South Carolina home health vs home care: one non-medical license, a Certificate of Need for home health, and separate lines of business

"Care services provided by caregivers are strictly limited to non-medical tasks." R.60-122 §700.B The rule then lists 13 services, from meal preparation, bathing, dressing and help walking to cleaning, laundry, shopping, errands, transportation, home safety hazards, help with communication and medication reminders. R.60-122 §700.B The full list: non-medical only, on the South Carolina guide.

• Skilled care is out. Skilled care is a service ordered by a physician or other authorized healthcare provider that "Requires the skills of technical or professional personnel such as registered nurses, licensed practical nurses, physical therapists, occupational therapists, and speech pathologists or audiologists", furnished by or under such personnel. R.60-122 §102.V In-home care excludes it. S.C. Code 44-70-20(2)(a)
• No continuing medical supervision. In-home care is personal in nature and does not need the continuing attention or supervision of trained and licensed medical personnel. R.60-122 §102.J.3
• Class I. Section 700 is marked (I), so caregivers doing skilled tasks would be a Class I matter by the rule’s own notation. R.60-122 §205.D Penalties: inspections and penalties.
• A nurse on staff does not change this. The license covers non-medical care whoever gives it. By our reading, hiring a nurse lets you use them for the roles the rule names, such as reviewing drug tests and self-assessments, R.60-122 §402.B, §406.A not to give skilled care to in-home care clients.

What is not settled. R.60-122 does not say what a medication reminder includes: whether a caregiver may open a container, hand it over or fill a pill organizer. SCDHHS’s words apply to Medicaid personal care, not to the DPH license. Our reading: a private-pay in-home care provider keeps to reminding and observing, does not touch the medication, and asks DPH before allowing more. That is how Policy 5.2, Medication reminders, in the CareRulebook manual is written. We have listed the question for DPH.

The Act’s only service-based exemption is "an individual or agency who provides only a house cleaning service". S.C. Code 44-70-20(3)(b) The rule’s list of care services a licensed provider gives includes cleaning, laundry, shopping, errands, transportation and help with communication. R.60-122 §700.B Against that, the definition of in-home care joins its three parts with "and": care primarily to help with an activity of daily living or a personal need, given to help with an activity of daily living, and personal in nature. S.C. Code 44-70-20(2)

Our reading: a business offering only companionship and homemaker help probably needs the license, because DPH’s rule treats those services as in-home care, but the statute can be read the other way. We found no written DPH answer. Ask DPH (IHCP@dph.sc.gov) before operating without a license; no one may operate or advertise as an in-home care provider without one. R.60-122 §103.A

• DHEC’s 2015 memo, still linked on DPH’s in-home care and home health pages, says an in-home care provider that also offers private duty nursing "should maintain separate lines of business between its in-home care offerings and private duty nursing offerings". DHEC memo, Aug 13, 2015 The memo predates the 2026 rule and cites the old regulation number, so we use it as guidance only.
• Staff who only nurse. The 2015 memo says DHEC would not review the records of staff who only provide private duty nursing, because it does not regulate it. DHEC memo, Aug 13, 2015
• Staff who do both. The 2015 memo says a staff member who provides both in-home care and private duty nursing is an in-home caregiver, and every caregiver rule applies to them. DHEC memo, Aug 13, 2015 That means the drug tests, background and registry checks, training and self-assessment that R.60-122 sets for caregivers. R.60-122 §403
• The 2026 rule makes it a duty. "If the provider provides services or care other than in-home care services, the provider must maintain separate lines of business regarding such other services or care." "This includes, but is not limited to, maintenance of separate representations to the public regarding these businesses, separate maintenance of caregiver records, and separate maintenance of client records." R.60-122 §103.C.6

By our reading, "separate representations to the public" means separate marketing, such as separate web pages and brochures, and nothing for the nursing business suggesting it is covered by the in-home care license. The rule does not say whether the two businesses may share an office or a legal entity; ask DPH. Nurses’ own licensing, through the Board of Nursing, is outside this page.

• CON first. "A home health agency shall obtain a Certificate of Need before licensure." S.C. Code 44-69-75(A) The In-Home Care Providers Act has no such requirement. S.C. Code 44-70
• Still applied in 2026. DPH’s September 2026 CON update lists a Certificate of Need approved on September 17, 2026 for establishing a new home health agency, and other home health matters under review, so DPH still applies the CON requirement to home health. DPH, CON Update, September 2026
• The CON Act’s own list. Since 2023 Act No. 20, the CON Act’s list of projects needing a Certificate of Need names nursing homes and hospitals; the hospital part is repealed from January 1, 2027. Home health is not on that list, but the home health Act (44-69-75(A), amended in 2024) still requires a Certificate of Need before licensure. S.C. Code 44-7-160 By our reading, the home health requirement rests on 44-69-75(A) itself, and DPH’s 2026 approvals show it is applied.
• Unsure? DPH’s CON program gives written determinations on whether the CON Act applies to a proposed facility or service; staff do not give them by phone. DPH, Certificate of Need

The home health license

• Term. A home health agency license lasts twelve months from the date of issue, and each subunit is licensed separately. S.C. Code 44-69-30
• Inspections. Each licensed home health agency is inspected at least once a year, including whether care follows the patient’s physician’s orders. S.C. Code 44-69-70
• Policies. The home health regulations must require the agency’s policies to be set by a professional group that includes at least one physician and one registered nurse. S.C. Code 44-69-60
• Services. The other services are physical, occupational or speech therapy; medical social services, home health aide services and other therapeutic services; and medical supplies and appliances. S.C. Code 44-69-20(5)
• Unlicensed home health. Violating the home health Act is a misdemeanor, with a fine of up to $500 or up to six months in prison, or both. S.C. Code 44-69-100
• The rule. DPH licenses home health agencies under Regulation 60-77, with its own application form (3289-ENG-DPH). We have not saved R.60-77 itself. DPH, Home Health Agencies

• License first. SCDHHS requires the DPH in-home care license to enroll for Medicaid personal care; losing it ends the contract. SCDHHS Scope, B.2
• A nurse supervisor. Personal care "must be provided under the supervision of a RN or LPN", who may be contracted. SCDHHS Scope, D.1, E.3 "For PCS, a task list must be developed by an RN or LPN Supervisor." SCDHHS Scope, E.2
• Supervisory visits. The Medicaid nurse supervisor visits the participant’s home within 30 days after personal care starts, then at least once every four months. SCDHHS Scope, E.3.e-f
• Experience. SCDHHS requires the owner or administrator of a Medicaid personal care agency to have at least three years of health care administrative experience. SCDHHS Scope, B.1
• Office. SCDHHS already required Medicaid personal care agencies to be housed in a commercially zoned or unzoned office. SCDHHS Scope, B.3 R.60-122 now requires the same for every in-home care provider’s primary office. R.60-122 §103.D.1 See the administrator and office.
• Complaints. For Medicaid personal care, the nurse supervisor tells the participant of their right to complain, with names, phone numbers and addresses; both sign. The first point of contact is someone employed by the provider, and the second is the relevant licensing agency, such as DPH. SCDHHS Scope, E.3.a.iii
• One R.60-122 difference. "For clients receiving care services pursuant to a Medicaid program, a service agreement is not required." The care services plan, rights form and disaster plan still apply to every client. R.60-122 §601.B.2 More on each: South Carolina client paperwork.

The data DPH publishes does not say which of the licensed providers also hold Medicaid contracts. DPH Find a Facility This page and the CareRulebook manual cover the DPH license, not SCDHHS enrollment.