Utah home health agency license: R432-700, DACS clearances and the two-year fee

Does your business need this license?

Utah defines a home health agency by headcount and service type. It is an agency, organization or facility, or a subdivision of one, that “employs two or more direct care staff persons” who provide licensed nursing services, physical, speech or occupational therapy, medical social services, or home health aide services “on a visiting basis” ⁠¹. Home health agencies count as health care facilities under Utah Code Title 26B, Chapter 2, Part 2. No one may establish, conduct or maintain one without a license from the Department of Health and Human Services (DHHS) ⁠¹⁠².

Two points set the edges:

• Solo licensed professionals are outside it. The statute excludes “an individual who provides services under the authority of a private license,” and R432-700 says the rule does not apply to a single individual practicing under their own professional license or registration ⁠¹⁠⁴. Once you hire a second nurse or an aide, you are an agency.
• Non-medical help needs a different license. Utah licenses personal care agencies separately under R432-725. That covers two or more people helping with activities of daily living on a visiting basis, limited to tasks that need no direct intervention or supervision by a licensed health professional ⁠¹⁵. If you will not offer nursing or therapy, start with the Utah personal care agency license. A home health license can include personal care aides, as described below. The reverse is not true.

Hospice is also its own category. The FY2027 fee brief lists separate “Hospice Agencies” and “Home Health Agencies” fees ⁠¹⁰.

R432-700 frames home health as skilled care. Admission must rest on “an assessment that the client needs skilled nursing services” and meet listed criteria. Examples include care that only professional staff can perform safely, or medical complications such as a diabetic client with impaired circulation ⁠⁴. Services are delivered in the client’s residence, or “under special circumstances” at their workplace, and are directed and supervised by a licensed practitioner ⁠⁴.

Who licenses you and which rules apply

Licensing sits with the DHHS Division of Licensing and Background Checks, Office of Licensing (OL), in its health facilities program ⁠¹⁴. Three layers of rules apply to every Utah home health agency:

One quirk is worth knowing before you read the rules yourself. R432-700-6 still tells licensees to comply with “Rule R432-2, General Licensing Provisions” ⁠⁴. R432-700 was last changed on July 6, 2023, and continued on August 6, 2026 ⁠⁴. On October 12, 2026, the state’s administrative code site returned no rule numbered R432-2. The application clearances that founders need now appear in R432-1-8, last changed December 28, 2023 ⁠⁵. R432-1-2 says that rule exists to “centralize general licensing requirements in a single rule,” which suggests R432-700-6 is a stale cross-reference to what is now R432-1. The code site does not say so outright, so ask the Office of Licensing whether any other general rule applies beyond R432-1 and R380-600.

The money rule: nothing before approval

R380-600 is stricter than many states on pre-licensure activity. Until OL approves the license, you may not “accept any fee,” “enter into any agreement to provide a client service,” or “provide any client service” ⁠⁶. In practice, you cannot sign referral-source service contracts or pre-book private-pay clients while the application is pending.

OL also collects the application fee before it performs “any on-site visit or document review” ⁠⁶. An application that is not completed within six months of submission must be filed again with new fees. A denied applicant must wait at least three months before reapplying ⁠⁶.

What goes in the application

Utah Code 26B-2-207 leaves the form to the department ⁠³. Between R380-600-3 and R432-1-8, an initial home health application must include:

1. The OL application and fees. A complete application in the format OL provides, with the fee for each license category ⁠⁵⁠⁶.
2. Owner information and assurances. Names, phone numbers, email and mailing addresses for the owners of the legal entity. You must also give written assurances that none of them ⁠⁵:
   • has a felony conviction;
   • has been found in violation of a law related to their relationship with a health care facility;
   • has a qualifying patient abuse, neglect or exploitation conviction;
   • has held, now or within the past five years, a financial interest in a facility that went into patient-care receivership, closed after decertification or license revocation, or was involuntarily terminated from Medicaid or Medicare.
3. Responsible decision-makers. Contact information for each owner and program director ⁠⁶.
4. Background checks. A background check for each covered individual ⁠⁶. For home health, this means the DACS process described below.
5. Policies and procedures. Any that OL requires ⁠⁶. R432-700 requires many; see the policy list below.
6. Fire and local clearances. Documentation of compliance with fire and business license requirements, or an exemption ⁠⁶. R432-1-8 requires a certificate of fire clearance from the state fire marshal or local fire authority at the initial application, at each renewal, on a change of ownership and after construction or remodeling. It also requires a certificate of occupancy from the local building official for the initial application and any change of location ⁠⁵. You must also comply with city and county zoning, fire, safety, sanitation and building codes ⁠⁵⁠⁶.

R380-600 also requires architectural plans “as applicable for a healthcare facility” ⁠⁶. R432-700 sets no physical plant standards for a home health office, which suggests this item rarely applies to a visiting agency. Confirm with OL before you sign a lease.

OL can deny an application if a director, owner or anyone involved in billing appears on the federal OIG List of Excluded Individuals and Entities. It can also deny if the applicant stays associated with someone whose OL license was revoked within the past five years ⁠⁶. Screen your billing staff before you file.

Neither R432-700, R432-1 nor the Part 2 licensing sections cited here mention a certificate of need for home health agencies.

Fees as published

The figures below come from the Legislative Fiscal Analyst’s brief on DHHS fees for FY2027 (July 1, 2026 to June 30, 2027). The brief was presented to the Social Services Appropriations Committee on January 23, 2026, and lists fees “proposed” for legislative approval ⁠¹⁰. Amounts are as published on October 12, 2026. The brief is a proposal, and the Division’s own adopted fee schedule could not be retrieved, so ask the Office of Licensing for its current fee schedule before you budget.

The two-year base fee is a new line in FY2027, with no prior amount listed. The brief describes it as a base fee that applies “to any new or renewal license” plus the category fee ⁠¹⁰. The home health fee appears under the brief’s “Two Year Licensing Base” heading ⁠¹⁰. The brief also lists a $32 state public safety check for workers in sensitive industries, which DHHS passes through to the Department of Public Safety ⁠¹⁰. The brief also lists a one-year base fee of $371.92 under “Annual License,” but it does not say whether the $2,138.52 home health fee is reduced for a one-year license. Ask the Office of Licensing what a first, one-year license costs in total.

DACS: clearing every nurse and aide before they see patients

Utah screens home health workers through the Direct Access Clearance System, not through an employer-run check. A home health agency is a “covered provider.” Covered individuals include nursing assistants, personal care aides, licensed nurses, and providers of medical, therapeutic or social services ⁠⁷. The statute says a covered provider “may engage a covered individual only if the individual has certification for direct patient access” ⁠⁸. The one exception lets you engage someone while their application is pending, under circumstances the department sets by rule ⁠⁸.

You collect each person’s identifying information and submit the application and fee to the department ⁠⁸. The department may review Department of Public Safety arrest, conviction and disposition records, including state, regional and national files, juvenile court records and other sources ⁠⁹. It may grant certification, deny or revoke it, or limit when an individual may have direct patient access ⁠⁹. Build DACS time into your hiring plan, because your first nurse cannot start visits until the clearance is in place.

Governing body, administrator and director of nursing

R432-700 is written for an organization, not a solo practice. Before your survey, you need the following documents and appointments in place.

Governing body. It “assumes full legal responsibility” for the agency. It adopts an organization chart, policies that protect client rights, a financial management system, and bylaws ⁠⁴. The bylaws must cover a statement of purpose, member selection, officer terms, a conflict-of-interest statement and annual meetings. They must also appoint “by name and in writing” a qualified administrator ⁠⁴.

Administrator. The administrator must have “at least one year of managerial or supervisory experience” ⁠⁴. They designate a qualified alternate in writing and must be available, personally or through the designee, during operating hours ⁠⁴. Their duties include appointing a primary care provider, appointing a registered nurse or healthcare professional to supervise professional services, and appointing the members of the quality assurance committee. They also set up budgeting and accounting and a billing system that itemizes services and charges ⁠⁴. Policies are reviewed at least annually, with the review date documented ⁠⁴.

Director of nursing services. All nursing runs under a director of nursing services, who designates a registered nurse to act in their absence ⁠⁴. The director writes nursing policies, reviews them annually, sets nursing schedules and directs in-service training ⁠⁴. Every RN and LPN needs a valid Utah license from the Department of Commerce ⁠⁴.

Quality assurance committee. It reviews client services every quarter. It needs at least three members “who represent three different licensed or certified health care professions” ⁠⁴. It reviews a sample of active and closed records and the coordination of care, and checks whether clinical notes match plan-of-care goals. It sends a written report to the administrator after each meeting ⁠⁴. Separately, the administrator writes an annual program evaluation for the governing body ⁠⁴. Before you file, settle who those three professionals will be. A nurse-only startup does not meet this rule.

Staff qualifications and supervision

CPR under R432-700 means an in-person course with on-site skills testing by a licensed instructor, so online-only cards do not qualify ⁠⁴. R432-1 also requires direct care employees and volunteers to wear an ID badge showing their first or last name and their title ⁠⁵.

RN supervisory visits follow a fixed schedule. The registered nurse visits for the initial assessment, then ⁠⁴:

• every two weeks for clients receiving skilled services;
• every three months for clients on long-term maintenance services;
• any time a change in the client’s condition is in question.

Aides work only from written instructions from the RN, or from the therapist when the task extends therapy ⁠⁴. A personal care aide may remind clients to take medication and open containers, help with grooming, toileting and meals, take temperatures and provide transportation ⁠⁴. Unlicensed staff may administer medication only after delegation by a licensed health care professional under R156-31B-701. The delegating nurse must document supervision and training and be reachable in person or by phone ⁠⁴.

Policies and client-care rules to write before your survey

R432-700 requires written policies on these subjects ⁠⁴:

• personnel, including job descriptions, licensure checks, orientation, evaluations and in-service training;
• emergency and after-hours care, given to clients and families;
• employee health screening and immunization under R386-702;
• contracts, which need effective and expiration dates, a description of services and a copy of the contractor’s professional license;
• acceptance criteria, available to the public on request;
• discharge, which permits ending services in 15 listed situations, including when payment sources are exhausted, and requires a discharge summary;
• client rights, which must be distributed to clients and the public;
• client record content, confidentiality, retention and release;
• medical supplies and equipment, including how they are billed.

Clinical timelines are tight. A licensed health care professional must sign each plan of care and review it at intervals of no more than 60 days. For skilled services, the primary care provider must also approve the plan at least every 60 days ⁠⁴. Orders taken remotely must be signed by the ordering practitioner within 31 days. Orders may be faxed ⁠⁴.

Branch offices

A branch is a location run by your agency within the scope of its existing license and approved by the department ⁠⁵. To add one, you submit a program narrative listing the parent and branch addresses, the services offered at the branch and the administrative support available there. OL then decides whether the site qualifies. A qualifying branch receives its own license identifying it as a branch of the parent ⁠⁵. The FY2027 fee brief lists $371.92 for each new or renewed satellite or branch office ⁠¹⁰.

License term, inspections and renewal

By statute, a health facility license can run up to 24 months. It cannot be assigned or transferred, it must be posted where the public can see it, and it covers one facility at one site run by one person ⁠². Under R380-600, OL licenses expire at midnight on the last day of the month of issue, one year after the effective date, unless issued as a two-year license ⁠⁶. A health care provider can apply for a two-year license after two consecutive license periods in good standing. Inspections continue on the same schedule as for annual licenses ⁠⁶. Because the two-year option requires good standing for the two consecutive license periods immediately before the application, a new agency’s first license cannot be a two-year license under this rule ⁠⁶.

Renewal deadlines ⁠⁶:

• file at least 30 days before expiration;
• up to 30 days after expiration, file with the late fee;
• after that, file a new initial application.

You may request an extension of up to 90 days if fees are paid and any noncompliance is resolved ⁠⁶. OL may refuse to renew an agency that has provided no service in the past 24 months ⁠⁶. Every renewal also needs a fresh fire clearance ⁠⁵.

OL may make announced or unannounced inspections ⁠⁶. An accredited agency in good standing may be exempt from the annual licensing inspection. OL can still inspect, investigate complaints and run an annual validation survey ⁠⁵. Utah Code 26B-2-207 makes inspection information public, except details identifying individuals. Accreditation information is private except for the department’s summary ⁠³.

Changes need advance filings. You must file a program change application at least 30 days before a change of administrator or management company, a name change or an ownership transfer of less than 50% ⁠⁶. A new license application is due 30 days before a move, a change in the population served, or a transfer of 50% or more of ownership. No new clients may be accepted until the new license issues ⁠⁶. To close, you must notify OL and your patients at least 30 days ahead ⁠⁶. Violations can bring penalties under Utah Code 26B-2-208 and R432-3. Operating in violation of R432-700 can also be charged as a class A misdemeanor ⁠⁴.

Medicare and the 2026 enrollment freeze

A Utah license lets you serve private-pay clients and other payers that do not require Medicare certification. Medicare billing is a separate federal enrollment. On May 13, 2026, CMS imposed a six-month nationwide moratorium on Medicare enrollment of new home health agencies, branches and practice locations. Only applications received by the Medicare contractor before that date continue, and CMS may extend the freeze in six-month increments ⁠¹¹⁠¹³. While the moratorium lasts, accreditation by a CMS-approved organization “will not serve as the basis for Medicare participation through deemed status” ⁠¹². The first six months run to about November 13, 2026, and CMS says any extension or lifting will be announced in the Federal Register ⁠¹¹⁠¹³. No extension had been announced when this guide was checked on October 12, 2026, but ask CMS or check the Federal Register before you file. The Federal Register notice leaves it to each state to decide whether to apply a home health moratorium to its own Medicaid program ⁠¹¹. The sources here do not describe Utah Medicaid’s enrollment requirements for home health agencies, so ask Utah Medicaid directly.

Plan your first year around private-pay and non-Medicare business. If you are deciding between models, compare this license with the personal care agency license. If you want a facility-based model instead, see the assisted living facility license or the adult day care license.

Sources

1. 1
   Utah State Legislature, Utah Code 26B-2-201, Definitions (health care facility licensing) Checked 12 Oct 2026 · Back to text ↑
2. 2
   Utah State Legislature, Utah Code 26B-2-206, License required, expiration and renewal Checked 12 Oct 2026 · Back to text ↑
3. 3
   Utah State Legislature, Utah Code 26B-2-207, Application for license, public records Checked 12 Oct 2026 · Back to text ↑
4. 4
   Utah Office of Administrative Rules, Utah Admin. Code R432-700, Home Health Agency Rule Checked 12 Oct 2026 · Back to text ↑
5. 5
   Utah Office of Administrative Rules, Utah Admin. Code R432-1, General Licensing Provision Checked 12 Oct 2026 · Back to text ↑
6. 6
   Utah Office of Administrative Rules, Utah Admin. Code R380-600, Office of Licensing general procedures Checked 12 Oct 2026 · Back to text ↑
7. 7
   Utah State Legislature, Utah Code 26B-2-238, Definitions for direct patient access Checked 12 Oct 2026 · Back to text ↑
8. 8
   Utah State Legislature, Utah Code 26B-2-239, Certification for direct patient access required Checked 12 Oct 2026 · Back to text ↑
9. 9
   Utah State Legislature, Utah Code 26B-2-240, Department authorized to grant, deny, or revoke clearance Checked 12 Oct 2026 · Back to text ↑
10. 10
    Utah Office of the Legislative Fiscal Analyst, Health and Human Services Fees (FY 2027), Social Services Appropriations Committee, January 23, 2026 Checked 12 Oct 2026 · Back to text ↑
11. 11
    Federal Register (CMS), Medicare, Medicaid, and CHIP: Announcement of Nationwide Temporary Moratoria on Enrollment of Home Health Agencies Checked 12 Oct 2026 · Back to text ↑
12. 12
    Centers for Medicare & Medicaid Services, QSO-26-11, Home Health Agency and Hospice enrollment moratorium Checked 12 Oct 2026 · Back to text ↑
13. 13
    Centers for Medicare & Medicaid Services, Provider Enrollment Moratoria Checked 12 Oct 2026 · Back to text ↑
14. 14
    Utah DHHS Division of Licensing and Background Checks, Health Facilities: Rules and Descriptions Checked 12 Oct 2026 · Back to text ↑
15. 15
    Utah Office of Administrative Rules, Utah Admin. Code R432-725, Personal Care Agency Checked 12 Oct 2026 · Back to text ↑

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