The short answer Kentucky licenses skilled home health agencies (with CON) through the Cabinet for Health and Family Services and certifies non-medical Personal Services Agencies.
What Kentucky requires
Kentucky
Licensing agency. The Kentucky Cabinet for Health and Family Services, Office of Inspector General (OIG), licenses home health agencies under KRS ch. 216B and 902 KAR 20:081, and certifies Personal Services Agencies under KRS 216.710-.716 and 906 KAR 1:180.
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CON barrier. Home health agencies require a Certificate of Need tied to county-level need methodology, making new skilled licenses hard to obtain; Personal Services Agency certification has no CON.
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PSA certification. Non-medical agencies (personal care, homemaker, companion, respite) must hold PSA certification, renewed annually, with background checks via Kentucky's KARES/national background check program for direct care staff.
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Surveys. OIG's Division of Health Care conducts initial and renewal surveys and complaint investigations for both categories, with statements of deficiency and plan-of-correction enforcement.
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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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