The short answer Delaware licenses skilled home health agencies and non-medical Personal Assistance Services Agencies (PASAs) through the Division of Health Care Quality.
What Delaware requires
Delaware
Licensing agency. The Delaware Division of Health Care Quality (DHSS) licenses home health agencies (skilled) and Personal Assistance Services Agencies under 16 Del. C. ch. 11 and Title 16 of the Delaware Administrative Code (Reg. 3345 for PASAs).
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PASA license. Agencies providing only personal care, companionship, homemaker, or transportation services must hold a Personal Assistance Services Agency license — a distinct, lighter-weight category than home health.
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Surveys and renewal. DHCQ performs initial licensure surveys, annual license renewal, and periodic unannounced inspections with plan-of-correction requirements; it is also the CMS survey agency for Medicare-certified home health.
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Background checks. Delaware requires criminal background checks and adult abuse registry checks for direct care workers in both license categories under 16 Del. C. § 1141 et seq.
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The federal baseline (applies in every state)
Federal
No federal home care license. There is no federal license for home care or home health agencies. Licensure is a state function: each state (and DC) decides whether and how to license home health agencies and non-medical personal care/companion agencies, so requirements vary dramatically by jurisdiction.
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Medicare certification (42 CFR Part 484). Agencies that bill Medicare for skilled home health must be certified as meeting the Medicare Conditions of Participation at 42 CFR Part 484 (patient rights, comprehensive assessment, QAPI, skilled professional services, home health aide standards, and more), on top of any state license.
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Accreditation with deemed status. Most new Medicare home health agencies obtain certification through a CMS-approved accrediting organization with deeming authority — ACHC, CHAP, or The Joint Commission — whose surveys substitute for the state agency's Medicare certification survey.
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State survey agencies enforce both. State survey agencies (usually the state health department) operate under agreements with CMS to survey Medicare-certified agencies, and most also run the state licensure survey program — initial surveys, renewal/recertification surveys, complaint investigations, and plan-of-correction enforcement per the CMS State Operations Manual.
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