The short answer New York licenses non-medical/private-duty agencies as LHCSAs under Public Health Law Article 36 with establishment approval by the PHHPC and a public-need methodology; the 2018-2020 application moratorium has expired but new-county access remains tightly gated.
What New York requires
New York
LHCSA licensure. Licensed Home Care Services Agencies (LHCSAs) — covering home health aide, personal care, and private-duty nursing services — are licensed by the NYS Department of Health under Public Health Law § 3605 and 10 NYCRR Part 766, with establishment approval by the Public Health and Health Planning Council (PHHPC).
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Moratorium history and current gates. The statutory moratorium on new LHCSA applications (2018 through March 31, 2020) has expired, but applications are now reviewed under a public need methodology plus character-and-competence and financial-feasibility standards added by the 2018-19 budget.
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County expansion rule. DOH's Administrative Licensure Amendment process (updated by DAL DHCBS 25-03, August 8, 2025) allows adding counties to an existing LHCSA license only where fewer than five LHCSAs actively serve patients in the requested county — a significant constraint on expansion.
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Pending legislation. Bills in the 2025-26 session pull in both directions: S3705 would repeal the public-need and financial-resources hurdles, while S4400 would impose a new processing moratorium on § 3605 applications effective April 1, 2027 — track both before filing.
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CHHAs and registration. Certified Home Health Agencies (Medicare/Medicaid skilled care) require full Article 36 certification with CON-style need review; LHCSAs must also complete annual DOH registration and statistical reporting or face revocation as non-operational.
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Surveys. DOH surveys LHCSAs and CHHAs on a periodic and complaint-driven basis against Part 766/763 standards, with statements of deficiency and plans of correction; CDPAP consolidation to a single statewide fiscal intermediary in 2025 reshaped the adjacent consumer-directed market.
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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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Primary sources for this page
- https://www.health.ny.gov/facilities/home_care/
- https://www.health.ny.gov/facilities/home_care/
- https://www.health.ny.gov/facilities/home_care/dal/docs/25-03.pdf
- https://www.nysenate.gov/legislation/bills/2025/S4400
- https://www.health.ny.gov/facilities/home_care/
- https://www.health.ny.gov/facilities/home_care/
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