How to start a private duty nursing agency in Utah

Utah requires a Home health agency license (Utah DHHS, R432-700), Medicare/Medicaid-certified from Utah DHHS — licensing (DLBC) and Medicaid (Division of Integrated Healthcare) to operate a private duty nursing agency.

License required

Yes

License

Home health agency license (Utah DHHS, R432-700), Medicare/Medicaid-certified

Issuing agency

Utah DHHS — licensing (DLBC) and Medicaid (Division of Integrated Healthcare)

Regulation

Utah Medicaid Provider Manual — Home Health Services, §8-11 Private Duty Nursing; Utah Admin. Code R432-700

1. Obtain a Utah home health agency license under R432-700
2. Obtain Medicare/Medicaid certification and enroll with Utah Medicaid
3. Employ or contract with Utah-licensed RNs/LPNs
4. Serve EPSDT-eligible members (others only by exception) with prior authorization using the PDN acuity grid

Staffing

• RNs and LPNs licensed under Utah Title 58

Program

Utah Medicaid (Utah Department of Health and Human Services, DHHS)

Enrollment portal

PRISM Provider Portal

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. Utah DHHS's enrollment pages do not list a separate state fee.

Fingerprinting

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. Utah DHHS's enrollment pages do not describe a separate state fingerprint process.

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. Utah DHHS's enrollment pages do not describe a separate state site visit process.

Revalidation

Federal rule (42 CFR 455.414) requires the state to revalidate every enrolled provider at least once every 5 years. Utah DHHS's become-a-provider page does not describe a separate state revalidation cycle.

Full Utah Medicaid enrollment guide →

CON program

No

Agency

Utah Department of Health and Human Services, Division of Integrated Healthcare (Medicaid certification of nursing care facilities)

Moratoria

Medicaid reimbursement is limited to nursing care facility programs that were Medicaid-certified as of May 9, 2016, plus programs approved under Utah Code 26B-3-311(5) and (7). The division may not process new Medicaid certification applications or reinstate expired certifications except as §26B-3-311 allows. Since May 4, 2021, new ICF/IID beds may be Medicaid-certified only if the statewide ICF/IID Medicaid bed total does not rise (Utah Code 26B-3-310).

Utah certificate of need details →

Model

open/provider choice

Services in scope

• personal care
• attendant care
• homemaker
• home health
• DSPD waiver services

Alternate EVV allowed

Yes

Program

https://medicaid.utah.gov/evv/

Utah EVV requirements →

State minimum wage

$7.25 an hour

Effective

2009-07-24

Scheduled increases

No scheduled change found in the official sources reviewed.

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)

27 (as of Sep 13, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

321,779 (as of Jun 1, 2026)

All Utah Private duty nursing Medicaid rates, ranked →

• UT Acquired Brain Injury (ABI) Waiver (1915(c))
• UT Community Supports Waiver for Individuals with Intellectual Disabilities and Other Related Conditions (1915(c))
• UT Community Transitions Waiver (1915(c))
• UT Limited Supports Waiver (1915(c))
• UT Medically Complex Children's Waiver (1915(c))
• UT New Choices Waiver (1915(c))
• UT Physical Disabilities Waiver (1915(c))
• UT Waiver for Individuals Age 65 or Older (1915(c))
• UT Waiver for Technology Dependent, Medically Fragile Individuals (1915(c))

Utah waivers and waiting lists →