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

Last reviewed: 2026-09-10

The Louisiana Department of Health (LDH) Health Standards Section (HSS) licenses Home Health Agencies to provide intermittent skilled nursing, physical therapy, occupational therapy, and speech-language pathology to Medicaid beneficiaries. Approval to operate requires passing the state's Facility Need Review (FNR) process before a licensure application can even be submitted.

Once FNR approval is secured, agencies must obtain state licensure through LDH HSS and typically achieve Medicare certification, which serves as the foundation for Medicaid enrollment. Providers then enroll through the Louisiana Medicaid Provider Enrollment Portal managed by Gainwell Technologies to bill for services under the state's Medicaid state plan and managed care organizations (MCOs).

1. Service Definition and Scope

Home Health Services in Louisiana encompass part-time or intermittent skilled nursing care and therapeutic services delivered in a beneficiary's residence. These services must be ordered by a physician under a documented plan of care and are designed to treat acute illnesses, injuries, or exacerbations of chronic conditions.

Medicaid covers these services to prevent institutionalization and promote recovery in the home environment. Personal care or home health aide services are generally only covered when provided in conjunction with skilled nursing or therapy.

• Skilled Nursing: provided by a Registered Nurse (RN) or Licensed Practical Nurse (LPN) under RN supervision.
• Physical Therapy: restorative services to improve mobility and function.
• Occupational Therapy: interventions to restore activities of daily living.
• Speech-Language Pathology: treatment for speech, language, and swallowing disorders.
• Home Health Aide: personal care services permitted only when skilled services are also being provided.

2. Regulatory and Oversight Agencies

The Louisiana Department of Health (LDH) is the primary umbrella agency governing healthcare services. Within LDH, the Health Standards Section (HSS) handles all facility licensing, Facility Need Review (FNR), and Medicare/Medicaid certification surveys.

Medicaid enrollment and claims processing are managed by Gainwell Technologies, the state's fiscal intermediary.

• Louisiana Department of Health (LDH): administers the state Medicaid program (https://ldh.la.gov).
• LDH Health Standards Section (HSS): conducts Facility Need Review, issues licenses, and performs surveys (https://ldh.la.gov/health-standards-section).
• Gainwell Technologies: operates the Louisiana Medicaid Provider Enrollment Portal and MMIS (https://www.lamedicaid.com).
• Centers for Medicare and Medicaid Services (CMS): oversees federal Medicare certification which LDH HSS surveys on their behalf.

3. Gatekeeping Prerequisites: Who Can Even Apply

Louisiana strictly controls the proliferation of new home health agencies through the Facility Need Review (FNR) process. An applicant cannot submit a licensure application without first obtaining an FNR approval letter from LDH HSS.

The FNR process requires applicants to prove a geographic need for additional providers in a specific service area. Without this approval, the state will not accept a licensing application.

• Facility Need Review (FNR): mandatory pre-licensure approval process determining geographic need (https://ldh.la.gov/health-standards-section/facility-need-review).
• FNR Fee: $200 non-refundable fee submitted to LDH Licensing Fee in Dallas, TX.
• Geographic Restriction: FNR approval is tied to a specific service area; moving outside this area requires a new FNR.
• Medicare Certification Prerequisite: Medicaid enrollment generally requires the agency to be Medicare-certified (Title XVIII).

4. Licensure and Certification Requirements

After FNR approval, agencies apply for a Home Health Agency license from LDH HSS. The process involves submitting a detailed application packet, passing a life safety and health survey, and obtaining a surety bond.

Because Medicaid enrollment requires Medicare certification, agencies must also submit a CMS-855A application to their Medicare Administrative Contractor (MAC) and undergo a federal certification survey.

• Application Form: HSS Home Health Agency Initial License Application.
• Licensure Fee: typically $600 for initial home health licensure.
• Surety Bond: $50,000 surety bond required for Medicaid enrollment.
• Initial Survey: conducted by HSS to verify compliance with state operational and clinical standards.
• Medicare Certification (855A): submitted to the MAC, followed by an HSS or accrediting organization survey.

5. Medicaid Provider Enrollment

Enrollment is processed through the Louisiana Medicaid Provider Enrollment Portal. Agencies must enroll as Provider Type 44 (Home Health Agency).

Once enrolled in fee-for-service Medicaid, providers must separately credential and contract with the Healthy Louisiana managed care organizations (MCOs) to serve the majority of the Medicaid population.

• Enrollment Portal: Louisiana Medicaid Provider Enrollment Portal via Gainwell (https://www.lamedicaid.com).
• Provider Type: Type 44 (Home Health Agency).
• Application Fee: subject to the CMS institutional provider application fee unless waived via Medicare enrollment.
• Form PE-50: Louisiana Medicaid Provider Enrollment Form required for certain updates and agreements.
• MCO Contracting: must separately contract with Healthy Louisiana managed care plans (e.g., Aetna, AmeriHealth Caritas, Healthy Blue, Humana, Louisiana Healthcare Connections, UnitedHealthcare).

6. Staffing, Training and Background Checks

Agencies must employ qualified clinical staff and maintain strict administrative oversight. All patient-facing staff must clear state and federal background checks.

The agency must designate a qualified Administrator and a Director of Nursing to oversee daily operations and clinical care.

• Administrator: must be a licensed physician, RN, or individual with a bachelor's degree and one year of supervisory experience in health care.
• Director of Nursing (DON): must be a Louisiana-licensed RN with at least one year of clinical experience.
• Criminal Background Checks: mandatory fingerprint-based state and FBI checks for all direct care staff.
• Direct Care Worker Registry: aides must be checked against the Louisiana Direct Service Worker Registry.

7. Documentation, Policies and Records

LDH HSS requires comprehensive policies covering patient rights, emergency preparedness, and clinical records. The physician-ordered plan of care (CMS-485 or equivalent) is the central compliance document.

Agencies must also comply with federal OASIS reporting requirements for adult patients.

• Plan of Care: must be signed by the ordering physician every 60 days.
• Emergency Preparedness Plan: must comply with CMS and state rules, updated annually.
• Clinical Records: must be retained for a minimum of 6 years from the date of discharge.
• OASIS Data: mandatory collection and transmission of the Outcome and Assessment Information Set for adult patients.

8. Billing, Rates and Claims

Home health services are billed using standard UB-04 institutional claim formats or 837I electronic transactions. Rates are established by LDH and published on the Louisiana Medicaid fee schedule.

Prior authorization is frequently required by MCOs for therapy services and extended nursing visits.

• Billing System: claims submitted via the Gainwell MMIS portal or directly to the respective MCO.
• Revenue Codes: typically billed under 042X (Physical Therapy), 043X (Occupational Therapy), 044X (Speech Therapy), and 055X (Skilled Nursing).
• Prior Authorization: required by most Healthy Louisiana MCOs before initiating therapy or extended nursing visits.
• Fee Schedule: published on lamedicaid.com under Fee Schedules -> Home Health.

9. Approval Sequence and Timeline

The end-to-end process from FNR to MCO contracting can take 12 to 18 months. FNR and Medicare certification are the longest phases.

Providers cannot bill Medicaid until the entire sequence, including MCO credentialing, is complete.

• Phase 1: FNR Application and Approval (30-90 days).
• Phase 2: State Licensure Application and Initial Survey (90-120 days).
• Phase 3: Medicare Certification (CMS-855A) and Survey (6-9 months).
• Phase 4: Medicaid Provider Enrollment via Gainwell (30-60 days).
• Phase 5: Healthy Louisiana MCO Credentialing and Contracting (90-120 days).

10. Common Denials and Survey Findings

HSS surveys frequently cite agencies for incomplete clinical documentation and failure to follow the exact physician orders. FNR applications are routinely denied if the applicant fails to prove geographic need or omits required attachments.

Medicaid enrollment applications are often delayed due to missing ownership disclosures or failure to match the exact legal name on the IRS CP-575.

• FNR Rejection: failure to include the $200 fee or required supporting documentation.
• Plan of Care Deficiencies: missing physician signatures or providing services outside the ordered frequency.
• Background Check Violations: allowing staff to provide care before background clearance is received.
• Emergency Preparedness: failure to conduct required annual drills or update the hazard vulnerability analysis.

11. Key Contacts and Resources

Primary interactions will be with LDH HSS for licensing and Gainwell for Medicaid billing.

Providers should regularly check the LDH and Gainwell websites for policy updates and fee schedule changes.

• LDH Health Standards Section: https://ldh.la.gov/health-standards-section
• Facility Need Review (FNR) Program: [email protected], https://ldh.la.gov/health-standards-section/facility-need-review
• Louisiana Medicaid Provider Portal (Gainwell): https://www.lamedicaid.com
• Healthy Louisiana (MCO Information): https://myplan.healthy.la.gov

See all Louisiana services · Louisiana Medicaid consulting · book a consultation.