South Carolina home health agency license: certificate of need first, then DPH licensure

Certificate of need still applies to home health

Many founders read that South Carolina repealed certificate of need in 2023 and assume home health is now open entry. It is not. Act No. 20 (effective May 16, 2023) rewrote S.C. Code 44-7-160 so that the general CON requirement covers nursing homes, with hospital projects covered until January 1, 2027.⁠⁶ But home health has its own CON clause in the home health statute. S.C. Code 44-69-75(A) says: “A home health agency shall obtain a Certificate of Need before licensure.” That section was amended again in 2024 (Act No. 164, effective May 20, 2024) and the requirement stayed in place.⁠¹

DPH reads the law the same way. When it briefed its board on Act 20, it listed home health agencies, along with nursing homes and hospitals, as still needing a CON.⁠⁷ The 2026 South Carolina Health Plan, published July 1, 2026, restates that a home health agency “shall obtain a CON before licensure”.⁠¹⁰ The program’s August 2026 update shows it at work: one new home health agency in Florence was approved on August 5, 2026, and a statewide specialty agency limited to nursing services was approved on August 26, 2026. Several other home health applications were still under review.⁠¹¹

Only two groups are exempt. The first is agencies that were providing home health services before July 1, 1980. The second is a multi-level continuing care retirement community with a skilled nursing facility that serves only its own contract residents, meets the home health licensing standards, and leaves residents free to use other agencies.⁠¹

If you are unsure whether your project needs a CON, you can ask the CON program in writing for a formal determination. Staff will not give one by phone.⁠⁸⁠⁹

Is your service home health at all?

South Carolina defines home health services as part-time or intermittent skilled nursing plus at least one other service. The nursing must be ordered by a physician, an APRN or a PA, and be provided by or under the supervision of a registered nurse. The other service can be:⁠¹

• physical, occupational or speech therapy;
• medical social services, home health aide services or other therapeutic services;
• medical supplies and the use of medical appliances; or
• any of these provided on an outpatient basis through arrangements with a hospital, nursing home or rehabilitation center, when the equipment cannot readily be brought to the home.

APRNs and PAs were added as ordering providers by Act No. 55 of 2021.⁠¹ Under Regulation 60-77, “intermittent” means less than daily, or less than eight hours a day if care is daily.⁠² Any public, nonprofit or for-profit organization that offers these services must be licensed, and so must any business that represents itself as providing home health services.⁠¹

Two neighboring business models fall outside this license:

• Non-medical personal care (bathing, dressing, help with walking, meals, medication reminders) needs an in-home care provider license under Regulation 60-122 (the 2015 memo cites it as Regulation 61-122). Home health agencies are excluded from that license.⁠⁵ See the South Carolina in-home care provider guide.
• Private duty nursing (continuous, long-term skilled nursing) is not regulated by DPH, according to its 2015 guidance memo. DPH expects an in-home care provider that also offers private duty nursing to run the two as separate lines of business.⁠⁵

Regulation 60-77 also requires a separate license for each type of care on the same premises, even under one owner.⁠²

Choosing counties: the decision that drives both approvals

In South Carolina, the county is the unit of planning, licensing and fees. That makes it your first business decision.

• CON. You must propose to cover the whole of each county and to serve residents throughout it, and you need an application for every county you name.⁠¹⁰
• License. The license lists counties on its face. You “shall provide services only in the county(ies) identified on the face of the License and shall provide services to the entire county(ies)”. DPH classes this standard as a Class I violation, its most serious category.⁠²
• Fees. The license fee and the inspection fee both rise with each county. Adding a county later requires an amended license and $50 per added county.⁠²

The licensing form lists all 46 South Carolina counties as checkboxes.⁠⁴

What the State Health Plan asks you to prove

The 2026 State Health Plan sets the CON standards for home health:⁠¹⁰

• Patient volume. DPH may approve a new agency, or an expansion of an existing one, if you show you will serve 50 or more patients projected to be in need in a non-rural county, or 25 or more in a rural county. A county is rural if its population is under 50,000.
• Evidence. This can include letters of support from physicians and other referral sources, underuse of home health services, missing services, waiting lists or delays, or existing agencies that have not met the minimum patient counts.
• Missing services. All six home health services should be available in each county: skilled nursing, physical, occupational and speech therapy, home health aide and medical social work. If a county has no hospital and its current agencies do not offer all six, that gap can justify a new agency.
• Track record. You should have no history of prosecution, consent orders, abandoning patients or losing a license. You must list every home health agency you operate and the states they are in.
• Two-year volume test. Within two years of starting services, you must serve at least 25 patients a year in each rural county and 50 in each non-rural county. You must agree in advance to give up your license for any county where you fall short.
• No one-agency limit. The plan says nothing in it stops DPH from approving more than one new agency in a county at a time.

DPH weighs five review criteria most heavily for home health: compliance with the Plan’s need, community need documentation, accessibility, quality of care and medically underserved groups. The Plan states that “the benefits of improved accessibility outweigh the adverse effects caused by the duplication of any existing service”.⁠¹⁰ DPH decides each application under the Plan in effect when it accepted the application.⁠⁹ The Plan ends its home health chapter with an inventory of licensed agencies by county.⁠¹⁰

Specialty and pediatric agencies

Specialty home health providers do not have to meet the need calculation, but they still need a CON.⁠¹⁰ The Plan also allows an exception for a pediatric agency limited to intermittent skilled nursing for patients 18 or younger. You must show unmet need in the county and describe the full range of pediatric services. The license is then restricted to children, and the agency is not counted in county inventories.⁠¹⁰ SC Medicaid’s home health manual (August 1, 2022 edition) says only one pediatric agency per county is issued a CON. The 2026 Plan does not state that limit, and nothing in the sources I checked says whether DPH still applies it. Ask the CON program in writing whether a pediatric CON is available in your county before you invest in an application.⁠¹³

The CON filing, step by step

Regulation 60-15 sets the procedure and the clocks.⁠⁹

1. Publish notice

   Within the 20 calendar days before you submit, publish a notice of your application in the legal section of a daily newspaper serving the project area for three consecutive days. DPH will not accept the application without the newspaper’s proof of publication.

2. File online with the filing fee

   Submit through DPH’s web-based CON application. A non-refundable $500 filing fee must reach DPH within 20 calendar days of the notice and application. Questions about the web application go to [email protected].⁠⁸

3. Completeness review

   DPH may ask for more information within 15 calendar days of accepting the application. You then have 15 calendar days to answer, or the application is deemed withdrawn.

4. Application fee

   Once the application is complete, DPH invoices you by certified mail for 0.5% of the total project cost, capped at $7,000. You have 15 days to pay. Recent home health projects have reported small totals: the August 2026 update lists new agencies at $1,000, $13,500 and $15,000, and a pediatric expansion at $15,575.⁠¹¹ On a $15,000 project the fee would be $75.

5. Review criteria notice

   DPH tells you which review criteria matter most. You have 30 days to add information.

6. Public review

   DPH publishes the start of the review in the State Register. Affected persons, including existing agencies serving the area, have 30 days to request a public hearing. DPH decides no sooner than 30 and no later than 90 days after publication, or within 120 days if a hearing is held. An affected person who told DPH of their opposition during staff review can seek final review of the decision.

7. Issuance

   The $7,500 issuance fee applies only to projects costing more than $1,400,000, which is unusual for home health.

8. Implement within a year

   The CON becomes void 12 months after issuance unless the project is implemented. Under Regulation 60-15, DPH may grant up to two extensions of up to nine months each, and you must request each one at least 30 days before expiry. DPH’s August 2026 update says Act No. 146 (effective May 15, 2026) now lets the DPH director grant further nine-month extensions, but only on a finding of substantial progress.⁠¹¹ You must file quarterly progress reports against your approved timetable, starting 90 days after you receive the CON.

Licensing with DPH under Regulation 60-77

With the CON in hand, you apply for the license itself. The application is Form 3289-ENG-DPH (revision 07/2025). DPH prefers to receive it by email at [email protected]. You can also mail it to the Bureau of Health Facilities Licensing, P.O. Box 2046, West Columbia, SC 29171. The bureau’s phone number is 803-545-4370.⁠⁴

Your agency name must not match or resemble the name of any other licensed South Carolina home health agency. If you are part of a chain, the name must include the geographic area where the agency is located.⁠²

DPH inspects every agency before initial licensing. It will not issue the license until you show “substantial compliance” with Regulation 60-77. If you already hold another DPH license, that facility must also be in substantial compliance first. Keep a paper or electronic copy of the regulation at the agency where all staff can reach it.⁠²

You may not admit any patient before the license’s effective date. DPH can order an unlicensed operation to stop immediately, and operating without a license is also a misdemeanor punishable by a fine of up to $500, up to six months in jail, or both.⁠¹⁠²

The license applies to the named agency at its listed locations. You cannot sell or transfer it. Branch offices go on the application. A subunit, which is too far away to share administration with the parent agency daily, must be licensed separately.⁠¹⁠²

Fees as published

At these rates, a one-county license costs $150 and a license for all 46 counties costs $2,400. The routine inspection fee for the same two cases is $275 and $1,400. License fees cannot be refunded under the regulation, and governmental agencies are exempt.⁠² Your annual license fee also includes any inspection fees you still owe.⁠²

Staff the regulation names

Regulation 60-77 sets no nurse-to-patient ratios. It requires these positions and checks:⁠²

• Administrator. A full-time administrator who is a physician, APRN or PA, a registered nurse, or someone with training and experience in health service administration and at least one year of supervisory administrative experience in home health or a related healthcare program. You must also name in writing who acts when the administrator is absent.
• Clinical manager. A physician, other authorized healthcare provider or registered nurse who supervises clinical work under each patient’s orders and treatment plan.
• Licensed disciplines. Therapists must hold South Carolina licenses from their boards. A medical social worker needs an LMSW or LISW plus one year of social work experience in health care.
• Health assessment and TB. Every staff member with patient contact needs a documented health assessment within 12 months before first patient contact. Each also needs a baseline two-step tuberculin skin test, or a single blood assay, within three months before contact. All staff need TB training every year.
• Written roles. You must define each position’s duties, qualifications and competencies in writing, and keep a job description signed by each staff member.

Every direct caregiver needs a criminal record check under S.C. Code 44-7-2910 before you hire or contract with them.⁠²⁠⁶ If the person can prove 12 months of South Carolina residency, a state check is enough. Otherwise you run a state check before hiring and start a federal check after.⁠⁶ Staff and volunteers may not have a conviction or no-contest plea for unlawful conduct toward a child or for abuse, neglect or exploitation of a vulnerable adult.⁠²

For fingerprint checks, you email DPH’s authorization form to [email protected]. DPH then issues a service code for fingerprinting with an approved vendor such as IdentoGO. SLED requires that you already have a valid relationship with the applicant when they are fingerprinted.⁠¹²

Policies and plans DPH inspects against

DPH expects these to be written and in use when it inspects:⁠²

• policies covering how you meet each part of the regulation, reviewed at least every two years and signed by the administrator;
• an emergency preparedness plan, updated at least once a year, plus a continuity plan for power or water outages and staff absences;
• infection control practices that follow OSHA’s bloodborne pathogens standard, and an annual TB risk assessment;
• a quality improvement program covering risk management and infection control, with a way to collect feedback from patients and their representatives;
• a written agreement with every contractor that delivers patient care;
• patient rights notices and an informed consent form that includes DPH’s contact details for complaints;
• procedures to keep unauthorized users out of patient records.

Several clinical deadlines are also fixed by rule:⁠²

• Complete each patient’s comprehensive assessment within five business days of admission.
• Make sure verbal orders are taken only by a licensed nurse or licensed therapist.
• Send records to a receiving provider within two business days after you are notified of a transfer.
• Finish each patient record within 30 days of discharge, and keep it for 10 years.

Admissions must not depend on how the patient pays, provided the payment offered is not less than the cost of the service.⁠¹⁠² Rebates, kickbacks and fee-splitting are prohibited.⁠¹

Inspections, reporting and penalties once you are open

The statute requires DPH to inspect each licensed agency at least once a year.⁠¹ Inspections can be unannounced. When no staff are in the office, you must post a notice at the entrance with a designated contact and the expected return time. The contact’s phone number cannot be the agency’s own number.⁠² If DPH cites deficiencies, you return a written plan of correction by the date on the report.⁠²

You report serious incidents to DPH within 24 hours. These include suspected abuse, neglect or exploitation by staff, medication errors with adverse effects, fractures, and hospital admissions or deaths that follow an incident. A written investigation report is due within five calendar days.⁠² You also report administrator changes within 72 hours, with full details within 10 days. If you close, you must notify DPH at least five business days beforehand.⁠² Every agency also files a Joint Annual Report with the Revenue and Fiscal Affairs Office.⁠²

Scroll the table sideways to see every column.

Source: Reg. 60-77 §302.E.⁠²

Renewal and changes

The statute makes each license valid for 12 months. The regulation leaves the license period to DPH.⁠¹⁠² To renew, you file the form and fee and must have no pending enforcement action. If you have not paid within 30 days after expiration, your agency becomes unlicensed.⁠²

You need an amended license before you move the office, change the name or address, change counties or open a branch.⁠² Adding a county also needs a CON, since applications are required for each county you want to serve.⁠¹⁰ A change of controlling interest, or a change of legal entity (for example, from a sole proprietorship to an LLC), needs a brand-new license, even if the owners stay the same.⁠² At a change of ownership, active patient records must be transferred to the new owner.⁠²

Medicare and SC Medicaid in 2026

A DPH license lets you operate, but most home health revenue comes from Medicare and Medicaid. Both are closed to new South Carolina agencies for now:

• Medicare. CMS put a six-month nationwide moratorium on Medicare enrollment of new home health agencies, branches and practice locations, effective May 13, 2026. It can be extended in six-month periods.⁠¹⁴ During the moratorium, accreditation will not get you Medicare participation through deemed status.⁠¹⁵ Once it is lifted, an agency that applies within six months is screened at the “high” level.⁠¹⁴
• SC Medicaid. The SCDHHS Home Health Services Provider Manual (August 1, 2022 edition) requires an agency to be Medicare-certified and to have an approved CON before it can contract with SCDHHS to serve Medicaid members. The one stated exception is pediatric home health, where the manual accepts CHAP accreditation in place of Medicare certification for Medicaid-only providers.⁠¹³

The CMS notice left Medicaid moratoria to each state.⁠¹⁴ Because SC Medicaid requires Medicare certification for general agencies, the federal freeze also blocks them from SC Medicaid in practice. Ask SCDHHS whether a pediatric agency can enroll through CHAP accreditation while the moratorium lasts.

The first six months end on or about November 13, 2026. CMS says it will publish any extension or lifting in the Federal Register, and no extension notice had been published as of October 12, 2026.⁠¹⁴ Check the Federal Register before you plan a Medicare enrollment date.

Recent changes and the agency name

• Agency name. Health facility licensing moved from DHEC to the S.C. Department of Public Health. Regulation 60-77 now names DPH, while the statute’s definitions still say DHEC.⁠¹⁠²
• Regulation. Regulation 60-77 was last amended in the State Register on May 23, 2025.⁠²
• Forms and guidance. DPH’s application form carries a 07/2025 revision date, and its home health page was updated November 10, 2025.⁠³⁠⁴
• CON. Act 20 of 2023 did not touch S.C. Code 44-69-75. The section was last amended by Act No. 164 of 2024, and the CON requirement survived that amendment.⁠¹⁠⁷

Sources

1. 1
   South Carolina Legislature, S.C. Code Title 44, Chapter 69: Licensure of Home Health Agencies Act Checked 12 Oct 2026 · Back to text ↑
2. 2
   South Carolina Department of Public Health, Regulation 60-77, Standards for Licensing Home Health Agencies Checked 12 Oct 2026 · Back to text ↑
3. 3
   South Carolina Department of Public Health, Home Health Agencies Checked 12 Oct 2026 · Back to text ↑
4. 4
   South Carolina Department of Public Health, Licensure Application, Home Health Agency (Form 3289-ENG-DPH, 07/2025) Checked 12 Oct 2026 · Back to text ↑
5. 5
   South Carolina Department of Public Health, Distinctions between in-home care services and home health services (memo, August 13, 2015) Checked 12 Oct 2026 · Back to text ↑
6. 6
   South Carolina Legislature, S.C. Code Title 44, Chapter 7: Hospitals, Tuberculosis Camps, and Health Services Districts (CON Act; criminal record checks of direct care staff) Checked 12 Oct 2026 · Back to text ↑
7. 7
   South Carolina Department of Public Health, Partial Repeal of Certificate of Need, Act 20 (board presentation, June 8, 2023) Checked 12 Oct 2026 · Back to text ↑
8. 8
   South Carolina Department of Public Health, Certificate of Need (CON) Checked 12 Oct 2026 · Back to text ↑
9. 9
   South Carolina Department of Public Health, Regulation 60-15, Certification of Need for Health Facilities and Services Checked 12 Oct 2026 · Back to text ↑
10. 10
    South Carolina Department of Public Health, 2026 South Carolina Health Plan Checked 12 Oct 2026 · Back to text ↑
11. 11
    South Carolina Department of Public Health, Certificate of Need Update, August 2026 Checked 12 Oct 2026 · Back to text ↑
12. 12
    South Carolina Department of Public Health, Background Checks for Direct Caregivers Checked 12 Oct 2026 · Back to text ↑
13. 13
    South Carolina Department of Health and Human Services, Home Health Services Provider Manual (August 1, 2022) Checked 12 Oct 2026 · Back to text ↑
14. 14
    Centers for Medicare & Medicaid Services, Announcement of Nationwide Temporary Moratorium on the Enrollment of New Home Health Agencies and Hospices (Federal Register, May 15, 2026) Checked 12 Oct 2026 · Back to text ↑
15. 15
    Centers for Medicare & Medicaid Services, QSO-26-11-HHA/Hospice: Nationwide enrollment moratorium Checked 12 Oct 2026 · Back to text ↑

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