NYC Home Health & Home Care License Attorney

Home Health Care Licensing in New York

Operating a home health care agency in New York requires navigating one of the most heavily regulated licensing frameworks in the country. The New York State Department of Health (DOH) oversees the licensing and certification of home care agencies, and the application process is rigorous, document-intensive, and subject to significant processing times. Whether you are applying for a new Licensed Home Care Services Agency (LHCSA) license, pursuing a Certified Home Health Agency (CHHA) designation, or acquiring an existing agency, experienced legal counsel is essential to achieving a successful outcome.

At Agarunov Law Firm, P.C., we represent home care entrepreneurs, healthcare organizations, and investors in all aspects of home health care licensing in New York and New Jersey. From new license applications through agency acquisitions and ongoing compliance, we guide our clients through every step of the regulatory process.

New License Applications

LHCSA (Licensed Home Care Services Agency)

A LHCSA license is required to provide home care services including nursing, home health aide services, personal care, and therapy services on a fee-for-service or private pay basis. The LHCSA application process involves submission of a detailed application to the DOH, disclosure of all principals, owners, and managing members, background checks and character fitness review for all disclosed parties, demonstration of financial viability and operational readiness, policy and procedure development compliant with 10 NYCRR Part 766, staffing plans and clinical supervision structures, and site inspection and operational readiness review.

We prepare comprehensive LHCSA applications that address every DOH requirement, including the operational plan, compliance infrastructure, and governance documents. Our goal is to submit applications that are complete and thorough on first submission, minimizing deficiency letters and delays.

CHHA (Certified Home Health Agency)

CHHAs are certified by the DOH and approved to participate in Medicare and Medicaid. CHHA certification involves a more extensive process than LHCSA licensing, including Certificate of Need (CON) review, public need demonstration, and CMS Medicare certification. We advise clients on CHHA feasibility, prepare CON applications, and coordinate the certification process.

Fiscal Intermediary Registration

For organizations providing Consumer Directed Personal Assistance Program (CDPAP) services, fiscal intermediary authorization is required. We assist with the application and compliance requirements for fiscal intermediary operations.

Purchase & Sale of Home Care Agencies

Acquiring an existing home care agency — whether a LHCSA, CHHA, or other licensed entity — is often the fastest path to market entry, as it avoids the lengthy new application process and provides an established patient base, staff, and payer relationships. However, agency acquisitions involve unique legal and regulatory requirements that go beyond a standard business acquisition.

Buyer Representation

We represent buyers in home care agency acquisitions, handling due diligence on the agency's license status, DOH compliance history, Medicaid enrollment, staffing, patient census, payer contracts, and any open investigations or deficiencies. We structure the transaction as either an asset purchase or change of ownership (CHOW), prepare and submit the DOH change of ownership application, negotiate the purchase agreement with healthcare-specific provisions, and coordinate the transition to ensure continuity of patient care and uninterrupted Medicaid billing.

Seller Representation

For agency owners looking to sell, we prepare the agency for sale by addressing compliance issues, organizing operational records, and ensuring the license and Medicaid enrollment are in good standing. We negotiate the purchase agreement, coordinate the DOH change of ownership process, and ensure a clean transfer that satisfies all regulatory requirements.

Change of Ownership (CHOW) Applications

Any transfer of ownership interest in a licensed home care agency requires DOH approval through a change of ownership application. This includes stock sales, membership interest transfers, and changes in controlling persons. We prepare and submit CHOW applications, respond to DOH inquiries, and manage the approval process to ensure uninterrupted operations during the transition.

Ongoing Compliance & Operations

• DOH Survey Preparation: Preparing agencies for DOH surveys and inspections, addressing deficiencies, and developing plans of correction
• Policy & Procedure Development: Creating and updating clinical and administrative policies compliant with 10 NYCRR Part 766
• Medicaid Enrollment & Billing Compliance: Enrollment applications, billing compliance reviews, and audit response
• Employment & Staffing Compliance: Employment agreements, credentialing, and Home Care Worker Wage Parity compliance
• HIPAA Compliance: Privacy and security programs tailored to home care operations
• Corporate Compliance Programs: Developing and maintaining compliance programs required for Medicaid-participating providers

The Law That Governs LHCSA Licensure in New York

Home care licensing in New York runs on Article 36 of the Public Health Law and the Department of Health regulations at 10 NYCRR Parts 765 and 766. Knowing which provision controls a given question is the difference between an application that is approved and one that sits in review for a year.

Licensure and the public-need test. Public Health Law § 3605 requires approval by the Public Health and Health Planning Council (PHHPC) before any licensed home care services agency operates. Since the 2018 amendments — Part B of Chapter 57 of the Laws of 2018, codified at § 3605(4) — PHHPC must weigh public need and financial feasibility alongside the character and competence of the operator. Before 2018, character and competence was the only test. Under the public-need methodology in Part 765, there is a rebuttable presumption that no need exists in a county already served by five or more active LHCSAs, which in practice covers every county in the New York City metro area. Overcoming that presumption is where most de novo applications succeed or fail.

The moratorium is over. A statutory moratorium suspended new LHCSA approvals from April 1, 2018 to March 31, 2020. It has expired and PHHPC has approved applications since, but approvals concentrate in the change-of-ownership and categorical-exemption pathways rather than new agencies in saturated counties. Guidance written during the moratorium still circulates online; much of it no longer describes current practice.

Change of ownership. Public Health Law § 3611-a treats the transfer of ten percent or more of the stock, membership interests or voting rights of an operating entity as a change of ownership requiring PHHPC approval. A CHOW of an agency actively serving at least 25 patients is reviewed for financial feasibility and character and competence only — no public-need review — unless the buyer seeks to serve counties outside the existing service area. That exemption is why acquiring an operating LHCSA is often faster than applying for a new license, and it is also why the patient count and the county list are the first two facts we verify in any acquisition.

Application mechanics. Applications are filed through the NYSE-CON system on DOH form 1056a, with the application fee set by § 3605(13). Since January 1, 2019, § 3605-b has also required LHCSAs to register with the Department to provide nursing, home health aide or personal care services and to be reimbursed for them. Operating standards after licensure — the director of patient services, clinical supervision, records, patient rights — are set in 10 NYCRR Part 766.

For a step-by-step account of the application process itself, see our guide to how to get a home health agency license in New York. For acquisitions, our article on LHCSA change of ownership in New York walks through the CHOW filing in detail.

What New York Metro Home Care Operators Should Know

Where New York home care work concentrates: all five NYC boroughs plus Nassau, Suffolk and Westchester counties. Payer mix differs sharply by borough — from Medicaid-dominated agencies in Brooklyn and the Bronx to balanced mixes in Queens and Staten Island to private-pay concentrations in Manhattan and Westchester — and it shapes how an agency organizes operations and compliance. Medicaid managed long-term care plans contract on a regional basis, so an agency serving several boroughs is negotiating with the same MLTC plans on different terms in different service areas.

Two compliance regimes apply on top of licensure. The Home Care Worker Wage Parity Law sets minimum total compensation for aides on Medicaid-funded cases in New York City, Nassau, Suffolk and Westchester, at rates that differ between the City and the suburban counties, and it carries certification and audit obligations for the agency. Federal electronic visit verification requirements under the 21st Century Cures Act, implemented through New York’s Medicaid program, apply to personal care and home health services and are a condition of reimbursement. Neither is a licensing question strictly, but both are questions a buyer asks in diligence and a regulator asks in a survey.

Serving New York and New Jersey

Agarunov Law Firm is licensed to practice in both New York and New Jersey. We represent home care agencies and entrepreneurs across all five NYC boroughs, Westchester and Long Island, and throughout New Jersey. New Jersey home health care licensing operates under the Division of Consumer Affairs and Department of Health, with different requirements than New York. Our dual-state licensing allows us to advise on the specific regulatory frameworks in each jurisdiction, including agencies operating across state lines.