Vermont home health agency designation: CON moratorium, Medicare and DAIL rules

What Vermont designates, and what it leaves alone

Vermont does not issue a home health license that anyone can apply for. DAIL instead “designates” agencies to provide two kinds of service. The rules call them designated services: (1) medically necessary, intermittent, skilled home health of the type covered under Medicare (Title XVIII) or Medicaid (Title XIX), and (2) hospice of the type those programs cover. Nothing else counts.⁠¹ Designation is the Department’s approval to provide skilled home health and hospice in Vermont.⁠¹

The rules define a home health agency as a for-profit or nonprofit business “certified by the Centers for Medicare and Medicaid Services to participate in Medicare and Medicaid”. The agency must provide part-time or intermittent skilled nursing plus at least one other service in the patient’s home: physical, speech or occupational therapy; medical social services; home health aide services; or another non-nursing therapeutic service such as nutrition or mental health counseling.⁠¹ In Vermont, Medicare certification is part of what makes you a home health agency at all.

Several business models are outside designation:

• Private duty. The rules list “wellness and prevention services, clinics, and private duty services” as not subject to designation.⁠¹
• Unskilled care. Personal care, homemaker, respite and companionship services are defined as unskilled services, and “Unskilled services are not designated services.”⁠¹ A designated agency may also offer them, but they do not need a designation.
• Residential settings. Care given inside a residential care home or assisted living residence falls under those facilities’ own licenses. See the Vermont residential care home license and the Vermont assisted living residence license.

Before you go further, decide which category your plan falls into. If you want to bill Medicare for skilled visits, everything below applies. If you plan private-pay companion care or private-duty nursing, DAIL’s home health designation does not apply to you, although other rules (nursing practice, Medicaid provider rules) may.

The certificate of need moratorium through 2030

This is the fact that decides most Vermont home health plans. Under 18 V.S.A. § 9434(a)(3), “the offering of any home health service” is a new health care project, and it cannot go ahead without a certificate of need from the Green Mountain Care Board.⁠⁴ Home health agencies are listed as health care facilities under the CON chapter.⁠⁵ Unlike most CON triggers, this one has no dollar threshold. The Board’s other thresholds rose sharply on May 13, 2025, under Act 15 (non-hospital capital projects went from $1.5 million to $10 million), but Act 15 left the home health trigger in place.⁠⁹⁠¹²

On top of the CON requirement sits a moratorium. It first appeared in 2010 Acts and Resolves No. 83, Sec. 2. Act 5 of 2019 extended it to January 1, 2025, and Sec. 93 of Act 87 of 2024 (signed March 13, 2024) extended it again.⁠¹¹⁠¹⁰ The provision reads:

“Notwithstanding any other provision of law, no CON shall be granted for the offering of home health services, which includes hospice, or for a new home health agency during the period beginning on the effective date of this act and continuing through January 1, 2030, or until the General Assembly lifts the moratorium …, whichever occurs first.”⁠¹⁰

The same provision makes two exceptions: a continuing care retirement community that holds a certificate of authority, and a licensed home for persons who are terminally ill as defined in 33 V.S.A. § 7102.⁠¹⁰

GMCB’s February 2025 testimony to the legislature described one further opening. Despite the moratorium, a CON for a new home health agency “may be considered and granted” if the GMCB and DAIL have certified that a serious and substantial lack of access to home health services exists in a particular county, and the agencies already serving that county have had notice and a reasonable opportunity to challenge the finding or fix the problem.⁠¹³ The exception is subsection (e) of the same 2010 session law, which has never been repealed in the later amendments: the commissioners of the state’s health-care regulator and of DAIL must each first certify the shortage.⁠¹⁷ Nothing in the sources checked says any county has been certified, so ask the Board whether a certification is open or pending for the county you want.

What this means for you as of October 12, 2026:

• A new entrant cannot obtain a home health or hospice CON unless it fits one of the narrow exceptions above.
• Out-of-state agencies are not exempt. The DAIL rules require “a home health agency established outside of Vermont” to get the CON first, like everyone else.⁠¹
• Buying an existing agency still triggers CON review. Section 9434(a)(3) also covers “the transfer or conveyance of more than a 50 percent ownership interest” in a health care facility other than a hospital or nursing home, and the DAIL rules require a new CON when more than 50% of a designated agency changes hands.⁠⁴⁠¹ The moratorium bars CONs for a new home health agency or new home health services. An ownership transfer of an existing designated agency is a separate CON question to raise with the Board before you sign anything.
• Redesignations and designation revocations are excluded from CON review.⁠⁶ An existing agency renewing its designation does not go back to the Board.

The federal Medicare freeze since May 13, 2026

Vermont requires CMS certification as a home health agency before you file for designation.⁠¹ Since May 13, 2026, CMS has refused to enroll new home health agencies, branches or practice locations in Medicare nationwide unless the Medicare contractor received the application before that date.⁠¹⁴ A parallel moratorium covers hospices. CMS’s survey memo says initial applications filed during the moratorium are denied and must be filed again after it ends. It also says accreditation will not produce deemed status for a prospective agency while the moratorium lasts.⁠¹⁵

The moratorium runs six months and can be extended in six-month increments.⁠¹⁶ A Federal Register search on October 12, 2026 found only the May 15 home health and hospice notices, so the first period ends in mid-November 2026 unless CMS extends it. CMS left Medicaid home health moratoria to each state.⁠¹⁴ Whether Vermont Medicaid has adopted its own home health enrollment moratorium is not stated in any official source checked, so ask the Department of Vermont Health Access before you plan around Medicaid enrollment.

The rules also allow a provisional designation of up to one year “for a home health agency seeking initial Medicare certification”.⁠¹ That provision does not override the CON requirement in rule 4.1, and the rules do not say how it fits with rule 4.2, which requires certification before filing. The official sources do not explain the sequencing. Ask DAIL’s Division of Licensing and Protection whether it would issue a provisional designation before Medicare certification, and what it would need from you.

Getting a certificate of need, if you qualify

If your project fits a moratorium exception, or you are buying an existing agency, the CON process in 18 V.S.A. § 9440 runs as follows:

1. Letter of intent

   File a letter of intent with the Board at least 30 days before the application. The Board decides within 30 days whether a CON is required. If you agree that your project is subject to review, you may skip the letter and file the application directly.⁠⁸ GMCB takes letters of intent and jurisdiction requests by email at [email protected].⁠⁹

2. Application

   The statute lists required contents, including a population-based description of your service area, financial statements, third-party reimbursement data, annual reports and four-year long-range plans, any contracts that could affect quality of care, and the status of any CONs you received in the previous three years.⁠⁸

3. Fee

   GMCB invoices 0.125% of project costs, minimum $250 and maximum $20,000, under 18 V.S.A. § 9441, as published on October 12, 2026. The application is not considered complete until the fee is paid.⁠⁹

4. Completeness review

   Within 90 days of receiving the application, the Board must either declare it complete or close the review period despite missing information. It may extend that period by 60 days, or longer with your consent.⁠⁸

5. Public notice, interested parties and hearing

   The Board posts notice of the complete application on its website. People who show they will be substantially and directly affected can get interested-party status, and the Office of the Health Care Advocate may intervene. A public hearing is generally required.⁠⁸ For an existing agency serving the same county, that interested-party route is a real factor.

6. Decision

   The Board must decide within 120 days after the completeness notice and may extend by up to 30 days.⁠⁸

The Board grants a CON if the project serves the public good and meets the criteria in 18 V.S.A. § 9437. These include fit with the Health Resource Allocation Plan, reasonable cost, “an identifiable, existing, or reasonably anticipated need for the proposed project that is appropriate for the applicant to provide,” and better quality or access.⁠⁷ The CON must cover the geographic service area where you want designation, because DAIL asks for “Proof of CON for the geographic service area where designation is sought.”⁠¹

The DAIL designation application

After you have both the CON and Medicare certification, you apply to DAIL’s Division of Licensing and Protection on Department-approved forms. You may not begin operating until DAIL approves.⁠¹ Under rule 4.5, the application must include:⁠¹

• your legal name as registered with the Vermont Secretary of State, any trade name, your physical address and any management company;
• DAIL’s disclosure of ownership form;
• all board members, officers, partners and key administrative staff, including the administrator and the director of nursing (or equivalent), with copies of their current licenses;
• proof of CON for the service area and proof of Medicare home health certification;
• full-time equivalent employees by discipline, and an organizational chart showing reporting and supervisory relationships;
• anyone holding 5% or more direct or indirect ownership, with the amount, and every physician with any financial interest, of any size, with the amount;
• the services you provide directly and those you arrange by contract;
• a sample admission packet; and
• anything else DAIL requests, such as accounts, salaries, tax status and evidence of financial solvency.

If you are accredited and deemed, you must give DAIL that documentation and report any change in status.⁠¹ For a corporation, the application must be signed by two officers and by the CEO or executive director, all with authority to bind the corporation.⁠¹ The rules say only that the application goes on Department-approved forms and that the disclosure of ownership form comes from the Department. The rules and DAIL’s facility-regulations page list no designation fee and link no application form, so ask the Division of Licensing and Protection for the current form and whether a fee applies.

DAIL weighs the CON decision, your compliance history, professional standards, standing with state and federal tax departments, and your part in state planning such as the Health Resource Allocation Plan. It also looks at your finances: an annual audit with an unqualified opinion from an independent auditor, credit reports, tax withholding history, any history of financial fraud or improper referral arrangements, and compliance with state contracts.⁠¹ An agency that is not in good standing with the Vermont Department of Taxes under 32 V.S.A. § 3113 will be denied or lose its designation.⁠¹ Material misstatements during designation can also lead to denial or revocation.⁠¹

DAIL surveys an agency before designating it.⁠¹ The designation must be posted where visitors to your business premises can see it, and it cannot be assigned or transferred.⁠¹

The obligation to serve your whole area

Designation carries a duty that private home care businesses do not have. A designated agency “has the obligation and the responsibility to provide or arrange for the provision of all designated services to all eligible patients within its designated geographic area who request services.”⁠¹ It must also take eligible patients referred by other designated agencies, subject to its ability to accept referrals.⁠¹ This duty follows from 33 V.S.A. § 6303, which requires DAIL standards that prevent discrimination by “income, funding source, geographic status, or severity of health needs.”⁠³ The rules repeat the bar on discrimination by source of payment or geography.⁠¹

When you cannot serve an eligible person, you must give information about alternative providers and help with the referral unless the person objects, no alternative exists, or funding is unavailable.⁠¹ You must make contact with each patient by the close of the next business day after receiving a physician order, unless the order says otherwise.⁠¹ Your fee schedule must be available to patients and the public on request.⁠¹ Agencies may pool services through shared services agreements, but the Commissioner must approve each one and has 60 days to decide.⁠¹

Governance: the consumer board requirement

Vermont dictates who sits on your board:

• Nonprofit agencies. The board must reflect the demographics of the area served, and a majority must be current or former patients or their family members. The board has overall responsibility for planning and operation.⁠¹⁠³
• For-profit and multistate agencies. You need a consumer advisory board that reflects the demographics of the Vermont area you serve. A majority must be current or former patients or family members, it must meet at least twice a year, and it advises your board of directors on planning, operations, patient needs and the local community services plan.⁠¹⁠³

In both cases the board president surveys members every year and certifies the composition to the Commissioner, and the annual independent audit must confirm it.⁠¹ The governing body must appoint a qualified CFO or CEO, adopt bylaws and oversee fiscal affairs.⁠¹

Operating requirements under the 2026 rules

Skilled services must follow the Medicare home health Conditions of Participation and the patient’s plan of care. The CoPs do not apply to patients who receive only unskilled services.⁠¹ Where state and federal rules differ, the stricter one applies.⁠¹ Beyond the CoPs, the Vermont rules add these requirements:

• Background checks. Check all employees, contractors and volunteers who give direct care under DAIL’s background check policy. Do not employ anyone with a substantiated record of abuse, neglect or exploitation of a child (from the Department for Children and Families) or of a vulnerable adult (from DAIL).⁠¹
• Written policies. Rule 7.7 lists the policies DAIL can ask for: admission, transfer, reduction and discharge; medical supervision and plans of care; emergency care; patient records; personnel, credentialing and training; quality improvement; complaints and grievances; electronic records security; supervision of licensed and unlicensed staff; and advance directives.⁠¹
• Emergency management plan. The plan must show how you will keep serving patients during an emergency, crisis or disaster.⁠¹
• Contracts. Clinical or direct-care contracts must contain the terms in rule 7.10, including a statement that the agency keeps administrative responsibility for the services.⁠¹
• Insurance. You must carry fire, professional liability, general liability and directors’ and officers’ liability coverage.⁠¹
• Unlicensed caregivers. Personal care or homemaker staff must work under a plan of care. You must train them on specific tasks for specific patients and have them supervised by a qualified supervisor.⁠¹
• Reporting deadlines. Report suspected abuse, neglect or exploitation of a vulnerable adult within 48 hours, suspected child abuse to DCF within 24 hours, and critical incidents to the DLP Survey and Certification Unit by the next business day.⁠¹
• Data. Each year, report complaints, waiting lists, ineligible applicants, patient counts under and over age 65, visits and visiting hours, and charitable programs. Survey results, audited financial statements and cost reports must reach DAIL within 10 business days of a request.⁠¹
• Choices for Care. Participants in the Global Commitment Choices for Care program must get written notice of their right to help from the State Long-Term Care Ombudsman.⁠¹

Surveys, enforcement and renewal

After designation, DAIL monitors compliance at least once a year. It may skip its own survey in a year when a Medicare certification survey takes place, and it may survey more often after an ownership change or complaints.⁠¹ If you fail to correct a violation or follow a plan of correction, DAIL may impose penalties of up to $500 a day for administrative rules, $800 a day for rules protecting patient welfare or rights, and $1,000 a day for rules protecting health or safety. Penalties count from the date of the first notice of violation.⁠¹ You can request a variance from a rule, but never from a patient-rights rule.⁠¹ Decisions can be appealed to the Human Services Board.⁠¹

A designation lasts four years. File your renewal application at least 60 days before it expires; DAIL may renew it for four years, grant a conditional or provisional designation, or deny it.⁠¹ If a designation is suspended, revoked or not renewed, you must notify all patients in writing within 5 days and publish a paid legal notice within 15 days.⁠¹

Ownership changes, moves and closures

For a planned change of ownership or location, you must file a new designation application at least 90 days ahead. If more than 50% of the ownership is transferred, you also need a new CON and must give DAIL a copy.⁠¹ If the change or a closure means discharging patients, these notices apply:⁠¹

Changes that do not require discharging patients, such as a new admission policy, need 30 days’ written notice to DAIL and patients.⁠¹ An agency in financial trouble may ask the Commissioner, with 90 days’ notice, for permission to stop a designated service, or may ask for temporary financial relief if funds are available.⁠¹

What changed in 2026

The Rules for the Designation and Operation of Home Health Agencies took effect July 1, 2026. They amend the rule adopted October 1, 2019 (Secretary of State Log #19-038), which DLP lists as effective through June 30, 2026.⁠¹⁠² The rule was adopted under 33 V.S.A. § 6303 after public hearings in August 2025, and the Legislative Committee on Administrative Rules did not object.⁠¹ Two dates are worth watching: the federal Medicare moratorium, whose first six-month period ends in mid-November 2026 unless CMS extends it, and the state CON moratorium, which ends January 1, 2030 unless the General Assembly acts sooner.⁠¹⁶⁠¹⁰

Sources

1. 1
   Vermont Agency of Human Services, Department of Disabilities, Aging and Independent Living, Rules for the Designation and Operation of Home Health Agencies (adopted rule, effective July 1, 2026) Checked 12 Oct 2026 · Back to text ↑
2. 2
   Vermont DAIL, Division of Licensing and Protection, Facility Regulations Checked 12 Oct 2026 · Back to text ↑
3. 3
   Vermont General Assembly, 33 V.S.A. § 6303, Home health services; local plans; board composition Checked 12 Oct 2026 · Back to text ↑
4. 4
   Vermont General Assembly, 18 V.S.A. § 9434, Certificate of need; general rules Checked 12 Oct 2026 · Back to text ↑
5. 5
   Vermont General Assembly, 18 V.S.A. § 9432, Definitions Checked 12 Oct 2026 · Back to text ↑
6. 6
   Vermont General Assembly, 18 V.S.A. § 9435, Excluded transactions Checked 12 Oct 2026 · Back to text ↑
7. 7
   Vermont General Assembly, 18 V.S.A. § 9437, Criteria Checked 12 Oct 2026 · Back to text ↑
8. 8
   Vermont General Assembly, 18 V.S.A. § 9440, Procedures Checked 12 Oct 2026 · Back to text ↑
9. 9
   Green Mountain Care Board, Certificate of Need Checked 12 Oct 2026 · Back to text ↑
10. 10
    Vermont General Assembly, Act No. 87 of 2024 (H.839), Sec. 93, as enacted Checked 12 Oct 2026 · Back to text ↑
11. 11
    Vermont General Assembly, Act No. 5 of 2019 (S.14), extending the moratorium on home health agency certificates of need Checked 12 Oct 2026 · Back to text ↑
12. 12
    Vermont General Assembly, Act No. 15 of 2025 (H.96), as enacted Checked 12 Oct 2026 · Back to text ↑
13. 13
    Green Mountain Care Board, via Vermont General Assembly, Green Mountain Care Board, Certificate of Need (CON) testimony follow-up on H.96, February 6, 2025 Checked 12 Oct 2026 · Back to text ↑
14. 14
    Centers for Medicare & Medicaid Services, Federal Register, Announcement of Nationwide Temporary Moratoria on Enrollment of Home Health Agencies (HHAs), 2026-09717 Checked 12 Oct 2026 · Back to text ↑
15. 15
    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 ↑
16. 16
    Centers for Medicare & Medicaid Services, Provider Enrollment Moratoria Checked 12 Oct 2026 · Back to text ↑
17. 17
    Vermont General Assembly, Act No. 83 of 2010 (H.658), Sec. 2, certificate of need work group; moratorium Checked 12 Oct 2026 · Back to text ↑

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