Rhode Island home nursing care provider license: RIDOH rules after the 2026 CON change
In Rhode Island, an agency that sends its own RNs, LPNs or licensed therapists into clients' homes needs a Home Nursing Care Provider license from the Rhode Island Department of Health (RIDOH). Rhode Island does not issue a license called "home health agency." The FY2027 state budget (P.L. 2026, ch. 84) took home nursing care providers out of the certificate-of-need statute on June 12, 2026, but RIDOH's rule and web page still describe the old certificate-of-need route, so ask RIDOH which process it is using before you file.
Contents15 sections
Key takeaways
- Until June 12, 2026, a new home nursing care provider needed a certificate of need. Article 12 of the FY2027 budget (P.L. 2026, ch. 84, 2026-H 7127 Sub A as amended) removed "home nursing-care provider" and "home-care provider" from the healthcare facilities covered by Rhode Island's certificate-of-need law, effective on passage, June 12, 2026.1314
- As checked on 2026-11-11, RIDOH's licensing rule (effective May 6, 2024) and its Home Nursing Care Providers page still say a certificate of need must come first. Ask RIDOH how it is processing new applications before you start a Letter of Intent.12
- The rule requires bonding of at least $10,000 per loss, liability insurance of at least $500,000 per occurrence, a Rhode Island office, a 24-hour phone line, and national accreditation within two years of your first license.1
- RIDOH's fee schedule (effective March 25, 2026) lists a $650 annual license fee. Every license expires on December 31.61
- Rhode Island Medicaid pays only home health providers that are Medicare-certified. CMS has been denying initial Medicare enrollment applications from home health agencies since May 13, 2026, so a new agency cannot count on Medicaid home health revenue yet.910
Quick facts
| Agency | RIDOH, Center for Health Facilities Regulation, 401-222-5960 |
|---|---|
| Law | R.I. Gen. Laws ch. 23-17; rule 216-RICR-40-10-17 |
| Annual license fee | $650 (as published on 2026-10-12) |
| Insurance | Bonding $10,000 per loss; liability $500,000 per occurrence |
| Accreditation | National accreditation within 2 years of initial licensure |
| Certificate of need | Removed from statute June 12, 2026 (P.L. 2026, ch. 84); rule not yet updated |
| License term | Up to 1 year, expires December 31 |
Fee from 216-RICR-10-05-2, effective March 25, 2026, checked October 12, 2026. That schedule still lists certificate-of-need fees for home nursing care providers. They were published before the June 12, 2026 budget change.
Home nursing care provider or home care provider
Rhode Island licenses in-home agencies under one rule, 216-RICR-40-10-17. The rule creates two licenses, and the difference between them is whether licensed nurses deliver care on an ongoing basis.1
- Home nursing care provider. Delivers “direct nursing services in the home” by an RN or LPN, or therapeutic services from a licensed professional. The rule’s examples of therapy are infusion, respiratory, occupational, speech and physical therapy that appear in the patient’s care plan. A home nursing care provider may also offer home care provider services, and nursing service agency services if they meet Part 10 of the same subchapter.1
- Home care provider. Delivers health services that need RN supervision, such as nursing assistant and homemaker services. It may not provide direct RN or LPN nursing “on an on-going basis.” See the Rhode Island home care provider guide.1
If your plan includes skilled visits, wound care, infusion or therapy, you need the home nursing care license. The rule requires a home nursing care provider to deliver RN or LPN nursing itself or under contract with another RIDOH-licensed agency. Homemaker, nursing assistant and therapy services are optional, and each may be provided directly or by contract.1
Two more points about who needs the license:
- Volunteer nurse groups are exempt. An organization that provides volunteer RNs and LPNs to the public does not need a license.1
- The name is protected. Without a license you may not advertise yourself as a “home nursing care provider,” a “home health care provider” or anything similar. Operating without a license carries a fine of up to $5,000, up to one year in prison, or both, for each offense.1
A home nursing care license is also one of the few routes to Rhode Island’s two-to-five-resident adult supportive care homes, which only existing licensed providers may operate.
The 2026 certificate-of-need change
Until June 12, 2026, opening a home nursing care agency in Rhode Island meant getting a certificate of need (CON) first. R.I. Gen. Laws 23-15-2, as compiled through the 2025 session, listed “home nursing-care provider” and “home-care provider” among the healthcare facilities covered by the CON law. Establishing a new healthcare facility counts as a “new institutional health service,” so a new agency needed a CON.43
The FY2027 budget, 2026-H 7127 Substitute A as amended, changed that. It was enacted on June 12, 2026 as P.L. 2026, ch. 84.13 Article 12, Section 10 rewrites the definitions in 23-15-2 and strikes “home nursing-care provider, home-care provider” from the list of covered facilities. Hospice providers remain on the list. Section 20 says the article “shall take effect upon passage,” so the change took effect on June 12, 2026.143 The budget puts no moratorium, need test or license cap on home nursing care providers in the certificate of need’s place.14 The General Laws page for 23-15-2 posted online still showed the pre-2026 wording on November 11, 2026.4
RIDOH’s own documents had not caught up when checked on November 11, 2026:
- The rule. 216-RICR-40-10-17, in force since May 6, 2024, still says “a certificate of need is required as a precondition to the establishment and initial licensure” of a home nursing care provider.1
- The web page. RIDOH’s Home Nursing Care Providers page, last updated January 15, 2025, still says to file a Letter of Intent and then a CON application with the Center for Health Systems Policy and Regulation.2
- The fee schedule. 216-RICR-10-05-2, effective March 25, 2026, still lists CON application fees for home nursing care providers: $500 plus 0.25% of capital cost, or $750 plus 0.25% for expedited review.6
A statute overrides an older rule, but RIDOH decides what goes in your file. Before you spend money on a CON application, call the Center for Health Facilities Regulation at 401-222-5960 and ask two questions: whether it still expects a Letter of Intent, and whether a new application will go before the Health Services Council.2 RIDOH’s published materials do not say how it has handled new applications since June 12, 2026, so get its answer in writing.
If RIDOH still asks for a CON after June 12, 2026, the CON rule sets the process. The Letter of Intent is due at least 45 days before the application. Regular-review applications are due by 4:30 p.m. on January 10 or June 10, and RIDOH may decide within 120 days after it notifies affected parties.5
The licensing review in the rule
The rule’s own review procedure is in section 17.4.2(C). It covers “an application for initial licensure or for a license in connection with a change in the owner, operator or lessee,” and sends certificate-of-need review to Part 22 instead:1
- RIDOH has 10 working days from receiving an application “in acceptable form” to give the public notice and a 30-day comment period, when practicable.
- RIDOH decides within 90 days of accepting the application.
- RIDOH bases its decision on the findings and recommendations of the Health Services Council, unless it puts in writing why it disagrees.
RIDOH’s Office of Health Systems Development publishes the same three-phase process (a completeness check within 10 working days, public Health Services Council review, and up to 90 days for review and decision). Its page describes that process for a Change in Effective Control and lists initial licensure only for other facility types, so it does not settle how a new home nursing agency is reviewed.8
The rule’s Council criteria are written for change-of-owner reviews, and the applicant carries the burden of proof. A new owner should expect questions on:1
- Track record. The character, commitment, competence and standing in the community of the owners, operators and directors. If any of them owned, operated or directed a health care facility in the past five years, in Rhode Island or elsewhere, their record on safe care, quality improvement and access counts.
- Who is behind the applicant. A complete disclosure of every individual and entity that makes up the applicant.
- Money. The financial commitment, the amount and source of owner’s equity, and the short- and long-term feasibility of the financing plan.
- Quality and access. How credible the quality assurance program is, and plans to serve traditionally underserved populations.
What the application must contain
You apply on RIDOH forms, with “evidence of ability to comply” with Chapter 23-17 and the rule.1 The rule sets these specific items:
- A notarized ownership list. Names and addresses of every direct and indirect owner, with ownership percentages. The list also covers anyone holding a mortgage, note or other obligation secured by the agency, the officers and directors of corporate owners, and all partners. You must update it every year.1
- Office locations. The central office plus every branch office. You can run branches under one license, but the license is posted at the central office, and each branch must keep the clinical records of the patients it serves.1
- The fee. The fee is non-refundable and payable to the Rhode Island General Treasurer.1 The fee schedule lists a $650 annual licensure fee (as published on 2026-10-12).6
The rule makes your governing body responsible for adopting or maintaining the following:1
- Bylaws.
- A defined range of services and geographic service area.
- Written policies on referrals, transfer of patient information, and staff screening.
- A written agency-wide quality improvement plan.
- An emergency preparedness plan that meets 42 C.F.R. § 484.102, the Medicare home health standard, reviewed every year.
- Back-up plans for system or equipment failures.
The rule also requires an operational plan for recognizing and managing patients with Alzheimer’s disease or dementia.1
Insurance, office and phone line
Your governing body must adopt policies for carrying two kinds of coverage:1
- Employee bonding (theft and damage): at least $10,000 per loss.
- Liability insurance: at least $500,000 per occurrence.
You must keep an office in Rhode Island with enough room for staff, equipment, supplies and records. Patients and staff must be able to reach responsible staff by phone 24 hours a day, seven days a week.1
Administrator, nursing direction and the advisory committee
You need a full-time administrator who meets one of three tests:1
- a Rhode Island-licensed physician;
- someone with training and experience in health service administration and at least one year of supervisory or administrative experience in home nursing care, home care or related programs; or
- a registered nurse who meets the qualifications in 42 C.F.R. Part 484.
If the administrator is not a nurse, the nursing service must be directed by an RN licensed in Rhode Island.1
Only home nursing care providers (not home care providers) must also set up a Professional Advisory Committee:1
- Members. At least one physician, one registered nurse, and a representative of each therapy you offer. The administrator sits as an ex officio member, and at least one member must be neither an owner nor an employee.
- Meetings. At least twice a year. The physician must attend at least one meeting a year.
- Duties. The committee reviews, every year, your scope of services, admission and discharge policies, plans of care, clinical records, personnel qualifications and program evaluation.
Staff: screening, training and supervision
| Requirement | What Rhode Island requires |
|---|---|
| Criminal records check | National, fingerprint-based check through the Attorney General’s Bureau of Criminal Identification for staff who have routine patient contact with no other employee present. The employee pays the cost.7 |
| Health screening | Before the employee delivers any services, under RIDOH’s health care worker screening rule 216-RICR-20-15-7.1 |
| License verification | Check staff licenses electronically in RIDOH’s licensure database.1 |
| Employment status | People you place are your employees, not independent contractors.1 |
| In-service training | Ongoing, including infection control, HIPAA, and recognizing and reporting abuse, neglect, mistreatment and exploitation.1 |
| Performance reviews | Every year, reviewed with and signed by the employee within 45 days of the evaluation.1 |
| Homemakers | 20 classroom hours plus at least 5 hours of practical experience, then a passed final exam.1 |
| Nursing assistant supervision | An RN does an in-home assessment before service starts, or within 48 hours if documented extraordinary circumstances prevent it. After that, an RN supervises on site and reviews the plan of care at least every three months.1 |
If the background check turns up disqualifying information, the employer decides whether to keep the employee.7 The rule requires that judgment to be made promptly.1
The rule has no fixed staff-to-patient ratio. It requires “a sufficient number of qualified personnel.”1
Patient care rules surveyors check
- Clinician orders. Patients receiving medical services must be under an attending clinician who orders the plan of care. The clinician and your staff review the plan at least every 60 days from the start of care. The patient gets a copy of the plan and of the scheduled service hours.1
- Patient rights. Each patient receives a written notice of their rights before care begins. A signed copy goes in the record and another stays in the patient’s home.1
- Referral disclosure. If you refer a patient to a facility in which you have a financial interest, you must tell the patient in writing and offer RIDOH’s list of alternative providers.1
- Records. Keep clinical records for at least seven years after discharge. For a minor, keep them seven years after the patient turns 18.1
Uncompensated care: a home nursing-only condition
A home nursing care provider must meet Rhode Island’s community standard for uncompensated care as a condition of its first license and of every renewal. The standard is 1% of net patient revenue each year, cost-adjusted with the ratio of costs to charges from the Medicare cost report. Agencies that do not file Medicare cost reports must submit an audited financial report, or another report the Director accepts.1 Home care providers are not subject to this requirement. Budget for free or written-off care, and plan the audit cost if you will not file Medicare cost reports.
Accreditation within two years
Your agency must earn accreditation from a nationally recognized accrediting body within two years of the date of its first license, and keep it to stay in good standing.1 The rule does not name the accrediting bodies.
Medicare, Medicaid and the federal freeze
Rhode Island’s Medicaid home health manual says providers must be licensed by RIDOH, located and working in Rhode Island (except for listed border communities), and “certified to participate in the Medicare program.”9 A Medicaid home health business therefore depends on Medicare certification first.
As of October 12, 2026, that step was blocked. CMS stopped accepting initial Medicare enrollment applications from home health agencies nationwide effective May 13, 2026, for six months. The moratorium can be extended in six-month increments.1012 CMS’s guidance to state survey agencies adds:11
- Initial applications filed during the moratorium are denied and must be filed again after it ends.
- Accreditation will not produce Medicare deemed status for a new agency while the moratorium lasts.
As of October 12, 2026, no extension notice had been found. CMS left decisions about Medicaid moratoria to each state.10 No Rhode Island Medicaid home health moratorium was found.
A RIDOH license on its own still lets you serve private-pay clients. If you are relicensing, keep in mind that the Medicaid manual requires your RIDOH renewal to reach Gainwell Technologies at least five business days before the December 31 expiration.9
Renewal, inspections and closing
- Renewal. Licenses run no more than one year and expire on December 31. Renewal requires inspection and RIDOH approval, and RIDOH takes renewals online.12 Moving your office within a year you have already paid for costs no extra license fee.1
- Inspections and corrections. RIDOH may inspect at any time, including medical records, and refusing an inspection is grounds for denial or revocation. RIDOH sends a notice of deficiencies within 15 days of an inspection. Your plan of correction is due within 15 days of that notice.1
- Selling the agency. A license cannot be transferred. A change in owner, operator or lessee needs a Change in Effective Control application and Health Services Council review.2 The fee schedule lists $1,500 to $50,000 for that application (as published on 2026-10-12).6
- Closing. Tell RIDOH 60 days before you voluntarily stop operating, and send a plan for transferring patients, handling records and notifying the public.1
What to watch in 2026 and 2027
- Rule updates. Watch for RIDOH to amend 216-RICR-40-10-17 and the fee schedule to match Article 12. The sources checked show no amendment after the May 6, 2024 rule version and the March 25, 2026 fee schedule; ask RIDOH whether one is pending.16
- The federal moratorium. Its first six-month period runs to about mid-November 2026. An extension or an early end would be announced in the Federal Register and on CMS’s moratoria page.1012
Sources
- 1
- 2 Rhode Island Department of Health, Home Nursing Care Providers Checked 12 Oct 2026 · Back to text ↑
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
- 11
- 12 Centers for Medicare & Medicaid Services, Provider Enrollment Moratoria Checked 12 Oct 2026 · Back to text ↑
- 13
- 14
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Related guides
- Rhode Island home care provider license: RIDOH licensure after the 2026 certificate-of-need changeRhode Island · Non-medical home care agency
- Rhode Island adult supportive care homes: 2 to 5 residents, existing providers onlyRhode Island · Small residential care home
- Rhode Island assisted living residence license: RIDOH levels, fees and stepsRhode Island · Assisted living facility
- Rhode Island adult day care program license: RIDOH rules, staffing and the no-fee applicationRhode Island · Adult day care
Rhode Island and neighboring states
Compare all 51| State | License | Who needs it | State fee |
|---|---|---|---|
| Rhode Island (this guide) | Home Nursing Care Provider license | Own nurses or therapists in homes; no certificate of need since June 12, 2026 | $650 |
| Connecticut | Home Health Care Agency license (and Homemaker-Home Health Aide Agency license) | Nursing plus another home service, 24 hours a day, in patients' homes | $300 per agency plus $100 per satellite office (statute, checked 2026-10-12) |
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.