Every home health agency operating in California must hold an active license from the California Department of Public Health (CDPH) before delivering care in a patient’s home, and California home health agency regulations layer state licensing rules under Title 22 with federal Conditions of Participation for any agency that bills Medicare or Medi-Cal. The state framework governs who runs the agency, who touches patients, how care is planned and documented, and what happens when something goes wrong. The federal layer adds quality reporting, emergency preparedness, and payment consequences. Getting either layer wrong can mean fines, loss of reimbursement, or closure.
Getting Licensed by CDPH
California Health and Safety Code Section 1725 prohibits any entity from providing skilled nursing, therapy, or other medical services in a patient’s home without a CDPH license.1California Legislative Information. California Health and Safety Code 1725 The rule applies equally to private companies, partnerships, government agencies, and nonprofits.2CDPH – CA.gov. HHA Initial Application Packet
The application requires a completed CDPH packet, the fee, and an on-site survey. For fiscal year 2025–26, the initial license application fee is $2,946.3CDPH – CA.gov. Fiscal Year 2025-26 Fee Schedule CDPH adjusts fees periodically, so confirm the current amount before filing. Applicants also need to show financial stability through a business plan, proof of liability insurance, and evidence of adequate working capital. Anyone with ownership or management control must pass a criminal background check for healthcare fraud and patient abuse history.
The pre-license survey checks written policies, staffing documentation, record-keeping systems, and office conditions against Title 22. Any deficiencies must be fixed before the license issues. The agency must also have an administrator and a director of patient care services in place.
Medicare and Medi-Cal Certification
A CDPH license by itself does not authorize billing to Medicare or Medi-Cal. Agencies that want reimbursement from those programs also have to meet the federal Conditions of Participation in 42 CFR Part 484, which cover care planning, patient rights, emergency preparedness, infection control, and quality assessment.4eCFR. 42 CFR Part 484 – Home Health Services CMS conducts its own certification survey. Losing Medicare certification does not automatically pull the state license, but it cuts off the largest revenue stream for most agencies.
Medi-Cal participation adds a surety bond requirement. Federal rules bar Medicaid reimbursement for home health services unless the agency has furnished a qualifying bond to the state Medicaid agency, and the bond must be effective before the provider agreement takes effect.5eCFR. 42 CFR 441.16 – Home Health Agency Requirements for Surety Bonds Agencies acquiring an existing provider through purchase or ownership transfer must have the bond in place from the date of that transaction.
Required Leadership and Governance
Title 22 requires every home health agency to have a governing body that sets policy, oversees operations, and ensures compliance. The governing body formally appoints an administrator and defines that person’s authority in writing.
Administrator
The administrator handles business operations, regulatory compliance, and financial management. Title 22 requires at least one year of supervisory or administrative experience in a home health agency, clinic, or health facility. The administrator has to be available during normal business hours and generally cannot manage more than one agency without written CDPH approval.
Director of Patient Care Services
The director of patient care services runs the clinical side and must be a registered nurse. The DPCS qualifies under one of two tracks: a bachelor’s degree or higher in nursing or a health-related field plus at least three years of recent clinical experience including one year in a supervisory or administrative role, or at least four years of recent experience in a home health agency, clinic, or health facility with at least one year supervising or managing staff.6Cornell Law School. California Code of Regulations Title 22, 74703 – Director of Patient Care Services The DPCS develops clinical policies, coordinates services across disciplines, and evaluates staff.
Quality Assurance Committee
Every agency needs a quality assurance committee that monitors compliance, conducts internal audits, and identifies improvements. Reporting lines from the governing body down to clinical staff should be documented in an organizational chart so accountability is clear.
Staff Screening and Training
All clinical staff must hold current, valid California credentials, whether they are registered nurses, licensed vocational nurses, physical therapists, occupational therapists, speech-language pathologists, or home health aides. The agency verifies credentials before anyone provides care.
Prospective employees go through criminal background checks with both the California Department of Justice and the FBI. Convictions for offenses like elder abuse or healthcare fraud can disqualify an applicant. Separately, every applicant must be screened against the Office of Inspector General’s List of Excluded Individuals and Entities. Employing anyone on that list means the agency cannot receive federal healthcare reimbursement for any service that person furnishes, orders, or prescribes.7U.S. Department of Health and Human Services Office of Inspector General. Exclusions FAQs This screening should be repeated periodically, not treated as a one-time hiring check.
Home health aides have the most structured training track. California requires a state-approved training program of at least 120 hours, with a minimum of 20 hours of hands-on clinical experience covering personal care, cleaning and care tasks, and nutrition.8Cornell Law School. California Code of Regulations Title 22, 74747 – Home Health Aide Training The curriculum also covers infection control, patient safety, and emergency procedures. A competency evaluation follows.
To keep certification active, home health aides complete 12 hours of in-service training or continuing education each year, totaling 24 hours over the two-year certification cycle. Online CEUs do not count.9CDPH – CA.gov. CNA/HHA In-Service Training/CEU Requirements
Care Planning and Supervision
Every patient needs a written plan of care based on physician or practitioner orders. The plan lists the services the patient will receive, the frequency of visits, and measurable goals. Federal rules require review and revision as often as the patient’s condition demands, and at minimum every 60 days from the start of care, with a physician or allowed practitioner signing each review.10eCFR. 42 CFR Part 484 – Home Health Services – Section 484.60
A registered nurse or therapist has to periodically observe home health aides and other direct-care staff in the patient’s home to confirm they are following the care plan competently and safely. Documentation must be kept and produced during state inspections. These supervisory visits are how agencies catch problems before they harm a patient.
OASIS Reporting Duties
Medicare-certified agencies must collect and submit Outcome and Assessment Information Set (OASIS) data for every patient receiving skilled services, regardless of the payer. As of July 2025, the requirement extends to all payers. The exceptions are patients under 18, maternity patients, and patients receiving only personal care or housekeeping services.11Centers for Medicare and Medicaid Services. OASIS-E2 Manual
OASIS assessments must be completed by a registered nurse, physical therapist, occupational therapist, or speech-language pathologist. Licensed vocational nurses, therapy assistants, social workers, and home health aides may not perform them. The collection deadlines are strict:
- Start of care: within 5 calendar days of the start-of-care date.
- Resumption of care: within 2 calendar days of the patient’s return home from a facility.
- Follow-up or recertification: during the last 5 days of every 60-day episode.
- Transfer, discharge, or death: within 2 calendar days of the event.
Submissions go through CMS’s internet Quality Improvement and Evaluation System (iQIES), and patients must receive an OASIS privacy notice.11Centers for Medicare and Medicaid Services. OASIS-E2 Manual Under the Home Health Quality Reporting Program, an agency that fails to submit qualifying OASIS data has its annual Medicare payment update cut by 2 percentage points, and at least 90% of submitted assessments must meet the CMS definition of a quality assessment to avoid that reduction.12Centers for Medicare and Medicaid Services. Home Health Quality Reporting Data Submission Deadlines
Emergency Preparedness Plan
Federal regulations require every Medicare-certified home health agency to maintain a written emergency preparedness plan covering natural and man-made disasters. The plan includes a risk assessment, a communication strategy for staff and patients during an emergency, and specific response policies.13Centers for Medicare and Medicaid Services. Emergency Preparedness Rule
All staff, contractors, and volunteers get initial training on the plan, with refresher training at least every two years. If the plan changes significantly, additional training is required immediately. The plan itself is reviewed and updated at least every two years.14eCFR. 42 CFR Part 484 – Home Health Services – Section 484.102
Testing is annual. Each year the agency participates in a community-based full-scale exercise, or, if one isn’t available, runs its own facility-based functional exercise. Every other year the agency runs an additional exercise, which can be a tabletop, a mock drill, or another full-scale event. Activating the plan during a real disaster counts as the next required exercise. All drills and real activations are documented, analyzed, and used to update the plan.14eCFR. 42 CFR Part 484 – Home Health Services – Section 484.102
Telehealth Boundaries
California home health agencies can use telehealth, but Medicare reimbursement rules have shifted. Through December 31, 2027, Medicare beneficiaries can receive telehealth services from anywhere in the United States, including their homes, and audio-only visits remain covered. Starting January 1, 2028, most telehealth services will again require the patient to be at a medical facility in a rural area, with a behavioral health exception.15Centers for Medicare and Medicaid Services. Telehealth FAQ – Updated 02-26-2026
Remote patient monitoring, like wearable devices that transmit vital signs, is not classified as telehealth under Medicare rules. It does not substitute for in-person visits and does not carry the same geographic and facility restrictions. Starting in 2028, physical therapists, occupational therapists, speech-language pathologists, and audiologists will no longer be able to bill Medicare for telehealth services at all.15Centers for Medicare and Medicaid Services. Telehealth FAQ – Updated 02-26-2026 Agencies relying on therapy-based telehealth should plan for that shift now.
Patient Rights and Records
California requires agencies to give every patient a written notice of rights at the start of care, including how to file a complaint. A compliance officer or patient advocate handles grievances internally. Patients have the right to help develop their care plan, to accept or refuse treatment, and to be informed about their condition in language they understand. Agencies obtain documented informed consent before starting services and record any change in patient preferences.
Records are protected by both HIPAA and California’s Confidentiality of Medical Information Act. The CMIA bars healthcare providers from disclosing individually identifiable medical information without written authorization and requires agencies that create, store, or destroy medical records to do so in a way that preserves confidentiality. Violations can bring civil fines, private lawsuits, and, in serious cases, criminal prosecution.
Penalties for Noncompliance
CDPH enforces the state rules through routine inspections, complaint investigations, and follow-up surveys. Consequences escalate from corrective action plans to fines to license suspension or revocation. The fine amount depends on severity, whether the violation caused actual harm, and whether it reflects a pattern.
For Medicare-certified agencies, CMS has a separate penalty schedule. The daily penalty for an agency not in substantial compliance with a condition of participation can reach $11,413 per day. When violations involve immediate jeopardy to patient health or safety, the maximum climbs to $26,262 per day. Lower-range penalties for process-related deficiencies that do not directly threaten patients start at $1,313 per day and can reach $2,625.16Federal Register. Annual Civil Monetary Penalties Inflation Adjustment These amounts adjust for inflation each year.
Agencies that bill for services never provided, inflate hours, or falsify clinical records face the federal False Claims Act. The statute imposes treble damages, so the agency owes three times the government’s loss, plus a per-claim civil penalty currently between $14,308 and $28,619 for each false claim.17U.S. Department of Justice. The False Claims Act For an agency that submitted hundreds of claims, the math becomes catastrophic quickly.
The Office of Inspector General can also exclude an agency or individual from all federal healthcare programs. Some exclusions are mandatory, including conviction for Medicare or Medi-Cal fraud, patient abuse or neglect, a healthcare-related felony involving fraud or financial misconduct, or a controlled-substance felony. OIG can also exclude on a discretionary basis for substandard care, kickback arrangements, license revocation, or false claims.18U.S. Department of Health and Human Services Office of Inspector General. Background Information – Exclusions An excluded agency loses access to Medicare, Medicaid, and every other federally funded health program, which for most home health agencies ends the business.