Kansas home health vs home care: Supportive Care and Skilled Services

Both levels are a Home Health Agency license from KDHE under the same Act and rules. K.S.A. 65-5102 KDHE describes the first level as Skilled Services together with HCBS attendant care, "(also now called Personal Care Services)", with supportive care included. Letter of Introduction, p. 1 Fees below are KDHE’s, not CareRulebook prices.

A home health agency is an organization that provides, for a fee, at the client’s home, one or more of three kinds of service. K.S.A. 65-5101(c)(1)

• Home health services means "any of the following services provided at the current residence of the patient on a full-time, part-time or intermittent basis: Nursing, physical therapy, speech therapy, nutritional or dietetic consulting, occupational therapy, respiratory therapy, home health aide or medical social service". K.S.A. 65-5101(d)
• Supportive care services: Help with activities of daily living that the client could do if physically able (bathing, dressing, eating, medication reminders, transferring, walking, mobility, toileting and continence care), given at home, that does not need supervision by a healthcare professional such as a physician assistant or registered nurse. Supportive care "does not include any home health services". K.S.A. 65-5101(k)
• Attendant care services means "basic and ancillary services provided under home and community based services waiver programs". K.S.A. 65-5101(a) The in-home care statute says basic attendant services include health maintenance activities, which "include, but are not limited to, catheter irrigation; administration of medications, enemas and suppositories; and wound care". K.S.A. 65-6201(b), (d) K.S.A. 65-6201 lists homemaker-type and companion-type services as "ancillary" to basic attendant care for someone who needs at least one basic service. K.S.A. 65-6201(c)

By our reading, this helps explain why KDHE puts attendant care with Skilled Services: it can include health maintenance tasks such as giving medications and wound care, which a supportive care worker may not do. KDHE’s own reason is that HCBS waiver services may include medical services driven by a plan of care. Letter, Option 1 (HCBS)

KDHE’s attestation, which every supportive care applicant signs: "Nursing services of any kind are prohibited with a Supportive Care Services license. This includes a nurse providing supervisory, assignment, delegation, oversight, medication administration/set-up, wound care", treatments, assessments or other nursing activities. Attestation Form, p. 2 The 16 assigned duties in K.A.R. 28-51-117(g) set the rest of the line. Where it falls on some common tasks:

• Medication. Supportive care workers and other staff of a supportive care agency may not take part in medication administration or set up medications. Workers help only with medications already sorted into marked reminder containers. K.A.R. 28-51-117(g)(1) No unlicensed employee of a home health agency may prefill insulin syringes; doing so is a class C misdemeanor. K.S.A. 65-5116(b)
• Skin and wounds. Skin care only on unbroken skin without active chronic skin problems; no applying medication, wound care or dressing changes. K.A.R. 28-51-117(g)(2)
• Catheters and ostomies. Workers may empty urinary collection devices, including catheter bags, and empty ostomy bags; inserting or removing catheters, external catheter care, suppositories and enemas are not allowed. K.A.R. 28-51-117(g)(13)
• Feeding. Help with feeding only if the client can chew and swallow without difficulty and stay upright; no syringe, tube or IV feeding. Clients at high risk of choking or aspiration need a licensed home health agency. K.A.R. 28-51-117(g)(7)
• Nails and oxygen. Supportive care workers may soak, push back cuticles without utensils and file nails; nail trimming is only for agencies licensed for home health services. K.A.R. 28-51-117(g)(10) Workers may remove and replace a cannula or mask to wash or shave, and may set oxygen flow by written instructions when changing tanks if specifically trained and competent. Respiratory care is skilled and not allowed. K.A.R. 28-51-117(g)(15)-(16)

Stay within your level. "Each home health agency shall offer only the home health services, HCBS, or supportive care services specified on the home health agency’s initial application or renewal application." K.A.R. 28-51-101(d)(2) KDHE says that, through surveys, it has found that blending services under one license often leads to agencies not complying with the regulations. KDHE answers, April 2026, p. 8 More on surveys in KDHE surveys and plans of correction.

Every duty and its limits: what Kansas non-medical caregivers can and cannot do.

KDHE’s letter to applicants: KDADS, which oversees the HCBS programs, "requires Skilled Services HHA licensure for all waiver programs", and in some circumstances CMS certification for some waiver programs. Letter of Introduction, p. 1 "We recommend you check with the KDADS HCBS program regarding specific waiver requirements beyond licensure." Letter of Introduction, p. 1

• Other payers. "Many payor programs, including Veterans Affairs, require Skilled Services HHA licensure", so KDHE says to check your payer programs’ requirements before applying. Letter, Option 2 The supportive care license is mainly for private pay, private duty and some private insurance. KDHE, Non-Medical Supportive Care Services
• Self-directed care is different. The Nurse Practice Act does not prohibit attendant care services directed by or for an individual in need of in-home care (the self-directed HCBS model). It is not a basis for a supportive care agency to do health maintenance tasks. K.S.A. 65-1124(l) Self-directed workers employed under K.S.A. 39-7,100(b)(2) are outside the Home Health Agency Act. K.S.A. 65-5112(f)
• An old opinion. Attorney General Opinion 2016-7 said a business providing only attendant care services did not need a home health agency license. It predates the 2017 amendments to the Act (L. 2017, ch. 17), and the current K.S.A. 65-5102 names attendant care services in the license duty. K.S.A. 65-5101, annotations
• Switching later. The rules do not say how a supportive care licensee moves to Skilled Services. By our reading it means a Skilled Services application to KDHE, with the higher fee and an RN clinical manager in place; ask KDHE first.

KDHE has said two different things.

• 2024: KDHE’s letter says "currently the Secretary of KDHE requires all agencies to be licensed as a home health agency in the state of Kansas unless the individual or persons are part of a recognized church or religious denomination". KDHE Letter of Introduction Its license page says the supportive care license includes "chore and/or companionship services". KDHE, Non-Medical Supportive Care Services
• April 2026: answering providers who asked for rules on housekeeping, meals, shopping, laundry and transportation, KDHE wrote: "These activities do not require hands-on care and many of these are available by businesses (cleaning agencies, grocery store delivery services, ride share companies, etc.) not required to be licensed as a home health agency." KDHE answers, April 2026, p. 36

Our reading: the license duty attaches to supportive care services, which the statute defines as help with activities of daily living, and names medication reminders among them. K.S.A. 65-5101(k) So a business offering only housekeeping, meals, shopping, laundry, errands, rides or companionship, with no hands-on help, probably needs no license; once you help with bathing, dressing, eating, transfers, walking, toileting or medication reminders, you need the supportive care license. KDHE has not confirmed this. Ask KDHE in writing before you operate without a license, because operating without one is a class B misdemeanor. K.S.A. 65-5114

Who else is outside the Act, and the quiz to check your plan: who needs a license, on the Kansas guide.

The office rules are the same for both levels. "Each parent office shall have a local street address with a local telephone number and shall be continuously staffed during posted and advertised office hours." The office hours are posted for public view, and no PO box may be the parent office. K.A.R. 28-51-100(hh) Office hours are "the times of the day and days of the week that a parent office is open and staffed to serve the public". K.A.R. 28-51-100(ff)

What KDHE says the office is for

• Visitors. "Current and potential clients and patients should be able to visit the agency to request records, ask questions", or file a complaint. "Staffing the office during posted and advertised office hours ensures that clients and patients have an avenue to address their needs." KDHE answers, April 2026, p. 2
• Surveyors. KDHE told providers in April 2026 that the current and drafted rules require an office the public can visit to ask about services and get records, and that surveyors can visit for surveys. KDHE answers, April 2026, p. 6
• Hours. "The current and proposed regulations do not detail the required hours an agency must be open." KDHE answers, April 2026, p. 2
• Second offices. KDHE says an office other than the parent office that keeps records is a branch office, which posts office hours and is staffed during them; an office used only for supply storage or staff documentation and not open to the public is not a branch office. KDHE answers, April 2026, p. 6

Can the office be in your home?

The rules do not say, and neither do KDHE’s documents. Nothing we found rules a home out, but the office must have a local street address, be staffed during the hours you post and advertise, and by KDHE’s account be a place clients can visit and surveyors can access. K.A.R. 28-51-100(hh) By our reading, a home office works only if you can meet all of that, including letting the public in during posted hours. Ask KDHE before you name a home address, and check your city or county zoning rules for running a business from home, which KDHE’s rules do not cover.

Around the office

• Service area. You serve clients only within "a geographic region within a 200-mile radius of a home health agency’s parent office". K.A.R. 28-51-100(vv) The administrator must reside within the service area; KDHE asks for evidence that the administrator and alternate live within 200 miles of the parent office. K.A.R. 28-51-103(b)(2)
• The license on the wall. "Licenses shall be posted in a conspicuous place in the main offices of the licensed home health agency." K.S.A. 65-5104(d)
• Moving. Tell KDHE before moving the parent office or changing the phone number; tell KDHE in writing within five days after a change of address or name and send back the old license for an amended one. K.A.R. 28-51-101(f)-(g)
• Agencies from other states. If a bordering state does not license home health agencies, or its rules are not substantially the same as Kansas's, an agency from that state "shall meet all requirements of this act and shall operate in Kansas from offices located in Kansas". K.S.A. 65-5104(f)

Drafted, not in force: a fixed office with a private space

Each parent and branch office would be a fixed physical office able to conduct day-to-day business, staffed in advertised hours, with posted hours, no PO box, and a private space for confidential document review, interviews and conversations; branch offices get administrator visits. Summary of Changes Guide KDHE’s October 2025 slides list "Have a designated space available for clients, patients, and surveyors which allows for confidential review of documents, interviews, and conversations." Listening session slides, slide 11 KDHE’s draft rewrite of K.A.R. 28-51 must still go through formal public comment; KDHE says it will tell agencies when the Notice of Public Hearing appears in the Kansas Register. None was found by October 2, 2026. Summary of Changes Guide, Introduction By our reading, if you choose an office now, one with a room where you can talk to a client or surveyor privately would also suit the draft.