How To Start A Home Care Agency In Ohio

Ohio Home Care & Home Health Regulations: An Essential Guide

Why Legal and Regulatory Framework Matters

If you’re starting a home care or home health agency in Ohio — whether offering non‑medical support like personal care and homemaking, or providing skilled medical services such as nursing, therapy, or home‑health aide care — you must comply with state regulations. These rules are intended to protect vulnerable clients, ensure quality of care, safeguard against abuse or neglect, and maintain accountability. Noncompliance can lead to license denial, fines, criminal penalties, or forced closure.

Since July 2022 — under a law passed as House Bill 110 — all home health and home care agencies (and many non‑agency providers) must obtain licensure through the Ohio Department of Health (ODH). Frost Brown Todd+2codes.ohio.gov+2

In the rest of this post, you’ll find what these regulations require, how to comply, and what it means in practice.

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Core Legal Structure: Statutes and Rules

Statutory Basis: Ohio Revised Code § 3740 & House Bill 110

• Under ORC § 3740, agencies or non‑agency providers seeking to provide home health services — skilled or nonmedial — must apply for and obtain a license. codes.ohio.gov+2codes.ohio.gov+2

• After September 30, 2021, and effective July 1, 2022, the new requirements took effect: both agencies and individual non‑agency providers must be licensed. Frost Brown Todd+2Dinsmore & Shohl LLP+2

• Under the statute:

  • Agencies providing skilled home health services must obtain a skilled home health services license. codes.ohio.gov+1

  • Agencies or non‑agency providers offering nonmedical home health services must obtain a nonmedical home health services license, unless they already hold a skilled license (in which case skilled license covers nonmedical services too). codes.ohio.gov+2Legal Information Institute+2

These legal requirements represent a major shift: what was once loosely regulated — especially non‑medical home care — is now firmly under the licensing regime. Frost Brown Todd+2Dinsmore & Shohl LLP+2

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Regulatory Implementation: Ohio Administrative Code Chapter 3701‑60

To operationalize the statute, ODH revised and expanded Chapter 3701‑60 of the Ohio Administrative Code (OAC), which now governs definitions, license applications, renewals, criminal background checks, compliance and enforcement. Legal Information Institute+2codes.ohio.gov+2

Main components of Chapter 3701‑60 include:

• § 3701-60-01 — Definitions of terms (home health agency, direct care, skilled services, non‑medical services, nonagency provider, etc.) codes.ohio.gov+1

• § 3701-60-02 — Applicability: who needs a license, and when. codes.ohio.gov+1

• § 3701-60-03 — Initial license application process & renewal. codes.ohio.gov+2Legal Information Institute+2

• § 3701-60-04 onward — includes enforcement, criminal record check requirements, reporting, recordkeeping, compliance actions etc. Legal Information Institute+2codes.ohio.gov+2

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Key Definitions & Service Types under Ohio Law

Understanding the regulatory definitions is essential because they determine whether a license is required, and which type. As per OAC 3701‑60-01: codes.ohio.gov+1

• Home health agency: any person or entity (excluding nursing homes, residential care, hospices) whose primary function is delivering one or more of the following services to a patient at their place of residence: skilled nursing, physical therapy, speech‑language pathology, occupational therapy, medical social services, or home health aide services. codes.ohio.gov+1

• Direct care: care or service provided in a patient’s home; or any activity where the caregiver is routinely alone with the patient or has access to the patient’s personal property or financial documents. codes.ohio.gov

• Skilled home health services – includes licensed/clinical services (nursing, therapy, social work, home health aide etc.) provided at home. codes.ohio.gov+1

• Nonmedical home health services – includes personal care / homemaking / assistance services: helping with bathing, dressing, toileting, meal prep, ambulation, basic home support tasks etc. codes.ohio.gov+2Frost Brown Todd+2

• Nonagency provider: an individual self-employed to provide “direct care” who does not employ others — subject to licensing as well under new law. codes.ohio.gov+1

This definition framework helps distinguish between “home health agency,” “home care agency,” and “nonagency provider,” each subject to licensing under appropriate categories.

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Licensing Requirements: What You Need to Do

1. Decide the Scope of Services: Skilled vs Non‑Medical

Your licensing strategy depends on what services you plan to provide:

• If you intend to offer skilled services (nursing, therapy, home‑health aide, etc.), you must apply for a skilled home health services license. codes.ohio.gov+2codes.ohio.gov+2

• If you only plan to offer nonmedical services (personal care, homemaking, assistance with ADLs, companionship, etc.), you may apply for a nonmedical home health services license — unless you already hold a skilled license (which covers nonmedical as well). codes.ohio.gov+2Legal Information Institute+2

A pre‑existing skilled license covers both skilled and nonmedical services — meaning agencies may prefer skilled license for flexibility. Legal Information Institute+2codes.ohio.gov+2

2. Complete the Application for Licensure

The application process under Rule 3701-60-03 requires (among other items): codes.ohio.gov+2Legal Information Institute+2

For Skilled Home Health Services License:

• Completed application form

• Non-refundable license fee: US$ 250 codes.ohio.gov+2nursenextdoorfranchise.com+2

• Documentation that the agency meets one of: Medicare certification, national accreditation (e.g., The Joint Commission, Community Health Accreditation Partner / CHAP, or other CMS‑approved national accrediting body), or certification by the Ohio Department of Aging (if applicable). Legal Information Institute+2codes.ohio.gov+2

• If agency was not providing skilled care before September 30, 2021 — must post a surety bond of US$ 50,000. Legal Information Institute+2codes.ohio.gov+2

• Details of agency: operating location address & contact, names and addresses of owners / controlling persons, corporate name/agents/officers, and list of services to be provided. codes.ohio.gov+1

• Description of geographic service area. Legal Information Institute+1

• Criminal records check policy (for agencies). codes.ohio.gov+2Justia Regulations+2

For Nonmedical Home Health Services License (if not holding skilled license):

• Completed application form

• Non-refundable license fee: US$ 250 codes.ohio.gov+1

• Operating location details (address, contact), names and addresses of owners/controlling persons, corporate name/officers/statutory agent (if any). codes.ohio.gov+1

• List and description of nonmedical services offered, any procedural/policy documentation for these services. codes.ohio.gov+1

• Documents filed with Ohio Secretary of State (if applicable). codes.ohio.gov+1

• Statement of days/hours of operation. codes.ohio.gov+1

• Description of geographic area to be served. codes.ohio.gov+1

• Fingerprint impressions of the primary owner (or nonagency provider). Legal Information Institute+2vorys.com+2

• If the applicant was not providing nonmedical care before September 30, 2021 — must post a surety bond of US$ 20,000. Frost Brown Todd+2Legal Information Institute+2

Important: if an agency holds a skilled home health services license, it may provide nonmedical services without obtaining a separate nonmedical license. Legal Information Institute+2codes.ohio.gov+2

3. Licensing Deadlines and Historic Context

• New regulatory regime took effect following House Bill 110. Agencies and providers had until July 1, 2022 to obtain proper licensure. Frost Brown Todd+2Dinsmore & Shohl LLP+2

• Since then — providing care (medical or nonmedical) without license is prohibited. codes.ohio.gov+2codes.ohio.gov+2

• Licenses are valid for three years. Renewals require a fee and continued compliance. codes.ohio.gov+2Legal Information Institute+2

Mid‑2022 regulatory updates to Chapter 3701‑60 reflect these changes. registerofohio.state.oh.us+2Legal Information Institute+2

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Compliance Safeguards: Background Checks, Reporting & Enforcement

To ensure safe and trustworthy service, Ohio law imposes several compliance measures beyond licensing. Key among them is criminal background checking.

Criminal Background Checks & Disqualifications

• Under Rule 3701-60-06, every applicant for a “direct care” position must undergo a criminal records check. This applies to employees, independent contractors, or any person providing direct care for an agency. codes.ohio.gov+1

• Fingerprints must be submitted; the agency pays the fee to the state bureau of criminal identification. Agencies may, at their discretion, pass the fee to the applicant (provided certain conditions are met). codes.ohio.gov+1

• Anyone convicted of “disqualifying offenses” — e.g., abuse, neglect, misappropriation, or certain crimes defined under Ohio law — is disqualified from direct care positions. codes.ohio.gov+2Legal Information Institute+2

• Agencies must have and submit a written criminal records check policy as part of licensing. Legal Information Institute+1

These measures help protect clients — many of whom may be vulnerable — from potential abuse, neglect, or exploitation.

Recordkeeping, Reporting, and Enforcement

Under Chapter 3701‑60, agencies are required to maintain detailed records, perform national database reviews for new hires, and comply with ongoing reporting obligations. Legal Information Institute+1

Rule 3701‑60‑04 outlines the process for license denial, suspension or revocation, and how an agency may request an informal dispute resolution or hearing under the administrative code if license is denied. codes.ohio.gov+1

Violations — such as operating without a license — are penalized. For example, providing skilled or nonmedical home health services without a valid license is prohibited. codes.ohio.gov+2codes.ohio.gov+2

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Skilled Home Health vs. Non‑Medical Home Care: What’s the Difference Under Ohio Law

Understanding the distinction is crucial, because regulatory burden, compliance, and licensing requirements vary significantly depending on the type of service.

Here is a simplified comparison:

Because a skilled license covers nonmedical services too, many agencies choose to obtain the skilled license to maximize flexibility. Legal Information Institute+2Dinsmore & Shohl LLP+2

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What This Means for Starting a Home Care / Home Health Agency in Ohio

1. Regulatory Compliance is Mandatory

Since July 1, 2022, you cannot legally operate a home care or home health agency in Ohio without a valid license. That applies whether you are a large agency, small startup, or individual provider. Frost Brown Todd+2codes.ohio.gov+2

Operating without a license can lead to criminal prosecution. Dinsmore & Shohl LLP+2codes.ohio.gov+2

2. Licensure Requirements Are Clearly Defined, Structured, and Uniform

Compared to earlier regulatory ambiguity, Ohio now provides a clear, uniform process:

• Standard application forms, clearly defined fees, criteria, and classification of services.

• Criminal‑background checks and fingerprinting requirements to protect clients.

• Defined service types (skilled vs nonmedical), and corresponding license categories.

• Bond requirements for new agencies/new providers (if they began after the cutoff date).

This clarity reduces uncertainty — but also means agency founders must carefully plan to meet all criteria before starting.

3. Costs and Documentation Are Manageable — But Must Be Planned For

With a license fee of $250, plus potential bond requirements ($20,000 for nonmedical agencies, $50,000 for skilled), the upfront regulatory costs are tangible but not prohibitive. codes.ohio.gov+2Legal Information Institute+2

However — compliance also means you must maintain:

• Proper records (ownership, services, policies & procedures)

• Criminal‑background check policies and process for any direct care worker (employee or contractor)

• Accurate documentation of services, service area, operational hours, and more

Neglecting any of these can jeopardize licensure or put the agency at risk.

4. Non‑Medical Home Care Is Regulated — Debunking Older Myths of “Unregulated Comfort Care”

Some past resources or word-of-mouth advice claimed that non‑medical home care — companionship, homemaking, ADL assistance — was unregulated in Ohio. That is no longer the case under HB 110 and Chapter 3701-60: nonmedical agencies (or nonagency providers caring for more than two clients) must hold a license. Frost Brown Todd+2codes.ohio.gov+2

This change underscores the growing recognition by policymakers that any care provided in the home — even nonmedical assistance — carries risk and should be regulated for safety, accountability, and quality.

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Practical Steps & Recommendations for Entrepreneurs

If you plan to start a home care or home health agency in Ohio, here’s a recommended roadmap:

1. Decide what type of services you want to offer (skilled vs nonmedical vs both).

2. Review the definitions under OAC 3701-60 to ensure your business model fits the legal categories.

   • Skilled care: nursing, therapy, home health aide.

   • Nonmedical care: personal care, companionship, homemaking, ADL support.

3. Prepare your application — gather required documentation: business info, ownership/control info, services list, geographic area, hours/days of operation, criminal‑records check policy, etc.

4. Budget for fees and bonds — $250 license fee; if new as of 2021, $50,000 bond for skilled agencies or $20,000 for nonmedical agencies.

5. Implement policies for background checks — ensure fingerprinting and criminal checks for all “direct care” employees or contractors.

6. Develop internal policies/procedures and documentation for services offered — policies for care delivery, recordkeeping, scheduling, reporting, and client care standards — these will likely be required for application and compliance.

7. Maintain compliance after licensing — keep records, renew license every three years, comply with reporting, and ensure all staff background checks remain valid.

8. If you expect growth or want flexibility, consider obtaining a skilled license even if starting as nonmedical — gives ability to offer broader services without additional licensing later.

9. Stay updated with ODH rule changes — Chapter 3701-60 can be updated; licensing rules, definitions, and requirements may evolve over time.

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Common Misconceptions & Clarifications

Misconception 1: “Non‑medical home care doesn’t need a license in Ohio.”
Reality: False under current law. As of July 1, 2022, nonmedical home care agencies and non‑agency providers must obtain a nonmedical home health services license (unless holding a skilled license) if they provide services through employees or care for more than two clients. Frost Brown Todd+2codes.ohio.gov+2

Misconception 2: “Only agencies need a license; independent caregivers don’t.”
Reality: The law applies both to agencies and to “nonagency providers” — self-employed caregivers — providing skilled or nonmedical services. codes.ohio.gov+2codes.ohio.gov+2

Misconception 3: “Licensing is optional if the caregiver is certified or trained.”
Reality: Certification/training alone does not substitute for the state license. Even with proper caregiver training, providing services without an active license violates state law.

Misconception 4: “If the business was operating before the law, there’s no bond or license requirement.”
Reality: There may be exceptions but most providers still had to obtain license by July 1, 2022 — failure to do so could result in criminal liability. For some, bond exemptions applied, but license was still required. Frost Brown Todd+2Gertsburg Licata+2

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Why Ohio’s Regulatory Approach Matters — And What It Means for Quality & Accountability

The sweeping reforms under House Bill 110 and Chapter 3701-60 represent Ohio’s recognition that home care — even nonmedical — has significant risks. Vulnerable individuals receive care in their homes, often involving intimate assistance, access to personal property, mobility support, or even medical tasks (in skilled care). Without regulation, there’s real risk of neglect, abuse, injury, or fraud.

By requiring licensing, background checks, defined service categories, and application/renewal procedures, the state:

• Ensures agencies/providers meet baseline standards before operating.

• Promotes accountability and transparency (ownership disclosures, defined service areas, recordkeeping).

• Helps protect clients — especially seniors, disabled persons, or medically fragile individuals — from unqualified or unscrupulous providers.

• Raises the professional standards of home health / home care industry, aligning with clinical and safety expectations.

For you as an entrepreneur: this regulatory clarity allows you to build a legitimate, compliant, and trustworthy agency — and to differentiate yourself in a market likely crowded with unregulated or semi-regulated caregivers. Compliance can be a selling point.

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Resources & Useful Links

• Chapter 3701‑60 of the Ohio Administrative Code — definitions, licensing rules, applicability, enforcement. Legal Information Institute+2codes.ohio.gov+2

• Ohio Revised Code, Chapter 3740 — statutory basis for licensure requirements. codes.ohio.gov+2codes.ohio.gov+2

• Application guidelines: “Home Health Agency Licensure” page on Ohio Department of Health website. odh.ohio.gov+1

• Background check requirements (Rule 3701‑60-06): criminal records checks, fingerprinting, disqualifying offenses. codes.ohio.gov+1

• Overview of regulatory changes: analysis of new licensure requirement under House Bill 110. Frost Brown Todd+2Dinsmore & Shohl LLP+2

• Distinction between home health vs nonmedical home care: comparative overview. CHAP+2Surety Bonds Direct+2