The short answer North Carolina licenses home care agencies (in-home aide, nursing, companion services) through DHSR; Medicare-certified home health requires a Certificate of Need.
What North Carolina requires
North Carolina
Licensing agency. The NC Division of Health Service Regulation (DHSR), Acute and Home Care Licensure and Certification Section, licenses home care agencies under N.C. Gen. Stat. § 131E-135 et seq. and 10A NCAC 13J.
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Home care agency license. One license covers in-home aide services, nursing, infusion, and companion/sitter services by service category; licenses expire December 31 and renew annually, with a flat per-agency statutory license fee ($560 for initial licensure).
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CON for home health. Medicare-certified home health agencies are subject to Certificate of Need review under N.C. Gen. Stat. § 131E-176 et seq., with new need determinations published in the annual State Medical Facilities Plan.
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Surveys. DHSR conducts an initial licensure survey, periodic and complaint surveys thereafter, and requires plans of correction; it also performs Medicare certification surveys as the CMS state agency.
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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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