How to start a private duty nursing agency in Ohio

Private duty nursing — Ohio Medicaid (Medicare-certified HHA, otherwise-accredited agency, or non-agency nurse).

License

Medicaid PDN provider: Medicare-certified home health agency, otherwise-accredited agency, or non-agency (independent) nurse

Issuing agency

Ohio Department of Medicaid

Accreditation

Otherwise-accredited agencies must hold and maintain accreditation from ACHC, CHAP or The Joint Commission.

Regulation

OAC 5160-12-02 (private duty nursing); 5160-12-03; 5160-12-03.1

1. Choose a route: Medicare-certified home health agency (OAC 5160-12-03), otherwise-accredited agency (OAC 5160-12-03.1), or non-agency RN/LPN (OAC 5160-12-03.1)
2. Otherwise-accredited agencies obtain national accreditation (ACHC, CHAP or The Joint Commission) for home health/PDN services
3. Execute an Ohio Medicaid provider agreement
4. Serve members under prior authorization and EVV rules

Program

Ohio Medicaid (Ohio Department of Medicaid, ODM)

Enrollment portal

Provider Network Management (PNM) module of the Ohio Medicaid Enterprise System (OMES)

Application fee

Organizational provider types pay a non-refundable fee of $750 per application in 2026 (42 CFR 455.460 and OAC 5160-1-17.8), paid online in PNM. Individual practitioners and practitioner groups do not pay it. The fee is waived if paid to Medicare or another state's Medicaid program within the past five years for new enrollments; ODM's revalidation FAQ uses a two-year window for revalidations. The application cannot be finished until the fee is paid or proof is uploaded.

Fingerprinting

ODM requires BCI&I criminal record checks for certain providers, notably Ohio Home Care Waiver non-agency providers, who have done annual checks. ODM is moving these providers to RAPBACK, the retained-applicant fingerprint database, which gives continuous criminal-history updates at no cost to the provider. 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 OAC 5160-1-17.8, some providers get pre- and post-enrollment on-site screening visits. Public Consulting Group (PCG) does the visits for providers not already screened by another state or federal agency. The visits are unannounced, and not cooperating can affect enrollment. 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.

Revalidation

ODM revalidates under 42 CFR 455.414 (at least every 5 years). It sends a notice about 120 days before the deadline, one per provider number, and also posts it in PNM correspondence. Do not start revalidation until the notice arrives. Revalidating with Medicare does not replace Ohio revalidation. ODM may do an on-site visit as part of it.

Full Ohio Medicaid enrollment guide →

CON program

Yes

Program

Certificate of Need (long-term care)

Agency

Ohio Department of Health (Director of Health)

Services covered

• long-term care facilities: licensed nursing homes and skilled nursing / long-term care beds (including county homes and hospital-registered long-term care beds)
• new long-term care facilities, increases in bed capacity, and relocation of beds between sites

Ohio certificate of need details →

Model

hybrid

State vendor

Sandata

Services in scope

• home health nursing and aide
• private duty nursing
• waiver nursing, aide and home care attendant
• personal care (waiver homemaker/personal care)

Alternate EVV allowed

Yes

Program

https://medicaid.ohio.gov/resources-for-providers/special-programs-and-initiatives/electronic-visit-verification

Ohio EVV requirements →

State minimum wage

$11.00 an hour

Effective

2026-01-01

Scheduled increases

Rises to $11.40 on 2027-01-01 ($5.70 tipped) for employers above the gross-receipts threshold.

Rate pass-through

HB 33 (FY2024-25 budget) requires DODD waiver provider rate increases to be used to raise wages and workforce supports; the bill's specific $17/$18 per hour rate language was vetoed, but the funding remained.

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.

Nursing care agencies (private duty nursing) — active organization NPIs (NPPES)

515 (as of Sep 13, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

2,597,852 (as of Jun 1, 2026)

All Ohio Private duty nursing Medicaid rates, ranked →

• OH Assisted Living Waiver (1915(c))
• OH Home Care Waiver (1915(c))
• OH Individual Options (IO) Waiver (1915(c))
• OH Level One Waiver (1915(c))
• OH MyCare Ohio Waiver (1915(c))
• OH OhioRISE Waiver (1915(c))
• OH PASSPORT Waiver (1915(c))
• OH Self Empowered Life Funding (SELF) Waiver (1915(c))

Ohio waivers and waiting lists →