the same licensure, screening and background-check rules ⁠¹.

Policies RIDOH expects to see

The application must show you can comply with Chapter 23-17 and the rule ⁠¹. In practice, the rule requires these documents in place:

bylaws or an equivalent;
an organizational chart, plus policies for each service;
admission and discharge criteria;
a written quality improvement plan with an annual program evaluation ⁠¹;
an emergency preparedness plan that meets 42 C.F.R. § 484.102, reviewed every year ⁠¹;
a 24-hour, seven-day telephone line so patients can reach responsible staff ⁠¹;
an Alzheimer’s and dementia operational plan covering staff training and family resources ⁠¹;
a written patient rights notice, signed by the client before care starts, with copies kept in the record and in the client’s home ⁠¹; and
clinical record policies, with records kept at least seven years after discharge (for minors, seven years after they turn 18) ⁠¹.

Renewal, inspections and closing

A license lasts no more than one year and expires on December 31 after it is issued ⁠¹. RIDOH sends renewal notices 60 days before expiration, and renewals are filed online ⁠². Each renewal is subject to inspection ⁠¹. If inspectors find deficiencies, RIDOH sends a notice within 15 days. You then have 15 days to submit a plan of correction, and RIDOH has 15 days to approve or reject it ⁠¹. Refusing an inspection is grounds for denial, suspension or revocation ⁠¹.

You must notify RIDOH in writing before any change of ownership, operation or location, and before adding or dropping a service ⁠¹. Voluntary closure requires 60 days’ notice and a plan for transferring patients and records ⁠¹.

Medicaid: what the payer rules add

Many Rhode Island home care agencies bill Medicaid. The EOHHS rule (210-RICR-20-05-1) lists the conditions for taking part ⁠⁸:

a RIDOH license;
a location in Rhode Island or a border community; and
a Medicaid provider number before you serve any members.

The same section also lists certification by CMS “to participate in the Medicare program as a provider of home health services” ⁠⁸. The rule does not say how that condition applies to an agency that holds only a Home Care Provider license and offers no skilled home health services. Ask EOHHS Provider Enrollment whether Medicare certification is required for the Medicaid provider type you plan to enroll in.

The billing rules affect how you staff:

Personal care, alone or combined with homemaking, “may only be billed when delivered by a nursing assistant and cannot be billed when delivered by a homemaker” ⁠⁸.
For members not enrolled in long-term services and supports, care needs a physician order and prior authorization, and is capped at 6 hours for an individual or 10 hours for a couple ⁠⁸.
EOHHS pays a shift differential for evenings, nights, weekends and holidays. It pays an enhanced rate to agencies with at least 30% of direct care staff certified in behavioral healthcare training. You must pass 100% of both increases through to the workers who earn them ⁠⁸.

Timing matters right now. EOHHS has a six-month moratorium on new enrollments for Severely Disabled Nursing Homecare (Type 65) and Personal Care Aid/Assistant (Type 72) providers, running from July 1, 2026, to January 1, 2027. “No applications for enrollment will be approved for new providers during this six-month period”; applications submitted before July 1 are not affected ⁠⁹. Watch the EOHHS enrollment page for any extension.

The 2026 bills that did not pass

Two Senate bills introduced in the 2026 session would have changed the certificate of need step in opposite directions:

S 2388 (introduced January 30, 2026) would have barred the Health Services Council from reviewing, and state agencies from issuing, approvals for new home care provider, home nursing care provider and hospice licenses before July 1, 2031, with exceptions that include changes in ownership or effective control. It would also have ordered a statewide utilization and capacity study ⁠¹⁰. Companion House bill H 8214 (introduced February 27, 2026) carried the same moratorium text.
S 2865 (introduced March 4, 2026) would have repealed the certificate of need statute, Chapter 23-15, in its entirety ⁠¹¹.

Both Senate bills were referred to Senate Health and Human Services ⁠¹⁰⁠¹¹. The State Law Revision Office’s list of 2026 public laws, posted August 28, 2026, shows none of S 2388, H 8214 or S 2865 enacted ⁠¹⁴. The budget took the narrower route instead: Chapter 23-15 stays in force, and its definition of healthcare facility still lists hospitals, nursing facilities, hospice providers, inpatient rehabilitation centers and freestanding emergency-care facilities, among others, while home nursing care and home care providers came off the list, effective June 12, 2026 ⁠¹³. The list of 2026 public laws posted August 28, 2026 shows no moratorium on new home care licenses enacted ⁠¹⁴.

For other adult care licenses in the state, see the assisted living residence, adult supportive care home and adult day care program guides, or the Rhode Island overview.

Sources

1
Rhode Island Department of Health, via Rhode Island Department of State, Licensing Home Nursing Care Providers and Home Care Providers (216-RICR-40-10-17), effective May 6, 2024 Checked 12 Oct 2026 · Back to text ↑
2
Rhode Island Department of Health, Home Care Providers Checked 12 Oct 2026 · Back to text ↑
3
Rhode Island Department of Health, via Rhode Island Department of State, Fee Structure for Licensing, Laboratory and Administrative Services Provided by the Department of Health (216-RICR-10-05-2), effective March 25, 2026 Checked 12 Oct 2026 · Back to text ↑
4
Rhode Island Department of Health, via Rhode Island Department of State, Determination of Need for New Health Care Equipment and New Institutional Health Care Services (216-RICR-40-10-22), effective January 4, 2022 Checked 12 Oct 2026 · Back to text ↑
5
State of Rhode Island General Assembly, R.I. Gen. Laws § 23-15-2: Definitions (Determination of Need for New Healthcare Equipment and New Institutional Health Services) Checked 12 Oct 2026 · Back to text ↑
6
Rhode Island Department of Health, Health Services Council review process (Change in Effective Control and Initial Licensure) Checked 12 Oct 2026 · Back to text ↑
7
State of Rhode Island General Assembly, R.I. Gen. Laws § 23-17-34: Criminal records review, nursing facilities, home nursing-care providers and home-care providers Checked 12 Oct 2026 · Back to text ↑
8
Executive Office of Health and Human Services, via Rhode Island Department of State, Home Care and Home Health Providers (210-RICR-20-05-1), effective June 3, 2025 Checked 12 Oct 2026 · Back to text ↑
9
Rhode Island Executive Office of Health and Human Services, Provider Enrollment Checked 12 Oct 2026 · Back to text ↑
10
State of Rhode Island General Assembly, 2026 S 2388: Relating to Health and Safety, Determination of Need (moratorium bill) Checked 12 Oct 2026 · Back to text ↑
11
State of Rhode Island General Assembly, 2026 S 2865: Relating to Health and Safety, Determination of Need (repeal bill) Checked 12 Oct 2026 · Back to text ↑
12
State of Rhode Island General Assembly, P.L. 2026, ch. 84 (2026-H 7127 Substitute A as amended), FY2027 appropriations act, enacted June 12, 2026 Checked 11 Nov 2026 · Back to text ↑
13
State of Rhode Island General Assembly, P.L. 2026, ch. 84, Article 12 (Relating to Health Care), Sections 10 and 20 Checked 11 Nov 2026 · Back to text ↑
14
State of Rhode Island General Assembly, State Law Revision Office, 2026 Public Laws, list by subject Checked 11 Nov 2026 · Back to text ↑

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Rhode Island and neighboring states

Compare all 51

Non-medical home care agency licensing in Rhode Island and neighboring states: license, size threshold and state fee
State	License	Who needs it	State fee
Rhode Island (this guide)	Home Care Provider license	Any in-home care or homemaker agency; no certificate of need since June 12, 2026	$650
Connecticut	Homemaker-Companion Agency registration	Any agency with 1+ employee giving companion or homemaker services	$375 to apply, $375 a year to renew

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.