Virginia home care organization license for personal care services

One license, three service lines

Virginia does not have a stand-alone “non-medical home care” or “personal care agency” license. The Code defines a home care organization (HCO) as any public or private organization, operated for profit or not, that provides one or more of three services at a person’s Virginia residence: home health services, personal care services, or pharmaceutical services ⁠¹. A personal care agency is simply an HCO licensed for the personal care line. The same law and the same regulation, 12VAC5-381, govern a skilled home health agency; that route is covered in the home health guide.

Every HCO must meet Part I (licensing) and Part II (administration) of 12VAC5-381, plus the part for each service it offers; for personal care that is Part V, 12VAC5-381-360 ⁠⁶. The Virginia Department of Health’s Office of Licensure and Certification (OLC) handles licensing through its Home Care and Hospice Unit, within the Division of Acute Care Services, which also investigates complaints against these providers ⁠¹⁹.

The license is issued to a “person,” which the rule defines broadly to include a corporation, partnership or other entity ⁠⁶, ⁠²⁴. It cannot be issued to anyone sanctioned under the federal anti-kickback statute, 42 U.S.C. § 1320a-7b ⁠³. It cannot be transferred or assigned ⁠²⁴.

Where the line falls: companion, homemaker and personal care

This is the question most founders get wrong, because the statute and the regulation draw the line in slightly different places.

The statute exempts “any organization providing only housekeeping, chore or beautician services” ⁠². The regulation goes further: 12VAC5-381 does not apply to providers of “only homemaker, chore or companion services” as those terms are defined in 12VAC5-381-10 ⁠⁷. The definitions therefore decide whether you need a license:

The homemaker definition expressly excludes feeding, bed baths, transferring, lifting, putting on braces or other supports, cutting nails, and shaving with a blade ⁠⁶. The moment your aides do any of those for a client, you are giving personal care and need the license. If your business plan includes helping clients in and out of bed or the shower, plan for licensure from the start rather than trying to grow into it.

“Client’s residence” includes a client’s own house or apartment, a relative’s home, or an assisted living facility, but not a hospital or nursing facility ⁠⁶. An agency sending aides into an assisted living facility to give one-on-one help with daily living is still providing services at a residence.

The other exemptions, and who they do not cover

The statute also exempts a natural person who works on an individual basis and is either acting alone under a medical plan of care while licensed under Title 54.1 (for example, a nurse), or retained directly by the client or someone acting for the client ⁠². That exemption protects an individual aide hired privately by a family. It does not cover a business that recruits aides and places them with clients, because the exemption is limited to a natural person working on an individual basis.

A third exemption applies only after initial licensure: an HCO that later becomes Medicare- or Medicaid-certified, accredited by a CMS-recognized organization, or licensed for hospice is exempt from the article ⁠². The regulation confirms that organizations seeking federal certification or national accreditation must first get the state license and serve clients ⁠⁷. Exemption is not automatic; a licensed organization files a written request with a one-time $75 fee, and exempt organizations remain subject to OLC complaint investigations ⁠⁷, ⁠⁹. For a private-pay personal care agency, which does not seek Medicare certification, this route rarely applies.

The money test: budget and three months of reserves

Virginia requires every applicant for an initial HCO license to file a detailed operating budget projecting expenses for the first three months after the license issues, and proof of reserve operating funds sufficient to run the organization for that same three-month period ⁠³, ⁠¹⁰. The rule accepts four forms of reserve:

• cash;
• cash equivalents readily convertible to known amounts of cash with insignificant risk of change in value;
• borrowed funds immediately available to the applicant; or
• a line of credit immediately available to the applicant ⁠¹⁰.

Proof is a current balance sheet showing the funds, a letter from an officer of the bank or other financial institution holding them, or a letter of credit from a lender showing the amount available ⁠¹⁰. Neither the statute nor the rule sets a dollar figure; the amount is whatever your own three-month budget shows. The statute bars VDH from asking for more financial documents at renewal than it required at initial licensure ⁠³.

After opening, financial records must follow generally accepted accounting principles, be audited at least every three years by an independent CPA (or as otherwise provided by law), and sit behind documented controls against theft and embezzlement ⁠¹⁰.

People you need before you file

A governing body. The organization must have a governing body legally responsible for management, operations and finances. It decides which services are offered, approves the written policies every year, and establishes a quality improvement committee ⁠³³.

An administrator. The governing body appoints an administrator with at least one year of training and experience in direct health care service delivery, plus at least one year within the last five years of supervisory or administrative management experience in home health care or a related health program ⁠¹¹. The administrator or a designee who can perform the same duties must be available at all times during operating hours and for emergencies ⁠¹¹. The rule names no license or certificate for the administrator; the test is experience.

A registered nurse. For personal care, the organization must designate a registered nurse responsible for supervising the service ⁠¹³. The RN develops each client’s written plan of services with the client and family, covering the needs assessment, functional limitations, permitted activities, special diet, the specific personal care tasks and their frequency ⁠¹³. Supervision happens as often as the client’s needs, the RN’s assessment and your policies require, but never more than 90 days apart, and an RN or LPN must be available during all hours that personal care is being delivered ⁠¹³. A founder without a nursing license needs to employ or contract that nurse coverage before opening.

A quality improvement committee. Its members must include the organization’s RN (or director of skilled services), a member of the administrative staff, a representative of each service including contracted services, and someone able to represent client rights, who may be a staff member, a client or a family member ⁠²⁷. Results go to the governing body every year ⁠²⁷.

Insurance and bond

The statute requires liability insurance and third-party crime insurance or a blanket fidelity bond ⁠³². The regulation sets the minimums, which must be in force at all times:

The governing body must also make sure contractors carry appropriate coverage ⁠¹². VDH states that umbrella and excess liability insurance may be used to meet the minimums ⁠¹⁹.

Policies the rule expects to exist

12VAC5-381-180 lists the written policies an HCO must implement, approved by the governing body and reviewed at least once a year ⁠¹⁸. The administrative list has 18 subjects, including admission and discharge criteria, informed consent, advance directives including Durable Do Not Resuscitate Orders, client rights, medication management if applicable, mandated reporting of abuse, neglect and exploitation under Code of Va. § 63.2-1606, communicable and reportable diseases, record retention, emergency and on-call services, infection control, complaints, telemonitoring and approved variances ⁠¹⁸. Separate financial policies must cover admission agreements, verification of services delivered, billing methods, notice of fee changes, billing corrections and refunds, and delinquent accounts ⁠¹⁸. Personnel policies must cover job descriptions, credential checks, annual evaluations, contractor verification, criminal background checks and a drug-free workplace ⁠¹⁸, ⁠⁴.

The organization also needs an emergency operations plan for inclement weather or natural disaster, including a current list of clients who would need specialized assistance ⁠¹⁷.

Applying through the VDH OLC Portal

1. Open an OLC Portal account

   New licenses, renewals, exemption requests and changes to a licensing record are all filed through the VDH OLC Portal; the Applications & Forms page links to account-request instructions ⁠²⁰, ⁠¹⁹.

2. Read 12VAC5-381 before filing

   VDH directs HCO applicants to review the licensure regulations before applying ⁠¹⁹.

3. File a complete application at least 60 days before your planned opening date

   The OLC treats an application as complete only when all requested information and the $1,500 fee are in. It notifies you in writing if anything is missing, and an incomplete application goes inactive six months after OLC receives it, after which you must reapply and pay again ⁠⁸, ⁠⁹.

4. Take the prelicensure consultation

   OLC offers a consultation to explain the regulation and the survey process, but schedules it only after a completed initial application is on file ⁠⁸.

5. Be ready for inspection

   Every applicant’s activities and services are subject to OLC inspection to determine compliance ⁠⁸, ⁠³. The rule does not say whether OLC surveys a new agency on site before it issues the first license, and it sets no deadline for a licensing decision; the prelicensure consultation is described as explaining “the survey process” ⁠⁸. Ask your OLC licensing representative at that consultation whether a pre-opening survey applies and what processing time to expect.

6. Add branches on the license

   One license can cover branch offices serving parts of your service area if each operates under your supervision and control; each branch address must appear on the license ⁠²⁴, ⁠³. VDH publishes a Home Care Organization Branch Request form ⁠²⁰.

An out-of-state organization should read § 32.1-162.9 B: the Commissioner may decline a license where Virginia has no reciprocal HCO licensing agreement with the state where the applicant resides or is licensed ⁠³. Neither the statute nor 12VAC5-381-20 lists any reciprocal agreements or the states they cover ⁠³, ⁠²⁴. If you live in or are licensed in another state, ask OLC before filing whether Virginia has such an agreement with that state.

Fees

Sections 12VAC5-381-40 and -70 were last amended effective May 22, 2025 ⁠⁸, ⁠⁹.

Hiring aides: background checks and qualifications

Criminal records. Every applicant for compensated employment must give a sworn statement disclosing criminal convictions and pending charges, in or outside Virginia; a materially false statement is a Class 1 misdemeanor ⁠⁴. Within 30 days of employment you must obtain an original criminal record clearance or criminal history record from the Virginia State Police Central Criminal Records Exchange, and you may not accept a report dated more than 90 days before the hire date ⁠⁴, ⁠¹⁵. Until it arrives, the employee may not work in direct patient contact unless directly supervised by an employee whose check is complete ⁠¹⁵. You may not hire anyone convicted of a barrier crime listed in § 19.2-392.02, except that one misdemeanor not involving abuse or neglect is allowed after five years ⁠⁴. A report stays valid while the employee remains in continuous service with you; a worker coming from another HCO needs a new check, except for transfers within 30 days between organizations under the same owner, or a leave of absence of no more than six consecutive months ⁠¹⁵.

Aide qualifications. Home attendants (the rule’s term for personal care aides, home health aides and CNAs) must speak, read and write English and meet one of six qualifications: nursing school completion, a Board of Nursing-approved nurse aide program, Virginia CNA certification, current enrollment in nursing school with at least one clinical course completed, a competency evaluation meeting 42 CFR 484.36(b) (limited to personal care tasks for personal care aides), or the Department of Medical Assistance Services “Personal Care Aide Training Curriculum,” 2003 edition, which qualifies an aide for personal care only ⁠¹⁴. Each aide needs at least 12 hours of in-service training a year, which can be combined with on-site supervision ⁠¹³.

Orientation and records. New employees and contractors are oriented on the organization’s philosophy, confidentiality, client rights, mandated abuse reporting, personnel policies, emergency preparedness, infection control, cultural awareness and the rules for their position ⁠²⁹. Anyone entering a client’s home must be identifiable by name tag, uniform or similar means, and personnel records are kept for three years after employment ends ⁠²⁹.

Running the agency day to day

The rule requires regular posted business hours, full operation during those hours, and on-call service 24 hours a day, seven days a week ⁠¹⁷. You may accept a client only when you can meet that client’s needs at home, and advertising may not contain false or misleading claims or fee disclosures ⁠¹⁷.

Aides write signed, dated notes on the day of service, and the notes must be in the client record within seven working days; client records are kept at least five years after discharge or last contact ⁠²⁸. Clients must receive your complaint procedure at admission along with contact details for your organization, the State Ombudsman and the OLC complaint unit, and you must tell a complainant your proposed resolution within 30 days ⁠³⁰.

You may use “drop sites” for the convenience of staff giving direct care, but a drop site cannot have assigned staff, accept referrals or be advertised. If it operates as a business office, it is a separate organization that needs its own license ⁠²⁵.

Inspections, changes and renewal

OLC makes unannounced on-site inspections at least once every two years ⁠¹⁶. As part of an inspection it may also visit clients at home; you arrange those visits and must explain to the client that consent is voluntary and does not affect their care or other health benefits ⁠³⁴. After an inspection, the administrator has 15 working days from receiving the report to submit an acceptable plan of correction, and corrections must be completed within 45 working days of the last day of the inspection ⁠¹⁶.

Notify OLC 30 days in advance of changes to your service area, mailing address, ownership, services, operator, administrator, name, or a closure ⁠¹⁷. A change of operator, name or address requires a reissued license and the $250 fee, with 30 working days’ written notice to the OLC director ⁠²³, ⁠⁹.

The license expires on the third anniversary of its issuance or renewal ⁠³. OLC makes renewal applications available at least 60 days before expiration; if you file a complete and accurate renewal on time, your license stays in effect even if the new one has not been issued yet ⁠⁸. A late renewal adds $50 ⁠⁹.

Getting paid by Virginia Medicaid

Under the Commonwealth Coordinated Care Plus (CCC Plus) Waiver rules, agency-directed personal care and respite care must be provided by an agency licensed by VDH, certified by VDH under Medicare or Medicaid, or accredited by the Joint Commission or CHAP ⁠²¹. Aides of VDH-licensed agencies must meet 12VAC5-381 and also receive at least 12 documented hours of agency-provided training each year ⁠²¹. DMAS or its contractor screens each request to participate ⁠²¹.

For the developmental disability waivers, agency-directed personal assistance can be provided by a VDH-licensed personal care provider, among others. In that case the agency must employ or subcontract an RN or LPN with at least one year of related clinical nursing experience to supervise assistants, and assistants must complete at least 40 hours of training on the needs of people with disabilities, including intellectual and developmental disabilities ⁠²².

If your HCO license is revoked, suspended or expires, the Commissioner notifies DMAS so it can terminate or suspend your Medicaid provider agreement ⁠²⁶.

Penalties for operating without a license

Owning, establishing, managing or operating an unlicensed HCO is a Class 6 felony, and the Commissioner may ask the Attorney General to seek a circuit court injunction to stop it ⁠⁵. The Commissioner may also revoke or suspend a license for noncompliance; a suspended or revoked organization must stop operating ⁠²⁶. When a rule causes a special hardship, you can ask the OLC director in writing for a variance; OLC can grant one only for its own regulations and only where client safety is not endangered ⁠³¹.

Related Virginia licenses

If clients need care in a group setting rather than at home, Virginia licenses adult day centers and assisted living facilities through the Department of Social Services, not VDH. An agency that wants nurses and therapists working under a medical plan of care adds the home health service line under the same HCO license; see the home health guide.

Sources

1. 1
   Virginia General Assembly, Legislative Information System, Code of Virginia § 32.1-162.7: definitions (home care organizations) Checked 12 Oct 2026 · Back to text ↑
2. 2
   Virginia General Assembly, Legislative Information System, Code of Virginia § 32.1-162.8: exemptions from article Checked 12 Oct 2026 · Back to text ↑
3. 3
   Virginia General Assembly, Legislative Information System, Code of Virginia § 32.1-162.9: licenses required; renewal thereof Checked 12 Oct 2026 · Back to text ↑
4. 4
   Virginia General Assembly, Legislative Information System, Code of Virginia § 32.1-162.9:1: barrier crimes; criminal records check; drug testing Checked 12 Oct 2026 · Back to text ↑
5. 5
   Virginia General Assembly, Legislative Information System, Code of Virginia § 32.1-162.15: violation; penalties Checked 12 Oct 2026 · Back to text ↑
6. 6
   Virginia Administrative Code, 12VAC5-381-10: definitions (Home Care Organization Regulations) Checked 12 Oct 2026 · Back to text ↑
7. 7
   Virginia Administrative Code, 12VAC5-381-30: exemption from licensure Checked 12 Oct 2026 · Back to text ↑
8. 8
   Virginia Administrative Code, 12VAC5-381-40: license application; initial and renewal Checked 12 Oct 2026 · Back to text ↑
9. 9
   Virginia Administrative Code, 12VAC5-381-70: fees Checked 12 Oct 2026 · Back to text ↑
10. 10
    Virginia Administrative Code, 12VAC5-381-190: financial controls Checked 12 Oct 2026 · Back to text ↑
11. 11
    Virginia Administrative Code, 12VAC5-381-170: administrator Checked 12 Oct 2026 · Back to text ↑
12. 12
    Virginia Administrative Code, 12VAC5-381-210: indemnity coverage Checked 12 Oct 2026 · Back to text ↑
13. 13
    Virginia Administrative Code, 12VAC5-381-360: personal care services Checked 12 Oct 2026 · Back to text ↑
14. 14
    Virginia Administrative Code, 12VAC5-381-290: home attendants Checked 12 Oct 2026 · Back to text ↑
15. 15
    Virginia Administrative Code, 12VAC5-381-110: criminal records checks Checked 12 Oct 2026 · Back to text ↑
16. 16
    Virginia Administrative Code, 12VAC5-381-80: on-site inspections Checked 12 Oct 2026 · Back to text ↑
17. 17
    Virginia Administrative Code, 12VAC5-381-150: management and administration Checked 12 Oct 2026 · Back to text ↑
18. 18
    Virginia Administrative Code, 12VAC5-381-180: written policies and procedures Checked 12 Oct 2026 · Back to text ↑
19. 19
    Virginia Department of Health, Office of Licensure and Certification, Home Care & Hospice Checked 12 Oct 2026 · Back to text ↑
20. 20
    Virginia Department of Health, Office of Licensure and Certification, Applications & Forms Checked 12 Oct 2026 · Back to text ↑
21. 21
    Virginia Administrative Code, 12VAC30-120-930: general requirements for home and community-based participating providers Checked 12 Oct 2026 · Back to text ↑
22. 22
    Virginia Administrative Code, 12VAC30-122-460: personal assistance service Checked 12 Oct 2026 · Back to text ↑
23. 23
    Virginia Administrative Code, 12VAC5-381-60: changes to or reissue of a license Checked 12 Oct 2026 · Back to text ↑
24. 24
    Virginia Administrative Code, 12VAC5-381-20: license Checked 12 Oct 2026 · Back to text ↑
25. 25
    Virginia Administrative Code, 12VAC5-381-270: drop sites Checked 12 Oct 2026 · Back to text ↑
26. 26
    Virginia General Assembly, Legislative Information System, Code of Virginia § 32.1-162.13: revocation or suspension of license Checked 12 Oct 2026 · Back to text ↑
27. 27
    Virginia Administrative Code, 12VAC5-381-250: quality improvement Checked 12 Oct 2026 · Back to text ↑
28. 28
    Virginia Administrative Code, 12VAC5-381-280: client record system Checked 12 Oct 2026 · Back to text ↑
29. 29
    Virginia Administrative Code, 12VAC5-381-200: personnel practices Checked 12 Oct 2026 · Back to text ↑
30. 30
    Virginia Administrative Code, 12VAC5-381-240: handling complaints received from clients Checked 12 Oct 2026 · Back to text ↑
31. 31
    Virginia Administrative Code, 12VAC5-381-120: variances Checked 12 Oct 2026 · Back to text ↑
32. 32
    Virginia General Assembly, Legislative Information System, Code of Virginia § 32.1-162.11: liability insurance required Checked 12 Oct 2026 · Back to text ↑
33. 33
    Virginia Administrative Code, 12VAC5-381-160: governing body Checked 12 Oct 2026 · Back to text ↑
34. 34
    Virginia Administrative Code, 12VAC5-381-90: home visits Checked 12 Oct 2026 · Back to text ↑

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