The short answer Rhode Island licenses skilled operators as home nursing care providers and non-medical operators as home care providers through the Department of Health.
What Rhode Island requires
Rhode Island
Licensing agency. The Rhode Island Department of Health, Center for Health Facilities Regulation, licenses home nursing care providers (skilled) and home care providers (personal care/homemaker) under R.I. Gen. Laws ch. 23-17 and 216-RICR-40-10 licensing regulations.
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Two license types. Agencies offering only non-medical services hold the home care provider license; adding nursing or therapy services requires the home nursing care provider license — and a Certificate of Need under R.I. Gen. Laws ch. 23-15 is a precondition to establishment and initial licensure for both provider types (216-RICR-40-10-17.4).
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Surveys and renewal. Licenses renew annually; RIDOH conducts initial and periodic surveys plus complaint investigations with plan-of-correction enforcement, and serves as the CMS survey agency for certified agencies.
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Workforce rules. Rhode Island requires national criminal background checks for home care employees and has layered on home care workforce standards (e.g., minimum-wage and benefit provisions for state-funded home care) in recent budget acts.
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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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