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

Last reviewed: 2026-09-10

New York authorizes Medicare-certified home health services through the establishment of Certified Home Health Agencies (CHHAs) under Article 36 of the Public Health Law, regulated by the New York State Department of Health (NYSDOH). These agencies provide intermittent skilled nursing, physical therapy, and home health aide services under a physician-ordered plan of care, governed by 18 CRR-NY 505.23 for Medicaid reimbursement.

Approval requires navigating a strict Certificate of Need (CON) process governed by the Public Health and Health Planning Council (PHHPC) before any licensure application is granted. Once established and licensed under Article 36, providers must obtain Medicare certification and subsequently enroll in the state's Medicaid Management Information System through the eMedNY portal to bill for services.

1. Service Definition and Scope

Under 18 CRR-NY 505.23, home health services in New York encompass medically necessary, part-time, or intermittent nursing services, home health aide services, and physical, occupational, or speech therapy. These services must be provided by a Certified Home Health Agency (CHHA) to individuals who require skilled care that cannot be safely or adequately provided by personal care services alone.

CHHAs are required to offer nursing, home health aide services, medical supplies, equipment, and appliances, plus at least one additional therapeutic service. The scope of practice is strictly limited to the patient's residence and must follow a physician-approved plan of care that is periodically reviewed.

2. Regulatory and Oversight Agencies

The primary regulatory body for home health services is the New York State Department of Health (NYSDOH), specifically the Office of Primary Care and Health Systems Management. This office oversees the licensure, surveillance, and enforcement of Article 36 regulations for all home care agencies.

The Public Health and Health Planning Council (PHHPC) acts as the gatekeeper for market entry, reviewing and approving all Certificate of Need applications. Medicaid enrollment and claims processing are managed by eMedNY, the state's Medicaid Management Information System.

3. Gatekeeping Prerequisites: Who Can Even Apply

New York imposes a strict Certificate of Need (CON) requirement for the establishment of any new Certified Home Health Agency (CHHA) under Article 36 of the Public Health Law. An applicant cannot simply submit a licensure application; they must first submit a CON application (Schedule 21) and prove public need based on the state's specific methodology for the requested counties.

The Public Health and Health Planning Council (PHHPC) must approve the establishment of the CHHA before licensure can proceed. Furthermore, the state periodically imposes moratoria on the processing of new home care agency applications, meaning the application window may be entirely closed unless the applicant meets specific exception criteria, such as acquiring an existing agency.

4. Licensure and Certification Requirements

Once CON approval is secured, the entity must complete the Application for Home Care Licensure (Form DOH-1056). This comprehensive application requires detailed disclosures of ownership, financial feasibility, organizational structure, and a summary of operating costs.

Because CHHAs provide skilled services, they must also obtain Medicare certification. The NYSDOH conducts an initial licensure survey, and upon successful completion, the agency is licensed under Article 36 and recommended for Medicare certification to the Centers for Medicare and Medicaid Services (CMS).

5. Medicaid Provider Enrollment

After obtaining the Article 36 license and Medicare certification, the CHHA must enroll in the New York Medicaid program through the eMedNY portal. Providers must select 'Option 1: Certified Home Health Agency' on the eMedNY Provider Enrollment Home Health page.

Enrollment requires submission of the specific CHHA enrollment form, proof of licensure, Medicare certification details, and an application fee. Providers must also comply with any active enrollment moratoria or revalidation requirements posted on the eMedNY site.

6. Staffing, Training and Background Checks

CHHAs must maintain a highly qualified clinical staff, led by a full-time Director of Patient Services who is a Registered Professional Nurse (RN) licensed in New York. The agency must employ sufficient RNs, therapists, and home health aides to meet the needs of their patient census.

All patient-facing staff must undergo rigorous background checks, including fingerprinting through the NYSDOH Criminal History Record Check (CHRC) program. Home health aides must complete a state-approved training program and be listed on the New York State Home Care Registry.

7. Documentation, Policies and Records

New York requires CHHAs to maintain comprehensive clinical records for every patient, documenting the physician-ordered plan of care, nursing assessments, and visit notes. These records must demonstrate the medical necessity of the intermittent skilled services provided.

Agencies must also implement a formal quality assurance program to evaluate the home care services provided, as mandated by the DOH-1056 application. Additionally, CHHAs must maintain policies ensuring the provision of charity care in accordance with 10 NYCRR Section 763.11.

8. Billing, Rates and Claims

Medicaid billing for CHHAs in New York is processed through the eMedNY system. New York utilizes an Episodic Payment System (EPS) for CHHA services, which reimburses agencies based on 60-day episodes of care, adjusted for patient acuity using a specific case-mix index.

Providers must submit claims electronically using the 837I (Institutional) format. Rates are established by the NYSDOH and vary by region and patient acuity, rather than a simple fee-for-service hourly rate for skilled nursing.

9. Approval Sequence and Timeline

The approval sequence for a CHHA is lengthy, often taking 18 to 24 months. It begins with the submission of the CON Schedule 21 application, followed by staff review and presentation to the Public Health and Health Planning Council (PHHPC) for establishment approval.

After PHHPC approval, the applicant submits the DOH-1056 licensure application. Once the physical office is ready, NYSDOH conducts an initial survey. Following licensure, the agency applies for Medicare certification, and finally, submits the eMedNY enrollment application.

10. Common Denials and Survey Findings

CON applications are frequently denied or returned if the applicant fails to mathematically prove public need in the requested counties according to the state's methodology. Applications are also rejected if submitted during an active NYSDOH moratorium without meeting exception criteria.

During initial and routine surveys, common citations include failure to maintain accurate and updated physician plans of care, inadequate supervision of home health aides by registered nurses, and incomplete criminal history record checks for staff.

11. Key Contacts and Resources

Prospective CHHA providers must interact with multiple divisions within the New York State Department of Health and the eMedNY system. The Bureau of Project Management handles the initial CON and licensure applications.

For Medicaid enrollment and billing inquiries, eMedNY provides provider manuals, enrollment forms, and customer service support specifically tailored to Home Health Agencies.

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