How to start a home care agency in New Jersey (health care service firm registration, 2026)

The registration duty sits in the employment agency law, not the health licensing law. It applies to "any other firm, company, business, agency, or other entity that is not a home health care agency" licensed by the Department of Health "or a hospice", if it places or refers caregivers for these services (N.J.S.A. 34:8-45.1(a)). DCA may enforce it "whether the operations include the direct employment of individuals, the use of an Internet website or application, or any other process or business model" (same).

We quote N.J.S.A. 34:8-45.1 as amended in 2020 (P.L.2020, c.132). P.L.2026, c.45 amended the section again (law-firm and accounting-firm summaries describe its audit and renewal changes); we could not read it, and a law-firm summary from September 2026 still describes the 12-month accreditation duty (Holland & Knight).

The three kinds of service

• Companion services means "non-medical, basic supervision and socialization services which do not include assistance with activities of daily living, and which are provided in the individual’s home", and "may include the performance of household chores" (N.J.S.A. 34:8-45.1(a)).
• Personal care services are "services performed by licensed or certified personnel for the purpose of assisting an individual with activities of daily living that may involve physical contact", such as bathing, toileting, transferring, dressing and grooming (same).
• Health care services means "any services rendered for the purpose of maintaining or restoring an individual’s physical or mental health or any health-related services, and for which a license or certification is required as a pre-condition to the rendering of such services" (same).

Companion-only firms

As first enacted in 2002, the law excluded firms that placed staff only for companion, housekeeping, meal preparation, shopping, laundry, cleaning or transportation services (P.L.2002, c.126). P.L.2014, c.29, approved August 1, 2014, deleted that exclusion (P.L.2014, c.29), and DCA’s notice says: "Pursuant to the new law, any agency that provides companion services in the home will be required to be registered as a Health Care Service Firm. This law takes effect February 1, 2016." (DCA notice). The notice adds that employment agencies and temporary help firms "will no longer have the ability to place an individual in the home as a companion" (same).

Hands-on care: certified aides

"In order to place certified homemaker-home health aides, an agency regulated by the Division shall be licensed as a health care service firm." (N.J.A.C. 13:45B-14.7(a)) A firm "shall only refer or place actively certified homemaker-home health aides that are employed by the agency", and those aides do only tasks the health care practitioner supervisor has delegated or directed (14.7(b); 14.7(c)). The nursing law says an aide works on delegated nursing tasks only "under the supervision of a duly licensed registered professional nurse provided by the home care services agency that directly employs" them (N.J.S.A. 45:11-23(c)), and that law’s “home care services agency” includes health care service firms (same).

The health care practitioner supervisor

"An agency shall employ not less than one health care practitioner supervisor" (N.J.A.C. 13:45B-14.3(c)). The supervisor is a New Jersey licensed physician, or a registered nurse in good standing with a BSN and two years of public health nursing, or with three years of public health nursing (14.1). In these rules "“Agency” means a health care service firm" (14.1), so our reading is that a companion-only firm needs a supervisor too (see our readings).

What a firm may not do

• Start before registering. No recruiting or advertising for staff, offering services or contracting with a facility "without first obtaining registration" (N.J.A.C. 13:45B-13.6(a)1). Operating without registering can bring a penalty of $500 for each day, on top of any other penalty (N.J.S.A. 34:8-45.1(e)). That is a penalty, not a fee.
• Charge workers. No fee or liquidated damages charged to the people you employ, and no contract stopping them working for someone else. A firm that charges such a fee must obtain an employment agency license (13.6(a)2-3).

• Bond. "A bond of $10,000 to secure compliance with the Act." DCA may waive it for an entity with a net worth of $100,000 or more, shown by a certified financial report from a certified public accountant or licensed accountant (N.J.A.C. 13:45B-13.3(a)3). A bond is security, not a fee.
• Insurance. General liability insurance of "not less than $1,000,000" covering placed health care practitioners’ negligence, malpractice or other unlawful conduct (14.3(h)). Like the supervisor rule, this sits in the placement subchapter; our reading is that companion-only firms should carry it too; confirm with DCA.
• Late renewal. DCA’s fee schedule for the chapter lists a $25 late fee for renewals; it does not say whether that applies to health care service firms in particular (N.J.A.C. 13:45B-7.1, our reading).
• Accreditation. The accreditor sets its own fees; we did not research them.
• Yearly financial statement. From July 1, 2026, each renewal includes a financial statement for the previous calendar year: assets, liabilities, gross income, operating expenses and Medicaid personal care assistance income (13.5A(a)). The rule also sets audits for some firms, such as those with more than $250,000 of Medicaid personal care assistance income or $10 million or more of gross income (13.5A(b)-(e)).
• The 2026 law (reported). We could not open P.L.2026, c.45. Holland & Knight reports it was signed July 22, 2026 and moved the registration expiry from June 30 to September 30 (law-firm summary). PKF O’Connor Davies, an accounting firm, reports that it raises the Medicaid audit trigger to more than $500,000 and that DCA has suspended the audit and separate report for the September 2026 renewal, which needs only the financial statement (accounting-firm summary). Check DCA’s own renewal notice.

The statute makes accreditation a condition of registration: a firm "shall obtain within 12 months of registration accreditation from an accrediting body that is recognized by the Commissioner of Human Services as an accrediting body for homemaker agencies participating in the Medicaid program" (N.J.S.A. 34:8-45.1(c)).

• What accreditors apply. "For purposes of accreditation pursuant to this subsection, the accrediting body shall apply the standards set forth in N.J.A.C.13:37-14.1 et seq. and N.J.A.C.13:45B-13.1 et seq., as applicable." (same) Those are the Board of Nursing’s CHHA rules and DCA’s health care service firm rules. Accreditors also have standards of their own, which we did not read.
• At renewal. From the first renewal after May 21, 2019, every renewal includes evidence of accreditation (N.J.A.C. 13:45B-13.5(b)). A firm first registered less than 12 months before its first renewal need not show it at that renewal (13.5(c)).
• Losing it. Tell DCA in writing within 10 days of losing accreditation (13.5(d)).
• Who accredits. DCA’s July 2025 list names six bodies: ACHC, the Commission on Accreditation for Home Care (CAHC), CHAP, The Joint Commission, NIHCA and NAHC (DCA list).
• Medicaid too. The Medicaid home care rules, a program rule, also say health care service firms "shall be accredited, initially and on an ongoing basis" (N.J.A.C. 10:60-1.3(d)).

Certified homemaker-home health aides (CHHAs) are certified by the New Jersey Board of Nursing. Its guide says it certifies aides who complete the required training once a New Jersey agency promises them employment, and that "The Aide must renew his or her certificate every two years." (Board of Nursing consumer guide)

• Fees. The Board of Nursing’s fees are $50 to apply, $30 for initial certification in the first year of the two-year cycle or $15 in the second, and $30 to renew every two years (N.J.A.C. 13:37-5.5(b)).
• Medication. A CHHA gives a medication only when a registered nurse delegates that specific medication and documents the delegation in the nursing plan of care and the agency’s patient record (13:37-14.3(e)).
• RN review. When a CHHA is assigned to a patient an RN has assessed, the RN reviews the nursing plan of care with the CHHA, and meets them face to face to instruct them if the RN finds they are not yet adequately prepared for the delegated tasks (13:37-14.3(c)).
• Home-making. "A CHHA may perform home-making activities, as requested or assigned by the patient, the patient’s family, or a registered professional nurse responsible for the patient’s care." (14.3(b)) The Board’s guide adds that shopping, cooking and laundry for the family are generally not CHHA work (consumer guide).
• Money and gifts. A CHHA may not hold a client’s power of attorney or accept a loan. Money or gifts over $50 are documented, signed by the aide and an agency representative, and kept by the agency (14.18).
• No private work. The Board’s guide says "A certified Homemaker-Home Health Aide may not work privately." (consumer guide)
• Running your own training. A home care services agency may run a CHHA program with the Board’s written approval first, valid for 12 months (14.4(a)-(b)).
• Companions. We found no training rule for companions in the health care service firm rules. When you send a worker who is not certified, you tell the client in writing and name any course they completed (13:45B-13.8).

CHHAs: the Board checks

The Board of Nursing runs the criminal history check as part of certification. If it shows a conviction, "the applicant and the applicant’s prospective employer, if known, shall be notified that the Board has made a preliminary determination that the applicant is disqualified", and the applicant has 30 days to contest the record or, if they disclosed the conviction, to show rehabilitation (N.J.A.C. 13:37-14.9(d)). The Board denies certification in set cases, including when the check accurately shows a disqualifying offense under N.J.S.A. 45:11-24.3 and rehabilitation is not clearly and convincingly shown (14.9(f)5). The Board’s guide says it checks at certification and at renewal (consumer guide).

Companions and other uncertified workers

We found no fingerprint or criminal history check for companions in the health care service firm rules. That is our finding, not a rule that no check is needed. For a worker who is not certified, the firm certifies to the client "that it has verified the individual’s employment history or has obtained two character references for the individual" (N.J.A.C. 13:45B-13.8(a)4).

Owners and officers

Each officer, director, principal or owner certifies whether they have ever been convicted of a crime listed in N.J.S.A. 34:8-44 (13.3(a)2), and a later conviction means a new affidavit within 30 days (13.3(d)).

Hiring checks in the placement rules

On our reading these reach every worker you place; for uncertified workers see 13.8 above.

• Work history. Confirm employment at every employer the applicant disclosed for the past year, ask why each job ended, and record the answers and who gave them (14.6).
• Licenses. Verify each license or certification with the issuing board before placement, then inspect the current license within 45 days, and keep a verification record (14.4(c); 14.4(e)). If a license is suspended, revoked or restricted, end their employment and notify the client (14.4(f)).

New Jersey’s Adult Protective Services Act, as amended by P.L.2009, c.276 (approved January 17, 2010, in force on the 90th day after), says a health care professional, law enforcement officer, firefighter, paramedic or emergency medical technician "who has reasonable cause to believe that a vulnerable adult is the subject of abuse, neglect or exploitation shall report the information to the county adult protective services provider" (N.J.S.A. 52:27D-409(a)(1); P.L.2009, c.276). The Division of Aging Services’ 2022 mandated reporter sheet lists the same five groups (DoAS, 5-31-22). "Any other person" with reasonable cause "may report" ((a)(2)).

• Who is a health care professional. Anyone licensed or otherwise authorized under Title 45 or 52 to practice a profession regulated by listed boards, the Board of Nursing among them, plus nurse aides and personal care assistants certified by the Department of Health (N.J.S.A. 52:27D-407). Your nurses are covered. Our reading: CHHAs, certified by the Board of Nursing, probably are too, but the law does not name them. Companions "may report". Simplest for a firm: ask every worker to report.
• Vulnerable adult. A person 18 or older living in a community setting who, because of illness, disability or deficiency, lacks the capacity to make, communicate or carry out decisions about their well-being and is the subject of abuse, neglect or exploitation (52:27D-407).
• Where to report. To the APS provider in the adult’s county of residence; the statewide toll-free number is 855-TELL-APS (855-835-5277) (NJ APS fact sheet). DoAS says a trained APS social worker meets the adult face to face within 72 business hours of a report (DoAS). In an emergency, call 911 or the local police (fact sheet).
• No retaliation. An employer may not discharge, demote or cut the pay of an employee who reported in good faith, on pain of a fine of up to $1,000, and reporters are immune from civil and criminal liability unless they act in bad faith or with malicious purpose (52:27D-409(c)-(d)).
• Children. DCF says "In New Jersey, any person having reasonable cause to believe that a child has been subjected to abuse or acts of abuse should immediately report this information to the State Central Registry (SCR)." If the child is in immediate danger, call 911 as well as 1-877 NJ ABUSE (1-877-652-2873) (DCF).
• Reporting on staff. On our reading a health care service firm that places CHHAs is a “health care entity” under the 2005 reporting law, because the nursing law’s “home care services agency”, as amended in 2019, includes health care service firms that procure employment for homemaker-home health aides (45:11-23(c)). As enacted, that law asks such entities to tell DCA in writing within seven days when a health care professional they employ is discharged for impairment, incompetency or misconduct relating to patient care, among other events, and to keep records of patient-care complaints and discipline for seven years (N.J.S.A. 26:2H-12.2b; same; 26:2H-12.2a).

We read N.J.S.A. 34:8-45.1 as amended through 2020 (not the 2026 amendment, which we could not read), N.J.A.C. 13:45B-13 and -14, and the Board of Nursing’s CHHA rules for written duties that apply to a health care service firm. Here is what we found.

No list of written policies

We found no rule that lists written policies for health care service firms. The nearest duty is general: "The agency with the assistance of the health care practitioner supervisor shall be responsible for establishing such practices and procedures as may be necessary to assure the agency’s compliance with this subchapter." (N.J.A.C. 13:45B-14.3(d)) It does not say written and names no topics.

Records the rules do require

• An applicant form with set minimum fields and a signed release to contact the past year’s employers (14.2(a); 14.2(b)).
• License verification documents and a verification record (14.4(c)-(d); 14.4(e)), and the work-history record (14.6).
• A job order for every position, with setting, hours, title, duties, special skills, special equipment and any special employer policies (14.5(b)).
• A written, signed plan of care before placement in a home, the supervisor’s check-in record (at least once in each 30-day period) and in-home evaluation (at least once in each 60-day period), and copies of the plan for the client (14.9(a); 14.9(c)-(d); 14.9(g); 14.9(h)).
• A record of every task delegated to a CHHA, in the patient’s record (14.7(e)).
• Client notices: the Board of Nursing’s consumer guide, and the written notice for a worker who is not certified, each at least 24 hours before services. The client may waive the 24 hours in writing (keep the waiver two years), but still gets the guide or notice before services start (13.7; 13.8).
• Photo ID tags for CHHAs and DCA-regulated health care professionals (13.7(a)), and CHHA gift records for anything over $50 (13:37-14.18).
• Records kept seven years and open to DCA’s inspection (14.3(g); 14.3(f)).

Standards with no written form set

• Professional standards. Follow accepted professional standards for the services and all federal, state and local laws (14.3(a)-(b)).
• Matching. Make diligent inquiry and do not place someone whose qualifications do not reasonably match the need (14.5(a)).
• CHHA competence. The supervisor makes sure each CHHA shows competence in the care delegated (14.7(d)).
• Changes. Owner and managing agent details go to DCA before a change in ownership or management; other changes within 30 calendar days (13.3(b); 13.3(c)).
• Violations. The firm and its supervisor report any violation of the placement rules immediately (14.3(j)).

Left to you (our reading)

We found no rule for health care service firms on client contracts, grievances, infection control, emergency plans, staff orientation, or a schedule for reviewing policies. That does not mean those things do not matter. Accreditors must apply the state’s CHHA and health care service firm rules, as applicable, and also have their own standards, which we have not read; expect them to ask about your policies and procedures (our expectation). Clients, insurers and payers may ask for them too. The Board of Nursing’s 2014 “Best Practices for Health Care Service Firms” sets out clinical, personnel and administrative policies, but says it "is advisory only" and that "the contents remain aspirational only" (Board of Nursing).

A Department of Health home health agency is not the same thing. It is "an entity licensed by the Department to provide preventive, rehabilitative, and therapeutic services to patients on a visiting basis", and every home health agency provides at least nursing, aide and physical therapy services (N.J.A.C. 8:42-1.2).

• Certificate of need first. A home health agency cannot be set up or licensed without a certificate of need issued under a call (8:42-2.1(a)). In 2020 DOH cancelled the July 1, 2019 call, finding "not a sufficient need for additional new home health agencies at this time", and named July 1, 2022 as the next scheduled call (52 N.J.R. 6(2)). We found no later call in our sources.
• DOH’s fees and survey. DOH’s fees are $2,000 for a license application and each annual renewal, plus a $500 biennial inspection fee (8:42-2.2). DOH surveys before licensing, and the agency may not accept patients until approved (8:42-2.3).
• Named policies. Unlike the registration rules, the home health rules name policies and procedures, for example on CHHAs wearing ID tags (8:42-3.1(f)2).

• A supervisor for companion-only firms. The placement rules say every “agency” employs a health care practitioner supervisor, and “agency” means a health care service firm (14.1; 14.3(c)). The subchapter is framed around placing health care practitioners, which companions are not. The same goes for the $1,000,000 liability insurance, which covers placed health care practitioners (14.3(h)). Our reading: plan for a supervisor and the insurance, and confirm with DCA.
• CHHAs as mandated reporters. The APS law covers people licensed or otherwise authorized by the Board of Nursing, and certified nurse aides and personal care assistants, but does not name CHHAs (52:27D-407). Our reading: probably covered; train every worker to report.
• The renewal date. The rule says renew on or before July 1 (13.5(a)); law-firm summaries of P.L.2026, c.45 report a September 30 expiry (summary). Our reading: we could not read the 2026 law, and law-firm and accounting-firm summaries report that DCA is updating its rules after it (Holland & Knight), so follow the date on DCA’s renewal notice.
• The late fee. DCA’s fee schedule lists a late fee for renewals without naming which registrations it covers (13:45B-7.1). Our reading: assume it applies.
• Firms as health care entities. The 2005 reporting law covers a “home care services agency” as the nursing law defines it, and that definition, as amended in 2019, includes health care service firms that procure employment for homemaker-home health aides (P.L.2005, c.83; 45:11-23(c)). Our reading: those reporting and record duties reach firms that place CHHAs.
• How we read the law. The legislature’s website did not respond to us, so the statutes on this page are the official chapter laws as enacted, from the Rutgers Law Library collection (P.L.2020, c.132). We could not read P.L.2026, c.45 itself; what we say about it comes from law-firm and accounting-firm summaries and is labelled. The rules are the Cornell LII copy of the New Jersey Administrative Code, whose official text is published by LexisNexis. DCA’s web pages blocked our automated requests; its PDFs did not.

We found no current count of registered health care service firms. DCA’s web pages blocked our requests, and we did not find these firms in DCA’s bulk license roster.

• Health care service firms (2014): DCA’s 2014 list of registrations expiring 6/30/2015 had 954 “Health Care Service Firm” rows, one row per primary location, from before companion-only firms had to register (our count). Treat it as an old order of magnitude.
• Home health agencies: 39 rows on the Department of Health’s acute care facility list, run date 5 October 2026 (our count).
• Checking a firm. The Board of Nursing’s guide suggests checking DCA’s registry before using a firm, or calling 973-504-6370 (consumer guide).

For context only: health care service firms are among the agency types that may be Medicaid/NJ FamilyCare home care providers, and in the Medicaid personal care assistant program a registered nurse assesses and writes the plan of care within 48 hours of the start of service and supervises at least every 60 days (N.J.A.C. 10:60-1.3(a); 10:60-3.5). Those are program rules for Medicaid providers, not registration rules; this guide does not cover Medicaid enrollment.