The short answer Minnesota licenses all home care under a two-tier MDH framework — basic (non-medical) and comprehensive (skilled) home care licenses — with revenue-scaled fees and a robust correction-order survey system.
What Minnesota requires
Minnesota
Licensing agency. The Minnesota Department of Health (MDH) licenses home care providers under Minn. Stat. §§ 144A.43-144A.4799: a basic license for non-medical services and a comprehensive license for skilled/nursing services.
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Fees scale with revenue. Annual renewal fees are based on the agency's home care revenue, with statutory minimums for small providers — a distinctive Minnesota feature worth budgeting for as the agency grows.
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Surveys. MDH performs an initial survey within the first year (temporary license converts to full license after a satisfactory survey), then periodic core surveys; deficiencies are issued as correction orders with fines for repeat violations.
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Assisted living split. Since August 2021, housing-with-services settings moved to Minnesota's assisted living license, leaving the home care license focused on services in private residences — agencies serving both settings may need both licenses.
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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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