Nevada home health vs home care: personal care agencies, home health, ISOs and employment agencies

Each is a separate credential, and HCQC’s licensing pages cover all four. HCQC, health facility types HCQC also warns that an employment agency and a personal care agency are different licenses, and that fees are not refunded if you apply for the wrong one. HCQC PCA page Fees below are the state’s, from the compiled NAC, not CareRulebook prices.

Fees may already be higher. The LCB draft of R071-26 would raise the home health home office fees to $5,530 to apply and $2,765 to renew, and the employment agency fees to $1,498 and $749, while leaving the personal care agency fees at $1,374 and $687. R071-26 LCB draft The same draft would raise the ISO fees to $2,940 and $1,470. R071-26 LCB draft, section 8 The State Board of Health approved a 7% rise in most health facility fees (R071-26, approved regulations dated July 1, 2026). The LCB draft keeps the personal care agency fees at $1,374 and $687. Board of Health minutes, June 5, 2026 HCQC’s licensing page now says "Recent Amendments apply to Health Facility Licensing Fees". HCQC, Health Facilities Licensing We have not seen the approved text, so the table shows the compiled amounts; the home health, ISO and employment agency fees you pay today may be the higher ones. Check the amount in the state’s licensing system before you pay.

This site covers the personal care agency license in depth: the Nevada guide, the license application and the administrator and designee.

A personal care agency may provide, through employees or contractors, "Nonmedical services related to personal care to elderly persons or persons with disabilities to assist those persons with activities of daily living", NRS 449B.465(2) and, for persons with disabilities, medical services a provider of health care has authorized under NRS 629.091. NRS 449B.465(1); 629.091

• The skilled nursing line. Catheter insertion or irrigation; irrigation of any body cavity (ears, enemas, douches); dressings with prescription medication or aseptic technique; injections (except insulin pens under the rule); physical assessments; specialized feeding; digital rectal exams; massage; and any skilled nursing task beyond a CNA’s scope. NAC 449.3978(2), as amended by R089-24
• Health-related tasks the statute allows. With the client’s consent, attendants may check and record temperature, blood pressure, pulse, respiration or oxygen saturation, give insulin through an approved auto-injector, and run blood glucose tests, under the Board’s training rules. NRS 449B.130(1) Before doing these tasks, each year after, and whenever the device changes, the attendant is trained and shows understanding, follows the manufacturer’s instructions and meets CLIA rules where they apply. Trainers are a physician, PA, licensed nurse, pharmacist (insulin and glucose) or an experienced trained employee. NAC 449.39775
• Medication assistance since 2026. Since February 27, 2026, an attendant may assist with medication (including over-the-counter medicines and supplements) if there is a written agreement where the law requires one, the attendant has completed the required training, and the medication is prescribed or ordered and given per the practitioner’s written instructions. R089-24 section 14(1) Before assisting with medication, an attendant completes at least 16 hours of medication management training from a Division-approved course and gets a certificate, then at least 8 hours a year. R089-24 section 14(2)
• Nails, exercise and appointments. Since February 27, 2026, attendants may trim nails within limits, help with exercises and help clients schedule and attend medical appointments. NAC 449.39775(6), as amended by R089-24
• Nursing staff on your payroll. If you employ a nurse, nursing assistant or medication aide - certified as an attendant, by our reading you keep a record of their work assignments for at least 5 years, NRS 632.4725 and you report their conduct that breaks the nursing law to the State Board of Nursing. NRS 632.472(1)(d) Their license does not widen what your agency may do.

If a client needs more than this, by our reading the answer is a referral to a home health agency or other provider, coordinated with your service plan. NAC 449.3981(3)(e) Every task and its limits: what Nevada personal care attendants can and cannot do.

• What an ISO does. An intermediary service organization (ISO) is a nongovernmental entity that, for a person with a disability or a responsible family member, handles background checks, payroll, taxes and other employment and financial tasks for a personal assistant the person chooses. NRS 449B.500, 449B.510(1) A personal assistant works for pay, under the direction of the person with a disability or a responsible family member, to help the person keep their independence, personal hygiene and safety. NRS 449B.510(2)(c)
• The certificate. Operating an ISO needs a certificate from the Division, and operating one without it is a misdemeanor, unless the operator holds a personal care agency license. NRS 449B.530 A licensed personal care agency does not need a separate certificate to operate an intermediary service organization (the fiscal agent model for self-directed care). NRS 449B.530(2)
• Running both. A person who runs both an ISO and a personal care agency keeps separate records and clients for each, and distinguishes the ISO’s services from the agency’s personal care services. NAC 449.39515 That rule still cites the repealed NRS 449.0021 for the meaning of a personal care agency; by our reading it keeps applying until the Board replaces it. AB 519, section 147(2)
• An ISO is not an agency. The statute’s definition of a personal care agency leaves out ISOs. NRS 449B.015(2)(c)
• Before you apply. HCQC’s personal care agency page lists ISO documents (a client training checklist, an attendant training checklist, an ISO surveyor workbook, and client visit and telephone interview guidance) to review before deciding whether to apply for ISO certification. HCQC PCA page

• A separate license. An employment agency that contracts with people in Nevada to provide nonmedical personal care in the home needs its own license from the State Board of Health ($1,400 initial fee). HCQC warns applicants not to apply for the wrong one. HCQC PCA page; NRS 449B.105(1) An employment agency that contracts with people in Nevada to provide these nonmedical services needs the Board’s license whether or not it is located in Nevada; "employment agency" has the meaning in NRS 611.020. NRS 449B.105(1); 449B.040
• Background checks before any referral. A licensed employment agency may not refer anyone to a home to provide these services unless that person has met the NRS 449B.300 to 449B.340 background check rules; civil penalties are up to $10,000 for a first offense, then $10,000 to $20,000. NRS 449B.105(3)-(4)
• No second license for you. A licensed personal care agency that contracts with people to provide these nonmedical services does not need a separate employment agency license. NRS 449B.120
• Renewal. The employment agency to provide nonmedical services renews for $700 in the compiled NAC (state fee). NAC 449.013(2)(r)

By our reading, the difference is who runs the care: a personal care agency employs or contracts its attendants, NAC 449.3963 and supervises the care they give through home visits or calls, NAC 449.3982 while an employment agency contracts with people to provide the services and refers caregivers to homes. NRS 449B.105 HCQC asks you to read both definitions before you apply (its page still cites the repealed NRS 449.0021 alongside NRS 611.020; the personal care definition is now NRS 449B.015). HCQC PCA page

Nevada Medicaid pays for personal care through a provider agency model (a licensed personal care agency, under MSM chapter 3500) and a self-directed model, which runs through an intermediary service organization under MSM chapter 2600. MSM 3500

• The agency model. To enroll as a Nevada Medicaid personal care provider (provider type 30), an agency must hold this license. MSM 3503.1H(1)-(2) Medicaid personal care visits must be recorded in an electronic visit verification system that meets the 21st Century Cures Act. MSM 3503.1H(3)
• Starting fast. A Medicaid personal care provider supplies qualified staff within five working days of an accepted referral, or within 24 hours if Medicaid has identified the recipient as at risk. MSM 3503.1H(4)
• Household tasks. Medicaid personal care covers help with household tasks such as meals, laundry, light housekeeping and essential shopping only together with help with activities of daily living, and only when no legally responsible individual is available and capable. MSM 3503.1B
• An old name. The July 2026 Medicaid manual still says the license comes from the Division of Public and Behavioral Health; NRS 449B.030 now names the Health Care Purchasing and Compliance Division. MSM 3503.1H(1); NRS 449B.030 By our reading this is the same license; the regulator moved in 2025.

Billing Medicaid is optional; by our reading, the license you need is the same either way.

Nevada’s statute lists what counts as nonmedical personal care: toileting (elimination of wastes), dressing and undressing, bathing, grooming, preparing and eating meals, laundry, shopping, cleaning, transportation and other minor personal hygiene needs. NRS 449B.050 The statute makes any person other than a natural person that provides the services NRS 449B.465 authorizes, in the home, to elderly people or people with disabilities an agency that needs the license, with exceptions such as a contractor working alone with no employees. NRS 449B.015(1); 449B.100

• Homemaker work. Our reading: a company offering laundry, shopping, cleaning, meals or transportation to elderly or disabled clients needs the personal care agency license, even with no hands-on care, because those tasks are on the statute’s list.
• Companionship alone. It is not on the list, and the agency rules expect services that help with activities of daily living. NAC 449.3981(3)(d) Whether a purely social companion service needs a license is not settled. Ask HCQC in writing before you rely on operating without one; unlicensed operation is a misdemeanor. NRS 449B.485(1)
• Working alone. An independent contractor who provides these services without the help of employees is not an agency. NRS 449B.015(2)(a)
• Medicaid will not pay for homemaker-only care. Its personal care program covers household tasks only together with help with activities of daily living. MSM 3503.1B

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

• A physical location in Nevada. Every licensed agency needs a physical location in Nevada, shown by a fully executed lease (or recorded deed) proving the agency may operate from that address. HCQC Licensing Checklist HCQC also asks for a copy of your city or county business license, conditional use verification or special use permit, showing the agency name and physical location; receipts are not accepted. HCQC Licensing Checklist
• One license, one location, records kept there. Each license is issued to a specific person for a specific location. An agency may work from several work stations if it keeps client, staff and operations records at the licensed location. NAC 449.3972(1) A work station is a satellite office used only to receive copies of records and as a base for attendants serving an area outside their usual area. NAC 449.3968
• The license on the wall. The license is displayed in a conspicuous place at the agency. NAC 449.0114(1)
• Moving. Changes of ownership, location or services must be reported to the Division immediately. NAC 449.0114(5)
• The name. The agency’s name, sign or listing must not mislead the public about the services it offers. NRS 449B.475 By our reading, a personal care agency should not call itself a home health or nursing agency.

Can it be your home? The personal care rules do not say a home cannot be the licensed location. HCQC needs the lease or deed and the local business license or permit for that address, so by our reading a home office works if your city or county allows the business there and the lease or deed lets you run it. The rules set no office hours and do not say whether clients must be able to visit. Ask HCQC before you name a home address. We did not review the home health agency office rules.