The short answer The District licenses home care agencies through DC Health's Health Regulation and Licensing Administration under a single home care agency license covering skilled and personal care services.
What District of Columbia requires
District of Columbia
Licensing agency. DC Health's Health Regulation and Licensing Administration (HRLA) licenses home care agencies under the Health-Care and Community Residence Facility, Hospice and Home Care Licensure Act (D.C. Code § 44-501 et seq.) and 22-B DCMR ch. 39.
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Single license framework. The DC home care agency license covers agencies providing skilled nursing, therapy, home health aide, and personal care aide services; there is no separate non-medical-only category, so private-duty agencies license under the same framework.
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Business licensing overlay. Agencies also need a DC Basic Business License and must employ certified home health aides / personal care aides who meet DC Board of Nursing certification requirements.
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Surveys. HRLA conducts initial and renewal licensure surveys plus complaint investigations, and serves as the CMS state survey agency for Medicare-certified agencies; deficiencies require plans of correction.
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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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