HOME HEALTH SERVICES PROVIDER IN MASSACHUSETTS

Fatumata Kaba
Aug 7
3 min read

DELIVERING SKILLED NURSING, THERAPY, AND PERSONAL CARE TO INDIVIDUALS IN THE COMFORT OF THEIR HOMES

Home Health Services in Massachusetts offer medical, therapeutic, and personal care to individuals with disabilities, chronic illnesses, or recovering from hospital stays. These services are regulated by the Massachusetts Department of Public Health (DPH) and reimbursed by MassHealth and Medicare, depending on eligibility and service type.

1. GOVERNING AGENCIES

Agency: Massachusetts Department of Public Health (DPH)

Role: Licenses home health agencies under 105 CMR 140.000 regulations

Agency: MassHealth (Massachusetts Medicaid)

Role: Pays for home health services under the Medicaid State Plan and community-based waivers

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Oversees Medicare-certified home health agencies and HCBS compliance

Agency: Executive Office of Health and Human Services (EOHHS)

Role: Provides policy guidance, provider bulletins, and LTSS systems

2. HOME HEALTH SERVICE OVERVIEW

Home Health Care includes:

Skilled Nursing (e.g., wound care, injections, chronic disease monitoring)
Home Health Aide Services (e.g., bathing, grooming, mobility assistance)
Physical, Occupational, or Speech Therapy
Medical Social Work
Patient and caregiver education
Medication management and care plan oversight

These services are delivered based on a physician’s order and documented in a plan of care (POC).

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

To become a licensed home health agency (HHA) in Massachusetts, providers must:

Register a business entity with the MA Secretary of State
Obtain an EIN, NPI, and Medicaid ID
Apply for a Home Health Agency license through the DPH Determination of Need (DoN) Program
Submit a comprehensive application package and policy & procedure manual
Pass a DPH survey inspection
Employ qualified nursing and therapy professionals
Maintain malpractice insurance and secure EMR systems

4. MASSACHUSETTS HOME HEALTH LICENSURE PROCESS

Step 1: Business Formation & Planning

Establish legal entity and secure office location
Develop staffing and service model (e.g., skilled, aide-only, full-service)

Step 2: Apply to DPH for Licensure

Submit application under 105 CMR 140.000
Include org chart, medical director, policies, emergency plan, etc.

Step 3: Site Visit and Licensing Survey

DPH will inspect the office and review staff files, procedures, and compliance

Step 4: Enroll with MassHealth via ePREP

Select appropriate home health categories: RN, LPN, PT, HHA, MSW, etc.

Step 5 (Optional): Apply for Medicare Certification

For dual revenue streams and to serve Medicare-eligible patients

5. REQUIRED DOCUMENTATION

Articles of Organization or LLC registration
IRS EIN and Type 2 NPI
DPH Home Health License
MassHealth Provider ID and contract
Policy & procedure manual covering:
- Admission, discharge, and eligibility criteria
- Care planning, RN supervision, and therapy protocols
- Home Health Aide logs and time sheets
- HIPAA, infection control, and medication safety
- Quality assurance, grievances, and risk management
- Emergency and disaster preparedness
- Client rights, informed consent, and training documentation

6. STAFFING REQUIREMENTS

Role: Director of Nursing (RN)

Requirements: Active MA license, supervisory experience, responsible for clinical operations

Role: Licensed Practical Nurse (LPN)

Requirements: Works under RN delegation for skilled tasks

Role: Home Health Aide (HHA)

Requirements: Must complete state-approved training (75 hours), CPR certified

Role: Therapists (PT, OT, ST)

Requirements: State-licensed, responsible for evaluations and POC updates

Role: Medical Social Worker (if offering full-service model)

Training Requirements:

HIPAA and infection control
Delegation and nursing documentation
Abuse/neglect reporting (MANDATED)
ADL support, body mechanics, and safety
Annual skills review and continuing education

7. MASSHEALTH SERVICE TYPES & BILLING

MassHealth reimburses licensed HHAs for:

Skilled nursing visits
Home health aide visits
Physical therapy, occupational therapy, speech therapy
Social work (MSW) assessments
Telehealth services (in some cases, per bulletins)

Billing is done through:

MassHealth LTSS Provider Portal
Claims must follow POC requirements and be properly documented

8. TIMELINE TO LAUNCH

Phase: Business Registration and Planning

Timeline: 1–2 weeks

Phase: Policy Manual, Hiring, and DPH Application

Timeline: 4–6 weeks

Phase: DPH Survey and Licensure

Timeline: 6–10 weeks

Phase: Medicaid Enrollment and Service Start

Timeline: 4–6 weeks (can overlap)

9. CONTACT INFORMATION

Massachusetts Department of Public Health (DPH)

Website: https://www.mass.gov/guides/apply-for-a-health-care-facility-license

Home Health Licensure Regulations (105 CMR 140)

https://www.mass.gov/doc/105-cmr-140-the-licensure-of-clinics/download

MassHealth Provider Enrollment (ePREP)

Website: https://massfinance.ehs.state.ma.us

LTSS Provider Portal

Website: https://ltss.mass.gov

WAIVER CONSULTING GROUP'S START-UP ASSISTANCE SERVICE — MASSACHUSETTS HOME HEALTH AGENCY

We help clinicians and mission-driven organizations navigate licensing, Medicaid enrollment, and operational setup for Home Health Agencies across Massachusetts.

Scope of Work: