Last updated: November 2026
A New York licensed home care services agency (LHCSA) license authorizes covered home care services after written approval from the Public Health and Health Planning Council and issuance by the commissioner. Integral Healthcare Solutions (IHS) helps sponsors prepare application evidence and policies under Public Health Law section 3605 and 10 NYCRR 765-1.2 and 765-1.16. IHS drafts for the client and counsel to review; the client submits.
What is New York home care agency licensure?
We read section 3605 and section 3602, 10 NYCRR 765-1.2 and 765-1.16, and the Department of Health's LHCSA page and application FAQ (page opened November 5, 2026). The Senate sections show a May 16, 2025 revision; the regulations and FAQ identify April 1, 2020 as their effective date, and the LHCSA page a January 2026 revision. In brief:
- Coverage and exemptions (3602(2), 3605(1)). Agencies providing nursing, home health aide or personal care services directly or through contract need a license unless exempt. Subdivision 1 exempts agencies providing personal care or home care services exclusively through a program administered, operated or regulated by another state agency; organizations licensed and operating exclusively as nurses' registries under General Business Law article 11; and sole practitioners licensed under Education Law sections 6905 and 6906.
- Two steps (3605(2), (3)). No license issues without the council's written approval. After any health systems agency with geographical jurisdiction has had reasonable time to comment, the council acts solely on the subdivision 4 criteria. Proposed disapproval requires notice to the applicant, reasons and a hearing if requested or on the council's own motion.
- Four criteria (4). The council may not approve unless it is satisfied as to public need at the time and place and under the circumstances proposed; the character, competence and standing in the community of the applicant's incorporators, directors, sponsors, stockholders or operators; the proposed agency's financial resources and sources of financial revenues; and such other matters as it deems pertinent.
Who needs it and what triggers it?
Sponsors planning covered services need licensure before operating unless exempt.
- A start-up needs to assess its services, counties and public need review.
- A buyer needs to address the ownership-change process: per the Department's FAQ, a LHCSA license is not transferable and a new operator receives a new license number.
How does the review run, and what does the council look at?
The Department's application FAQ describes these steps:
- The applicant submits through the New York State Electronic Certificate of Need system.
- After Department review and approval or disapproval recommendations, the application goes on a council agenda; the FAQ describes six meetings a year.
- After contingent council approval, the applicant submits the manual to the regional office; the LHCSA page specifies submission after council and Department approval.
- Once the manual is acceptable, the regional office schedules a pre-opening survey. After a successful survey it recommends licensure and the Bureau of Home Care Licensure and Certification issues the license.
Public need
Each county is a planning area. Under 765-1.16(c)(1) there is a rebuttable presumption of no need for additional agencies where 5 or more LHCSAs are actively serving patients in the planning area as of April 1, 2020; beginning in 2021 the commissioner may adjust that target date for subsequent years. The FAQ defines actively serving as a plan of care in place plus services in the home, with 25 patients as the count. An application may still be filed there with a data-driven rebuttal for each such county; the FAQ says one missing a required rebuttal may not be accepted. The rebuttal should address the applicable factors in 765-1.16(d), whose list is not exhaustive.
Two exceptions: agencies under common ownership with an Assisted Living Program, PACE, Nurse Family Partnership or Continuing Care Retirement Community are not subject to public need review unless they seek to serve patients outside those programs or who are not PACE members. A change-of-ownership application for an agency actively serving at least 25 patients is evaluated only on financial feasibility and the character and competence of the proposed operator, unless the operator seeks to serve patients outside the approved planning area.
Character, competence and finances
Under 765-1.2(b)(2), qualifying and disclosure information may be required for proposed persons, incorporators, directors, controlling persons, officers, principal stockholders, sponsors, governmental subdivisions, individual operators or partners of the applicant or any parent or health-related subsidiary corporation, as applicable. Disclosures include, but are not limited to, health care, adult care and mental health facilities, programs or agencies controlled or operated in the United States, with names, addresses and dates of control or operation.
Under 765-1.2(b)(3) the financial review requires, at a minimum, working capital equal to at least two months of estimated operating expenses, a reasonableness test on financial capability or start-up funding sources, and projections showing revenues, including but not limited to operating revenue, equal to or greater than projected expenditures over time. The FAQ uses "greater than" expenses during the first two months and counts a loan or grant only if awarded before or at application and supporting documentation is submitted. It requires a certified public accountant's help at the applicant's cost. Counsel and the accountant should resolve the wording difference before filing.
How IHS helps
IHS turns the four criteria into a document set the sponsor can assemble and counsel can review. The steps:
- Scope check. IHS lists the planned services so counsel can confirm coverage or an exemption.
- County and rebuttal outline. IHS maps each requested county against the Department's presumption report and outlines the rebuttal, using data the sponsor supplies.
- Disclosure and financial worksheets. IHS builds the checklist for each person under 765-1.2(b)(2) and lays out the financial schedules for the sponsor's accountant.
- Policy set and mock review. IHS drafts the policy set for the agency's clinicians to approve, then reviews the finished file.
Your team supplies the facts, data, accountant, counsel's review, filing and all correspondence. The real limit: IHS does not file with, call or correspond with the Department or the council, and does not predict approval. IHS has three practice lines: accreditation consulting, compliance services and program development.
What to have ready
- Services and claimed exemptions for counsel (Public Health Law 3605(1), May 16, 2025 revision).
- County need status and applicable rebuttal evidence (10 NYCRR 765-1.16, effective April 1, 2020).
- All applicable parties and disclosure details described above (10 NYCRR 765-1.2(b)(2), effective April 1, 2020).
- Working capital evidence and timely loan or grant awards with supporting documents for submission (Department FAQ, effective April 1, 2020).
- Revenue and expense projections (10 NYCRR 765-1.2(b)(3), effective April 1, 2020).
- A manual for submission after council and Department approval (LHCSA page, January 2026 revision).
- Certification questions for counsel (Public Health Law 3605(8), May 16, 2025 revision).
If the rebuttal evidence or financial schedules are blank, book the free introductory call below before filing.
How it compares
License, certification and accreditation answer different questions.
- State license under 3605. Council approval precedes licensure; the commissioner must also make the adequacy and compliance findings in 3605(5).
- Certification. Under 3605(8), an agency licensed but not certified under section 3608 is not qualified to participate as a home health agency under title XVIII or XIX of the federal Social Security Act, subject to the title XIX contract exception explained in the Medicare or Medicaid certification FAQ below.
- Accreditation. A private accreditor reviews against its own standards and does not replace a license. See the ACHC home health page and the home health and hospice page.
What it costs
Scope turns on how many people and parent entities need disclosure files, how many counties need a rebuttal, and which financial schedules exist. Public Health Law 3605(13) sets a 2,000-dollar application fee. The Department's application FAQ requires a check payable to the New York State Department of Health to be received at its listed address within 30 days of submission; the fee is nonrefundable once the application is acknowledged. The applicant bears the accountant's cost. Verify current fees with the New York State Department of Health. IHS scopes each engagement after a free introductory call.
What this is not
This is not legal advice. IHS is a consulting firm, not a law firm; counsel decides whether you need a license.
It is not a prediction that the council will approve.
IHS does not contact the Department of Health or the council; IHS drafts, and the sponsor files and answers.
Frequently asked questions
Who must be licensed as a home care services agency in New York, and who is exempt?
Under Public Health Law 3605(1), agencies providing nursing, home health aide or personal care services directly or through contract need a license unless exempt. Subdivision 1 exemptions cover agencies providing personal care or home care services exclusively through a program administered, operated or regulated by another state agency; organizations licensed and operating exclusively as nurses' registries under General Business Law article 11; and sole practitioners licensed under Education Law sections 6905 and 6906. Counsel should assess the applicable statutory exemptions.
Who approves the application, and what happens after approval?
The council's written approval is required under Public Health Law 3605(2). The Department's FAQ describes manual submission after contingent council approval; its LHCSA page specifies council and Department approval before submission. An acceptable manual precedes the pre-opening survey; after a successful survey, the regional office recommends licensure and the Bureau issues the license.
What does the council weigh?
Under section 3605(4) it may not approve unless satisfied as to public need at the time and place and under the circumstances proposed, the character, competence and standing in the community of the incorporators, directors, sponsors, stockholders or operators, the financial resources and sources of financial revenues, and such other matters as it deems pertinent. It acts solely on those criteria.
What is the five-agency public need presumption?
Under 10 NYCRR 765-1.16(c)(1), five or more LHCSAs actively serving patients in a county as of April 1, 2020 create a rebuttable presumption of no need; beginning in 2021, the commissioner may adjust the target date for subsequent years. The Department's FAQ requires a data-driven rebuttal for each such county.
When does a change of ownership skip public need review?
Under 765-1.16(c)(2), a change-of-ownership application for an agency actively serving at least 25 patients is exempt from public need review and evaluated only on financial feasibility and the proposed operator's character and competence, unless the operator seeks to serve patients outside the approved planning area.
How much working capital does a start-up need?
Regulation 765-1.2(b)(3)(i) sets a minimum equal to at least two months of estimated operating expenses. The FAQ uses "greater than" expenses during the first two months and counts a loan or grant only if awarded before or at application and supporting documentation is submitted.
Does a state license mean Medicare or Medicaid certification?
No. Under section 3605(8), an agency licensed but not certified under section 3608 is not qualified to participate as a home health agency under title XVIII or XIX, though one with a contract with a state agency or its locally designated office or, as specified by the commissioner, with a managed care organization participating in the managed care program established under section 364-j of the Social Services Law, or with a managed long term care plan established under section 4403-f of the Public Health Law, may receive title XIX reimbursement. Have counsel read section 3608.
What does IHS prepare, and does IHS deal with the Department of Health?
IHS prepares the checklists, rebuttal outline, financial worksheets and policy set, and runs a mock review. IHS does not submit anything to, call or correspond with the Department of Health or the council. Your team files and answers, with counsel.