Starting a care business in Nevada

Expect old agency names on the paperwork. Statute now gives adult care licensing to the Health Care Purchasing and Compliance Division (a 2025 change) and defines the child care licensing "Division" as the Division of Social Services, but many forms, PDFs and rule texts still say Division of Public and Behavioral Health or Division of Welfare and Supportive Services. The same year, personal care agencies moved into their own statute, NRS chapter 449B, while the regulations in NAC 449 still cite the old section numbers.

A child care license starts at five children cared for for pay. A family home or group home takes 5 to 6 or 7 to 12 children, and the licensee, or a person named on the license, must live in the house. More than 12 children, day or night, makes the facility a child care center. Caring for four or fewer unrelated children is a small child care establishment, which may register online with the Division but is not licensed. Washoe County licensed its own providers until the State took over on July 1, 2024. Initial license fees run from $20 to $300 depending on capacity, but you also need a State Fire Marshal certificate of compliance, health and zoning approvals, and every licensed facility receives an A to F letter grade that is posted online.

Residential care is licensed from the first resident. Giving food, shelter, assistance and limited supervision for pay to one or two unrelated aged, infirm or disabled people in a home requires a home for individual residential care license. A third resident moves you to a residential facility for groups license, which is also how Nevada licenses assisted living: there is no separate assisted living license, only an assisted living endorsement on a group facility. Every group facility must be run under an administrator licensed under NRS chapter 654. An adult day care facility has no minimum size; any establishment that gives daytime care to aged or infirm adults needs a license.

Home care splits by the kind of care. A business that sends staff to help with bathing, dressing, toileting, meals and similar tasks needs a personal care agency license; an independent contractor working without employees is excluded, and an agency that only places caregivers needs a separate employment agency license. Skilled nursing at home requires a home health agency license. Since December 29, 2022, every licensed home health agency must meet the federal Medicare home health rules in 42 CFR 484, even if it never bills Medicare. Regulation R071-26, filed July 1, 2026, raised the initial fee to $5,530 for a home office. CMS has also stopped enrolling new home health agencies in Medicare nationwide since May 13, 2026, and Nevada Medicaid requires active Medicare enrollment, so a new agency cannot bill either program while the freeze lasts.

Four of the adult licenses (both residential licenses, personal care and home health) require a surety bond sized by headcount: $5,000 with fewer than 7 employees, $25,000 with 7 to 25 and $50,000 above 25, protecting clients aged 60 or older. Nevada has no certificate of need for opening any of these businesses. Its only comparable approval, under NRS 439A.100, covers new construction by a health facility costing more than $2,000,000 (or a higher amount set by regulation) in a county of fewer than 100,000 people or a city or town of fewer than 25,000 in a larger county. Operating without a license can bring a cease-and-desist order and a civil penalty of up to $10,000 for a first offense.