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Virginia · Home health vs home care · 12VAC5-381
Virginia keeps it simple: one home care organization license covers both personal care and home health. What changes when you add skilled services is who leads, who signs the plan, and who gives the care, and, for Medicare, a national pause on new home health enrollment in 2026.
Quick answer
In Virginia, home health and home care are licensed together. A home care organization (HCO) is one that provides home health, personal care or pharmaceutical services at a person’s residence, and one HCO license from the VDH Office of Licensure and Certification covers them all.
Home care usually means personal care: nonskilled help with daily activities, under a plan of services written by an RN. Home health means skilled services such as nursing or therapy, prescribed in a medical plan of care signed by the client’s primary care physician, led by a director of skilled services. Neither needs a Certificate of Public Need.
Billing Medicare as a home health agency is separate: you need the state license first, and CMS has paused new home health enrollment nationwide from May 13, 2026.
| Personal care (home care) | Skilled services (home health) | |
|---|---|---|
| What it covers | Nonskilled help with activities of daily living, and possibly instrumental activities. 12VAC5-381-10 | One or more of nursing, physical, occupational, speech or respiratory therapy, or medical social services. 12VAC5-381-300 A |
| License | Home care organization (HCO) license from the OLC. Va. Code § 32.1-162.9 A | The same HCO license. Va. Code § 32.1-162.7 |
| Plan | A plan of services written by an RN with the client and family. 12VAC5-381-360 C | A medical plan of care signed by the client’s primary care physician, re-signed at least every 60 days. 12VAC5-381-300 B, E |
| Who leads | A designated RN supervises personal care. 12VAC5-381-360 A | A director of skilled services: a Virginia-licensed physician or a registered nurse. 12VAC5-381-300 F |
| Who gives the care | Home attendants qualified by one of six routes. 12VAC5-381-290 | Nursing directly by an RN or LPN, except tasks an RN may delegate. 12VAC5-381-310 A |
| Certificate of Public Need | Not on the list of facilities that need one. Va. Code § 32.1-102.1:3 A | Not on the list either. Va. Code § 32.1-102.1:3 A |
| Medicare | Not Medicare home health. 12VAC5-381-30 A | State license first, then federal certification; new Medicare enrollment paused nationwide from May 13, 2026. QSO-26-11, Memorandum Summary |
"The organization shall provide a program of home health services that shall include one or more of the following": nursing, physical therapy, occupational therapy, speech therapy, respiratory therapy or medical social services. 12VAC5-381-300 A
Personal care keeps its own rules alongside: a designated RN supervises it, writes each client’s plan of services, and supervision is never more than 90 days apart. RN supervision for personal care →
No Certificate of Public Need is involved either way. The Code of Virginia lists the facilities that need one, and "The following medical care facilities shall be subject to the provisions of this article" covers hospitals, nursing homes, certain intermediate care facilities and specialized surgery, imaging and radiation centers, not home care organizations. Va. Code § 32.1-102.1:3 A
National · In force from May 13, 2026
To bill Medicare as a home health agency you need federal certification, and Virginia says an organization planning federal certification or national accreditation must first get a state license and serve clients. 12VAC5-381-30 A
Federal enrollment is paused for new agencies nationwide: "Effective May 13, 2026, CMS will halt the enrollment of new Hospice and HHA providers or HHA branch or practice locations." It lasts six months, can be extended, and "CMS regulations do not permit exceptions to a moratorium for individual providers or suppliers." It does not affect personal care, which is not Medicare home health. CMS, QSO-26-11
CareRulebook
CareRulebook writes a policy for every topic Virginia’s regulation lists for a personal care organization, with your details filled in and the rule quoted under every policy.
$199CareRulebook founding price for the first 50 Virginia organizations, then $249. Not an OLC fee.
No. The HCO regulations do not apply to providers of only homemaker, chore or companion services. Homemaker services stop short of feeding, bed baths, transferring and lifting. Help with activities of daily living is personal care, which needs an HCO license.
"In addition, this chapter is not applicable to those providers of only homemaker, chore or companion services as defined in 12VAC5-381-10."
No. You must designate an RN responsible for supervising personal care. An RN writes each client’s plan of services, supervision happens at least every 90 days, and an RN or LPN must be available whenever personal care is being provided.
"The organization shall designate a registered nurse responsible for the supervision of personal care services."
No. Nurse aide certification is one of six routes. For personal care, completing the Department of Medical Assistance Services Personal Care Aide Training Curriculum also qualifies, as does a competency evaluation on the personal care tasks. Aides must also speak, read and write English.
"However, this training is permissible for home attendants of personal care services only."
It depends. Not yet under the regulation. The statute says the rules must provide for supervision by interactive audio or video, but the amendment to do this is still under Executive Branch Review. The current regulation defines supervision as regular, documented, face-to-face guidance.
"Regulations governing the delivery of personal care services shall provide for supervision of home care attendants providing personal care services by a licensed nurse through use of interactive audio or video technology."
Virginia licenses both under one home care organization (HCO) license from the VDH Office of Licensure and Certification. Home care usually means personal care: nonskilled help with daily activities, under a plan of services written by an RN. Home health means skilled services, such as nursing or therapy, prescribed in a medical plan of care signed by the client’s primary care physician, with a director of skilled services.
No separate state license. The HCO license covers home health, personal care and pharmaceutical services. Adding skilled services brings extra rules in 12VAC5-381-300 and -310, and, for Medicare, federal certification after you have a state license and are serving clients.
The Code of Virginia lists the facilities that need a Certificate of Public Need: hospitals, nursing homes, certain intermediate care facilities, and specialized surgery, imaging and radiation centers. Home care organizations are not on that list.
You need a state HCO license and to be serving clients before you apply for federal certification or national accreditation. Separately, CMS halted Medicare enrollment of new home health agencies nationwide from May 13, 2026, for six months, which it can extend, with no exceptions for individual providers.
No. Virginia’s home care organization regulations do not apply to providers of only homemaker, chore or companion services.
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