In North Carolina, a home health agency is defined as an agency that provides home health care and medical services intermittently and is licensed and certified to receive Medicare and Medicaid funds in return. Although there are exceptions in certain circumstances, the North Carolina Division of Health Service Regulation highlights standard procedures for establishing your own home health agency in North Carolina (see References 1 and 2).

Establishing a Home Health Agency in North Carolina

Step 1.

Consult and review the Medical Facilities Planning Section of the State Medical Facilities Plan (SMFP) to ascertain whether there is a need for additional agencies and their respective review periods (see Reference 1).

Step 2.

Acquire a Certificate of Need (CON) that certifies a need for a home health agency in the county in which you want to operate. To do this, submit a CON application within the time specified in the Medical Facilities Planning Section of the State Medical Facilities Plan. You can expect to receive notification of your CON application approval or disapproval approximately 150 days after you submit your application for review (see Reference 1).

Step 3.

Request a license from the Acute and Home Care Licensure and Certification Section by submitting an application for licensure. If your agency meets all the requirements set forth in the Home Care Licensure Act, you will receive a license for your agency designating the services you are allowed to provide. If your agency does not meet the requirements set forth in the Home Care Licensure Act, you will be informed of any additional information that you must provide prior to receiving your license (see References 1 and 3).

Step 4.

Submit the appropriate federal Medicare/Medicaid certification forms, including the CMS 855 form so that your agency may receive an unannounced on-site survey. An unannounced on-site survey is an impromptu visit by a representative of the licensing committee who will evaluate your agency to determine if you qualify for approval (see Reference 1).

Step 5.

Wait for the Atlanta Regional Office of the Centers for Medicare Medicaid Services to approve your home health agency and assign your health care provider number (see Reference 1).


Within the first 30 days of the review period for your application for a CON, a written public comment period affords you and others the opportunity to comment about any home health agency proposals. A public hearing occurs usually within 30-50 days from the initial start of the review period to give you and other applicants the chance to respond to any comments made during the review period. Your agency must have served 10 skilled care patients and 7 active (not Medicare patients) to request an on-site survey (see Reference 1).


You cannot establish your home health agency in North Carolina if the State Medical Facilities Plan does not indicate that there is a need for the agency in the county where you want to operate (see Reference 1)