Connecticut - Home Health Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

The Connecticut Department of Public Health (DPH) Facility Licensing and Investigations Section (FLIS) licenses Home Health Care Agencies to deliver professional nursing, physical therapy, occupational therapy, speech therapy, and medical social services in a patient's residence. Agencies must secure this state license under Public Health Code 19-13-D66 through 19-13-D79 before applying to Accrediting Organizations (AOs) for Medicare certification, which serves as the foundation for enrolling in the Connecticut Medical Assistance Program (CMAP).

Medicaid reimbursement for intermittent skilled home health services flows through the Department of Social Services (DSS) and its fiscal agent, Gainwell Technologies. Providers submit their enrollment applications via the CMAP Provider Enrollment Portal, linking their DPH license and Medicare certification to their National Provider Identifier (NPI) to activate billing privileges for Connecticut Medicaid members.

1. Service Definition and Scope

In Connecticut, a Home Health Care Agency is defined as a public or private organization that provides professional nursing services and at least one other therapeutic service (physical therapy, occupational therapy, speech therapy, or medical social services) in the patient's home. These services must be delivered under a physician-ordered plan of care.

The scope of practice also includes the provision of home health aide services, provided these aides are supervised by a Registered Nurse. Agencies licensed at this level are distinct from Home Health Aide-only agencies and non-medical Homemaker-Companion agencies, which operate under different regulatory frameworks.

• Skilled Nursing: Intermittent care provided by an RN or LPN under RN supervision.
• Physical Therapy: Restorative therapy services ordered by a physician.
• Occupational Therapy: Services to improve activities of daily living and motor skills.
• Speech Therapy: Treatment for speech, language, and swallowing disorders.
• Medical Social Services: Counseling and resource coordination by a qualified MSW.
• Home Health Aide Services: Personal care and assistance delegated and supervised by an RN.

2. Regulatory and Oversight Agencies

The Connecticut Department of Public Health (DPH) is the primary regulatory body responsible for licensing Home Health Care Agencies and conducting Medicare recertification surveys. The DPH Home Health Unit within the Facility Licensing and Investigations Section (FLIS) processes initial applications and investigates complaints.

The Connecticut Department of Social Services (DSS) administers the Medicaid program, while Gainwell Technologies operates the CMAP portal for provider enrollment and claims processing.

• Connecticut Department of Public Health (DPH): https://portal.ct.gov/dph
• DPH Facility Licensing and Investigations Section (FLIS): https://portal.ct.gov/dph/facility-licensing--investigations/facility-licensing--investigations-section-flis/facility-licensing
• Connecticut Department of Social Services (DSS): https://portal.ct.gov/dss
• CMAP Provider Enrollment Portal: https://www.ctdssmap.com
• Accrediting Organizations (e.g., CHAP, ACHC, Joint Commission): Required for Medicare certification after DPH licensure.

3. Gatekeeping Prerequisites: Who Can Even Apply

Connecticut does not require a Certificate of Need (CON) for the establishment of a new Home Health Care Agency; the Office of Health Strategy (OHS) exempts this provider type from CON review. However, an applicant cannot bill Medicaid until they first obtain a DPH license and subsequently secure Medicare certification.

The state mandates that all applicants must first achieve licensure as a Home Health Care Agency before they can seek the addition of specialized services, such as outpatient hospice, to their license. There are currently no moratoria on new home health agency applications in Connecticut.

• Certificate of Need (CON): Not required for Home Health Care Agencies in Connecticut.
• Business Registration: Must be registered with the Connecticut Secretary of the State.
• DPH Licensure: Mandatory prerequisite before seeking Medicare certification.
• Medicare Certification: Required via an approved AO (CHAP, ACHC, Joint Commission) prior to Medicaid enrollment for skilled services.
• NPI Number: Must obtain an organizational Type 2 National Provider Identifier.

4. Licensure and Certification Requirements

To obtain a Home Health Care Agency license, providers must submit an application to the DPH Home Health Unit, demonstrating compliance with Public Health Code Sections 19-13-D66 to 19-13-D79. The application requires detailed organizational charts, resumes of key personnel, and comprehensive policies and procedures.

Upon achieving DPH licensure, the agency must apply to a CMS-approved Accrediting Organization to undergo an initial Medicare certification survey. DPH itself conducts Medicare recertification surveys for existing agencies.

• Application Form: Submitted directly to the DPH Home Health Unit.
• Licensure Fee: Required initial and renewal fees as set by DPH.
• Policies and Procedures: Must cover patient rights, infection control, and clinical protocols.
• Surety Bond: Not strictly required for skilled agencies, unlike the $10,000 bond for Homemaker-Companion agencies.
• Medicare Survey: Conducted by an AO to achieve deemed status for CMS.

5. Medicaid Provider Enrollment

Once licensed by DPH and certified by Medicare, the agency must enroll in the Connecticut Medical Assistance Program (CMAP) to bill Medicaid. Enrollment is conducted entirely online through the CMAP Provider Enrollment Portal operated by Gainwell Technologies.

Providers use the Provider Enrollment Wizard to submit their application, upload their DPH license and Medicare tie-in notice, and pay the required application fee. Re-enrollment is required periodically as notified by CMAP.

• Enrollment Portal: CMAP Provider Enrollment Wizard at www.ctdssmap.com.
• Provider Type/Specialty: Must select the specific taxonomy for Home Health Agency.
• Application Fee: Subject to the ACA institutional provider screening fee unless waived by Medicare payment.
• Required Documents: DPH License, Medicare Certification letter, W-9, and EFT authorization.
• Screening Level: High risk for new home health agencies, requiring fingerprinting and background checks for owners.

6. Staffing, Training and Background Checks

Connecticut Public Health Code mandates specific qualifications for agency leadership and clinical staff. A Home Health Care Agency must employ an Administrator and a Clinical Supervisor (Registered Nurse) who meet state-defined experience requirements in home health care.

All home health aides must successfully complete a Home Health Aide Competency Evaluation offered by a licensed agency. Comprehensive background checks are required for all staff providing direct patient care.

• Administrator: Must be a physician, RN, or individual with a bachelor's degree and specific administrative experience.
• Clinical Supervisor: Must be an RN with at least one year of home health experience.
• Therapists: PT, OT, and ST staff must hold active Connecticut DPH licenses.
• Home Health Aides: Must pass a state-recognized competency evaluation.
• Background Checks: State and national criminal history checks required for direct care staff.

7. Documentation, Policies and Records

Agencies must maintain comprehensive clinical records for every patient, anchored by a physician-ordered plan of care that is reviewed and updated at least every 60 days. Documentation must comply with both DPH regulations and Medicare Conditions of Participation.

Agencies are required to implement a Quality Assessment and Performance Improvement (QAPI) program and maintain an emergency preparedness plan that aligns with state and federal guidelines.

• Plan of Care: Must be signed by the attending physician within specific timeframes.
• OASIS Data: Must be collected and transmitted for all Medicare and Medicaid adult skilled care patients.
• Clinical Notes: Must be written and incorporated into the record within 7 days of the visit.
• Record Retention: Clinical records must be retained for a minimum of 7 years post-discharge.
• Emergency Preparedness: Must include individualized patient risk assessments and agency-wide continuity plans.

8. Billing, Rates and Claims

Home health claims are submitted to CMAP via the Gainwell Technologies MMIS portal using standard institutional claim formats (UB-04/837I). Services are billed using specific revenue codes and HCPCS codes as outlined in the DSS Home Health fee schedule.

Prior authorization is required for certain services, particularly when care exceeds initial evaluation limits or involves extended home health aide hours. Electronic Visit Verification (EVV) is mandated for personal care and home health aide services.

• Billing System: CMAP secure web portal via Gainwell Technologies.
• Fee Schedule: Published by DSS on the CMAP portal under Provider Fee Schedules.
• Prior Authorization: Managed by DSS or its designated utilization management contractor.
• EVV Mandate: Required for home health aide visits to capture time, location, and service delivery.
• Claim Format: 837I electronic transactions or direct data entry on the CMAP portal.

9. Approval Sequence and Timeline

The approval process begins with submitting the licensure application to the DPH Home Health Unit. DPH review and initial licensure typically take 3 to 6 months, depending on application completeness and FLIS backlog.

Following DPH licensure, the agency must operate and admit a minimum number of patients to undergo the Medicare accreditation survey (2-4 months). Once Medicare certification is granted, CMAP Medicaid enrollment takes an additional 30-60 days.

• Step 1: Submit DPH Home Health Care Agency application and fee.
• Step 2: Pass DPH initial review and obtain state license (3-6 months).
• Step 3: Admit patients and undergo AO Medicare survey (2-4 months).
• Step 4: Receive CMS tie-in notice and Medicare billing privileges.
• Step 5: Submit CMAP enrollment via Gainwell portal (30-60 days).

10. Common Denials and Survey Findings

Initial DPH licensure applications are frequently delayed due to incomplete policy manuals, missing resumes for the Administrator or Clinical Supervisor, or failure to demonstrate compliance with Public Health Code 19-13-D66.

During FLIS surveys, common deficiencies include failure to follow the physician's plan of care, incomplete or late clinical documentation, and inadequate supervision of home health aides by the Registered Nurse.

• Application Delays: Missing organizational charts or unqualified clinical leadership.
• Care Plan Deficiencies: Delivering services without active, signed physician orders.
• Aide Supervision: Failure of the RN to conduct required on-site supervisory visits every 14 days.
• Infection Control: Staff failing to demonstrate proper hand hygiene or bag technique during home visits.
• Background Checks: Missing documentation of criminal history checks in personnel files.

11. Key Contacts and Resources

The DPH Home Health Unit is the primary contact for licensure applications, regulations, and reporting reportable events. They can be reached via phone or email for application packets.

For Medicaid billing and enrollment inquiries, providers must contact Gainwell Technologies Provider Services through the CMAP portal.

• DPH Home Health Unit: https://portal.ct.gov/dph/facility-licensing--investigations/facility-licensing--investigations-section-flis/home-health-unit
• CMAP Provider Portal: https://www.ctdssmap.com
• DSS Home Health Information: https://portal.ct.gov/dss
• DPH FLIS Complaint Submission: https://dphflisevents.ct.gov/Complaints
• Medicare Information Hotline: 1-800-828-9769 (for existing CT agency info).

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