How to start a private duty nursing agency in Virginia

Virginia requires a Home health agency license or certification from the Virginia Department of Health from Virginia Department of Health (license); Department of Medical Assistance Services (enrollment) to operate a private duty nursing agency.

License required

Yes

License

Home health agency license or certification from the Virginia Department of Health

Issuing agency

Virginia Department of Health (license); Department of Medical Assistance Services (enrollment)

Regulation

12VAC30-50-132 (PDN under EPSDT); DMAS EPSDT Supplement — Private Duty Nursing (11/1/2022)

1. Obtain a VDH home health agency license or certification
2. Sign a participation agreement with DMAS or its contractor to provide PDN
3. Assign Virginia-licensed RNs/LPNs with a documented provider training program or at least six months of related clinical experience
4. Provide RN supervision by a Virginia-licensed RN supervisor

Staffing

• RNs/LPNs employed or subcontracted and supervised by the enrolled PDN provider
• Each nurse: Virginia license and either a documented training program or 6 months related clinical experience
• RN supervisor licensed in Virginia (at least one year of RN clinical experience)

Program

Virginia Medicaid / Cardinal Care (Department of Medical Assistance Services, DMAS)

Enrollment portal

Medicaid Enterprise System (MES) Provider Services Solution (PRSS), the 'Provider Portal'

Fiscal agent

Gainwell Technologies (PRSS enrollment and revalidation support and notices)

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. DMAS's revalidation plan says every revalidation includes collecting the application fee. The enrollment page does not list a separate state fee.

Fingerprinting

DMAS designates nursing facilities, DME, hospice, home health, prosthetic devices and doula services as high categorical risk. Its revalidation plan includes background checks for these providers. 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

DMAS's revalidation plan includes site visits for applicable provider types, including high-risk providers and the moderate-risk providers being revalidated off-cycle. 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

Fee-for-service and MCO network providers enroll in PRSS and revalidate at least every five years. DMAS sends a notice at least 90 days before the enrollment period ends, with Gainwell reminder emails at 60 and 30 days. Revalidation is electronic only, through PRSS (see the Manage Revalidation panel). Missing it ends participation in both fee-for-service and MCO networks. Under DMAS's June 2026 CMS strategy, high-risk types (nursing facilities, DME, hospice, home health, prosthetic devices, doula services) move to a 3-year cycle on July 1, 2027. The 808 high-risk providers will be revalidated off-cycle from August to December 2027, and some moderate-risk providers in early 2028.

Full Virginia Medicaid enrollment guide →

CON program

Yes

Program

Certificate of Public Need (COPN)

Agency

Virginia Department of Health; the State Health Commissioner issues certificates after review by regional health planning agencies

Services covered

• hospitals, including DBHDS-licensed psychiatric hospitals
• nursing homes and new nursing home services
• intermediate care facilities for substance abuse treatment
• certain small ICFs for persons with developmental disabilities (not ICF/IID of 12 beds or fewer in need areas)
• outpatient/ambulatory surgery centers and physician-office surgery
• cardiac catheterization, CT, MRI, PET, radiation therapy, stereotactic radiotherapy (non-linear-accelerator), proton beam therapy
• bed or operating room increases and bed relocations
• new medical rehabilitation, neonatal special care, open heart surgery, psychiatric, and organ/tissue transplant services

Virginia certificate of need details →

Model

open/provider choice

Services in scope

• personal care
• respite
• companion
• consumer-directed personal care
• home health

Alternate EVV allowed

Yes

Program

https://www.dmas.virginia.gov/for-providers/benefits-services-for-providers/long-term-care/programs-and-initiatives/electronic-visit-verification/

Virginia EVV requirements →

State minimum wage

$12.77 an hour

Effective

2026-01-01

Scheduled increases

Rises to $13.75 on 2027-01-01 (Va. Code 40.1-28.10 as amended in 2026).

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)

419 (as of Sep 13, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

1,635,168 (as of Jun 1, 2026)

All Virginia Private duty nursing Medicaid rates, ranked →

• VA Building Independence Waiver (1915(c))
• VA Commonwealth Coordinated Care Plus Waiver (1915(c))
• VA Community Living Waiver (1915(c))
• VA Family and Individual Support Waiver (1915(c))

Virginia waivers and waiting lists →