1. Program Definition and Services

Home Health Care Services in Virginia provide short-term, long-term, and intermittent skilled medical care and therapeutic interventions to individuals in their private residences. These services are prescribed by a physician and detailed in a clinical Plan of Care (POC). They aim to restore health, maximize functional independence, manage chronic medical conditions, and prevent unnecessary institutional or hospital placement. Services include:

• Skilled Clinical Nursing: In-home medical care delivered by a licensed nurse, including intravenous (IV) therapy, complex wound care, medication administration, injections, clinical health assessments, and continuous monitoring of unstable chronic conditions
• Therapeutic and Supportive Habilitation: In-home physical therapy, occupational therapy, speech-language pathology, and medical social work designed to improve functional mobility, communication skills, and activities of daily living (ADLs)

2. Regulations

The program is governed by the following state and federal rules:

• Virginia Administrative Code
• Virginia Code: Title 32.1, Chapter 5, Article 7.1 (Licensure of Home Care Organizations).
• Federal Conditions of Participation (CoPs)
• Virginia Mandated Reporter Laws

3. Licensing or Certification

An agency must obtain a Home Care Organization (HCO) License from the Virginia Department of Health (VDH) under the skilled home health category before operating. 

4. Responsible State Agency

The Virginia Department of Health (VDH) – Office of Licensure and Certification (OLC) is the primary regulatory and licensing body.

5. Application Process

• Form a legal business entity (LLC or Corporation) with the Virginia State Corporation Commission (SCC)
• Secure a Federal Employer Identification Number (EIN) from the IRS and a Type 2 National Provider Identifier (NPI) from CMS
• Complete the VDH HCO license application via the OLC Portal, submitting the required licensing fee and initial corporate financial viability documentation
• Undergo an on-site inspection and clinical record/policy review conducted by VDH licensing staff
• Submit a Medicaid provider enrollment application through the Virginia Medicaid Enterprise System (MES) provider portal
• Apply for and execute credentialed service contracts with state-contracted Managed Care Organizations (MCOs) and local Community Services Boards (CSBs)

6. Required Documentation

• Verified business registration records from the Virginia SCC and active Type 2 NPI
• VDH Home Care Organization License Application and proof of payment
• Home Health Care Policy & Procedure Manual
• Evidence of Indemnity Coverage
• Organizational Records
• Emergency Preparedness Plan
• Personnel Records

7. Timeline for Approval

The end-to-end process typically spans 3 to 5 months. This timeframe accounts for VDH application processing (up to 60 days), coordinating the initial on-site VDH licensure survey, correcting any cited deficiencies within 15 days, and processing the subsequent DMAS/MES Medicaid provider enrollment.

8. Pre-Application Process

Before filing a formal state application, prospective providers must organize their corporate operational core. This includes registering with the Virginia SCC, securing commercial insurance policies, building a balanced operational budget, preparing an initial roster of governing body members, and legally retaining a qualified Clinical Director.

9. Pre-Application Training

Virginia requires applicants to demonstrate thorough operational and regulatory capability before a license is granted. VDH mandates that applicants attend a scheduled licensure pre-conference session during the review process.

Additionally, administrative leaders and clinical supervisors must complete core orientation sequences spanning person-centered care, HIPAA data privacy standards, and state Medicaid compliance tracking.

10. Additional Notes

• Physician Orders Mandatory: No home health skilled service or therapy may be initialized or billed without a signed, dated order from the individual’s primary care physician
• Mandatory Staff Roles: The agency must explicitly designate individuals to fill four key administrative roles: (1) Administrator, (2) Alternate Administrator, (3) Nursing Director/Clinical Director, and (4) Financial Manager. An appropriately qualified RN may serve as both the Administrator and the Nursing Director
• Survey Preparedness: Failure to be fully prepared with completed policies, forms, or personnel frameworks at the time of the scheduled VDH initial survey will result in immediate cancellation, denial of the license, and a mandatory 120-day reapplication waiting period

Why Choose Waiver Consulting Group?

Starting or expanding your Medicaid waiver-funded agency can feel overwhelming, but it doesn't have to be. At Waiver Consulting Group, we simplify the process by guiding you through licensing, compliance, provider enrollment, policies & procedures, and regulatory approvals in any state.

With proven expertise, a structured process, and ongoing support, we take the guesswork out of launching your healthcare business. Whether you're a first-time entrepreneur or an established provider looking to expand, our team ensures you stay compliant, competitive, and fully operational.

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