How to start a home care agency in Nevada

Nevada requires a License to operate an agency to provide personal care services in the home (personal care agency, PCA) from Nevada Division of Public and Behavioral Health, health facilities licensing (Bureau of Health Care Quality and Compliance) to operate a home care agency. Fee: $1,374.

License required

Yes

License

License to operate an agency to provide personal care services in the home (personal care agency, PCA)

Issuing agency

Nevada Division of Public and Behavioral Health, health facilities licensing (Bureau of Health Care Quality and Compliance)

Fee

$1,374

Fee details

Initial license fee $1,374 (NAC 449.013(1)(n)).

Renewal

Every year · Annual renewal fee $687 (NAC 449.013(2)(n)); license expires 1 year after issue (NRS 449.089).

Insurance and bonds

Application checklist requires a certificate of insurance and an original surety bond (citing NRS 449.065); agencies must retain proof of liability coverage (NAC 449.3972). NRS 449.065 sets bond tiers of $5,000 / $25,000 / $50,000 by employee count for the facility types it names; the bond amount for personal care agencies is not stated separately on the checklist.

Survey and inspection

State Fire Marshal inspection is required for the initial license; Division may investigate compliance before renewal.

Regulation

NRS Chapter 449 (incl. 449.089); NAC 449.013, 449.3972-449.3977

1. Obtain local zoning approval or business license for the office
2. Complete the state elder abuse, neglect and exploitation training and test
3. Submit the notarized application with the $1,374 fee and all checklist documents
4. Applicant and corporate officers complete fingerprint-based background checks through Nevada DPS
5. Attend the mandatory new-applicant licensure training and background-check webinar
6. State Fire Marshal inspects and reports compliance to the Division
7. Division reviews and issues the license; renew every year

Staffing

• Administrator at least 18 with a high school diploma or equivalent, able to read, write, speak and understand English
• Administrator must designate someone in charge when absent
• Only trained attendants may serve clients

Training

• Attendants must complete an agency training program, with supervised on-the-job instruction, before working independently
• Topics include documentation, client rights and confidentiality, aging and disability needs, communication, first aid and CPR, emergencies, nutrition, bowel/bladder and skin care, fall prevention, infection control and body mechanics
• Attendants must be judged competent and have completed training within 12 months before first client contact
• Agency pays training cost and wages for training time

Program

Nevada Medicaid and Nevada Check Up (Nevada Health Authority)

Enrollment portal

Provider Flex (new enrollments, re-enrollments, ownership changes); Provider Web Portal (revalidations and updates)

Fiscal agent

Gainwell Technologies

Application fee

Under the federal rule (42 CFR 455.460), institutional providers pay the CMS application fee when they first enroll, re-enroll or revalidate. The fee is $750 for calendar year 2026. Individual physicians and non-physician practitioners do not pay it. A fee already paid to Medicare or to another state's Medicaid program counts. Nevada's enrollment page and booklet do not list a separate state fee.

Fingerprinting

Provider types 19, 29, 33, 58 (specialty 205), 63, 64, 65 and 93 (specialty 708) must send a signed Nevada Department of Public Safety fingerprint background waiver for each owner holding 5% or more, because those owners may need a fingerprint-based criminal background check under 42 CFR 455.434. Under federal rules (42 CFR 455.434 and 455.450), the state places provider types in 'limited', 'moderate' or 'high' risk levels. High-risk providers, and anyone who owns 5% or more of one, must submit fingerprints for a criminal background check.

Site visit

Under federal rule (42 CFR 455.432), the state must visit moderate- and high-risk providers before and after enrollment. Every enrolled provider must allow unannounced on-site inspections. Nevada's enrollment booklet does not describe a separate state site visit process.

Revalidation

At least every 5 years; DMEPOS providers (provider type 33) every 3 years. Notices go out 120, 90, 60 and 20 days before the due date. A provider can revalidate up to one year early through the Provider Web Portal ('Revalidate-Update Provider'). The application must be approved before the due date, or the contract ends and the provider cannot serve fee-for-service or MCO members. Nevada also runs an accelerated revalidation of high-risk providers (Web Announcement 3935).

Full Nevada Medicaid enrollment guide →

CON program

Yes

Program

Approval of Director for certain projects (NRS 439A.100), commonly called certificate of need

Agency

Nevada Department of Health and Human Services, Director (health planning); licensing withheld by the Health Care Purchasing and Compliance Division of the Nevada Health Authority

Services covered

• new construction by or for any health facility costing more than the greater of $2,000,000 or a regulatory amount, but only in counties under 100,000 population or in cities/towns under 25,000 inside larger counties
• closure of a hospital, or its conversion to another facility type, in counties of 100,000 or more (NRS 439A.102)

Nevada certificate of need details →

Model

hybrid

State vendor

Sandata (since 2023-12-15; AuthentiCare before)

Services in scope

• personal care
• home health
• attendant care
• homemaker
• chore
• respite
• companion

Alternate EVV allowed

Yes

Program

https://www.nevadamedicaid.nv.gov/EVV-PCA/

Nevada EVV requirements →

State minimum wage

$12.00 an hour

Effective

2024-07-01

Scheduled increases

No scheduled change found in the official sources reviewed.

Direct-care wage floor

SB 511 (2023): to get the $25/hour personal care services rate, providers must pay direct care workers at least $16.00/hour (from 2024-01-01) and sign a wage attestation.

Rate pass-through

Of the $25/hour PCS rate, not less than $16 must be paid as hourly wages to direct care workers (SB 511, s. 68).

HCBS 80/20 rule

Federal baseline: 42 CFR 441.302(k) requires the state to show that each provider spends at least 80% of Medicaid payments for homemaker, home health aide and personal care services under 1915(c) waivers on direct care worker pay and benefits. Compliance starts 2030-07-09 (for managed care, the first rating period starting on or after that date); annual payment-adequacy reporting under 441.311(e) starts 2028-07-09. A state may set a lower share for state-defined small providers and exempt providers facing hardship, each only through a public notice-and-comment process. The eCFR text has not changed since 2024-07-09. No state-published 80/20 implementation step (small-provider criteria, hardship exemption or reporting guidance) was found for this state in the official sources reviewed.

Personal care / in-home supportive care organizations — active organization NPIs (NPPES)

914 (as of Sep 13, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

711,617 (as of Jun 1, 2026)

All Nevada Home care Medicaid rates, ranked →

• NV HCBS Waiver for Individuals with Intellectual and Developmental Disabilities (1915(c))
• NV Home and Community Based Services (HCBS) Waiver for Persons with Physical Disabilities (1915(c))
• NV Waiver for Structured Family Caregiving (1915(c))
• NV Waiver for the Frail Elderly (1915(c))

Nevada waivers and waiting lists →