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New York - Skilled Nursing Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

In New York, providing skilled nursing services (RN and LPN) in the home requires licensure as a Licensed Home Care Services Agency (LHCSA) by the New York State Department of Health (DOH). This licensure is a rigorous Certificate of Need (CON) process that mandates applicants demonstrate public need, financial feasibility, and character and competence before they can even operate.

Once licensed, agencies must enroll in the New York State Medicaid program via the eMedNY portal to bill for services. The process is highly regulated, and recent updates to the administrative licensure amendment process and Medicaid revalidation requirements mean providers must strictly adhere to DOH and eMedNY guidelines to maintain compliance and active billing status.

1. Service Definition and Scope

Skilled Nursing Services in New York encompass care delivered by Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) in a patient's home under physician orders. This includes comprehensive assessments, medication administration, and skilled treatments.

These services are typically provided through a Licensed Home Care Services Agency (LHCSA), which arranges and oversees the delivery of nursing, home health aide, and personal care services.

2. Regulatory and Oversight Agencies

The primary regulatory body for LHCSAs in New York is the Department of Health (DOH), specifically the Bureau of Home and Community Based Services Licensing Unit and the Public Health and Health Planning Council (PHHPC).

Medicaid enrollment and claims processing are managed through eMedNY, the state's Medicaid Management Information System (MMIS).

3. Gatekeeping Prerequisites: Who Can Even Apply

New York imposes strict gatekeeping prerequisites for LHCSA licensure, most notably the Certificate of Need (CON) requirement. Applicants must prove public need, financial feasibility, and character and competence.

For expansions into new counties, DOH will only approve Administrative Licensure Amendments (ALAs) if there is a demonstrated need, defined as fewer than five LHCSAs actively serving patients in the requested county.

4. Licensure and Certification Requirements

To become a LHCSA, applicants must submit a comprehensive licensure application (DOH-1056) through the NYSE-CON system. The application requires detailed information on ownership, program analysis, operating costs, and quality assurance programs.

Applications are reviewed by DOH staff and then presented to the PHHPC for contingent approval. Following contingent approval, applicants must submit a policy and procedure manual and pass a preopening survey.

5. Medicaid Provider Enrollment

After obtaining LHCSA licensure, agencies must enroll in New York Medicaid through the eMedNY Provider Index. Enrollment requires submitting specific forms and documentation based on the provider type.

New York is currently requiring all providers to revalidate their enrollment by June 2028 through the new Medicaid Provider Services Portal (PSP).

6. Staffing, Training and Background Checks

LHCSAs must employ qualified RNs and LPNs licensed to practice in New York State. The agency must have a Director/Administrator and nursing supervisors to oversee clinical staff.

Agencies must conduct thorough background checks and ensure all staff meet character and competence standards as part of the licensure and ongoing operational requirements.

7. Documentation, Policies and Records

LHCSAs are required to maintain extensive documentation, including a comprehensive policy and procedure manual that must be approved by the DOH Regional Office prior to opening.

Agencies must also maintain detailed patient records, including physician orders, plans of care, and quality assurance program evaluations.

8. Billing, Rates and Claims

Medicaid billing for LHCSA services is processed through eMedNY. Providers must use the appropriate procedure codes and adhere to fee schedules published by DOH.

Providers can receive Electronic Remittance Advice (ERA) or PDF remittances via the eXchange in-box or FTP, requiring specific software for HIPAA-formatted information.

9. Approval Sequence and Timeline

The approval process begins with the submission of the CON application via NYSE-CON, followed by DOH staff review and PHHPC presentation (meetings occur every two months).

After PHHPC contingent approval, the policy manual is reviewed, and a preopening survey is scheduled. The entire process can take several months to over a year depending on PHHPC meeting schedules and survey readiness.

10. Common Denials and Survey Findings

Applications are frequently denied or delayed if they fail to demonstrate public need, especially under the new ALA rules requiring fewer than five active LHCSAs in a target county.

Survey findings often relate to inadequate policy and procedure manuals, failure to properly document physician orders, or issues with character and competence disclosures.

11. Key Contacts and Resources

Prospective LHCSAs should utilize the DOH website and eMedNY portal for the most current applications, manuals, and guidance documents.

Specific email addresses are designated for CON applications and Administrative Licensure Amendments to streamline communication with DOH.

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