The short answer New Jersey splits oversight sharply: non-medical agencies register as health care service firms with the Division of Consumer Affairs (with mandatory accreditation), while Medicare-style home health agencies are DOH-licensed and gated by Certificate of Need.
What New Jersey requires
New Jersey
Health care service firm registration. Agencies placing personnel to provide health care, personal care, or companion services in private residences must register as health care service firms with the NJ Division of Consumer Affairs under N.J.S.A. 34:8-45.1 et seq. and N.J.A.C. 13:45B, renewed annually.
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Accreditation mandate. New Jersey requires registered health care service firms providing health care services to obtain accreditation from an approved body (e.g., CHAP, ACHC, The Joint Commission) — new firms get roughly one year after registration to achieve it, a requirement unique among states.
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CHHA staffing rule. Hands-on personal care must be delivered by Certified Homemaker-Home Health Aides (CHHAs) certified by the NJ Board of Nursing and employed under nurse supervision — firms cannot use uncertified caregivers for personal care.
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DOH home health + CON. Skilled home health agencies are licensed by the NJ Department of Health under N.J.A.C. 8:42 and require a Certificate of Need (N.J.S.A. 26:2H), a 12-24+ month full-review process that makes new HHA licenses rare; hospice does not require CON.
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Survey process. DOH surveys licensed home health agencies (initial, renewal, and complaint surveys with plans of correction); Consumer Affairs enforces firm registration through investigations and penalties, leaning on the accrediting bodies for routine on-site quality review.
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Employment-model note. NJ registration rules and the state's strict ABC independent-contractor test effectively require employment (not 1099) models for caregivers — a recurring enforcement theme in NJ home care.
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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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