The short answer Louisiana licenses non-medical care through the Home and Community-Based Services (HCBS) provider license and skilled care through the home health agency license — Facility Need Review gates key HCBS modules, and a statutory moratorium restricts new home health licenses.
What Louisiana requires
Louisiana
Licensing agency. The Louisiana Department of Health (LDH), Health Standards Section, licenses home health agencies (La. R.S. 40:2116.31 et seq.) and Home and Community-Based Services providers (La. R.S. 40:2120.1 et seq.; LAC Title 48).
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HCBS provider modules. The HCBS license works on a module system — personal care attendant, respite, supervised independent living, and similar service modules are added to a single license, covering the non-medical market.
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Facility Need Review. Market entry is gated two ways: HCBS provider modules such as personal care attendant, respite, and supervised independent living require Facility Need Review (FNR) committee approval before licensure, while a statutory moratorium on issuing new home health agency licenses (La. R.S. 40:2116.32(F)) blocks most new skilled entrants — creating a resale market for existing licenses.
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Surveys. Health Standards Section conducts initial licensure surveys, annual license renewal, periodic unannounced surveys, and complaint investigations with plan-of-correction and sanction authority.
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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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