50-State Regulatory Atlas North Carolina
State licensing summary
North Carolina: healthcare licensing and regulation
North Carolina: separate license per office; certificate of need for medicare or medicaid agencies; compact member. Regulator: North Carolina Division of Health Service Regulation.
Educational summary, last reviewed October 17, 2026. Not legal advice — confirm with the state licensing agency or counsel.
11 findings: 9 verified, 2 provisional. How findings are sourced and labelled.
At a glance
- License
- State license requiredVerified
- Regulator
- North Carolina Division of Health Service Regulation
- Branch offices
- Separate license per officeVerified
- Certificate of need
- Certificate of need for Medicare or Medicaid agenciesVerified
- Service area
- Confirm with the state agencyProvisional
- In-state office
- See out-of-state rules below
- Medicare certification
- Separate federal step, only for agencies that bill MedicareVerified
Home health licensing
State license
VerifiedYes, one “home care agency” license (G.S. 131E-135 et seq.; 10A NCAC 13J). A “home health agency” is a home care agency certified for Medicare or Medicaid. Companion and homemaker services have a separate home assistance services provider category.
In practice: Hold the authority the state requires before the first patient is admitted there, and keep its number, category and expiry with the office it covers.
Source: 10A NCAC 13J .0902G.S. 131E-136NC DHSR: Certified home health agencies10A NCAC 13J .1108
Certificate of need
VerifiedMedicare-certified home health agencies only. Each certified site needs its own certificate of need and license.
In practice: Matters only if the agency will be certified for Medicare or Medicaid.
Source: 10A NCAC 13J .0902G.S. 131E-136NC DHSR: Certified home health agencies10A NCAC 13J .1108
Branch offices
Verified“Each agency premises shall obtain a license.”
In practice: Track each office’s authority on its own where the state licenses offices separately, and with the parent where it lists them.
Source: 10A NCAC 13J .0902G.S. 131E-136NC DHSR: Certified home health agencies10A NCAC 13J .1108
Service area
ProvisionalConfirm with the state agency Not established in this review.
In practice: Check the patient’s address against the approved service area before accepting a referral.
Source: 10A NCAC 13J .0902G.S. 131E-136NC DHSR: Certified home health agencies10A NCAC 13J .1108
Out-of-state agencies
ProvisionalConfirm with the state agency Not established in this review.
In practice: A license in one state does not authorize care in another; the patient’s state decides.
Source: 10A NCAC 13J .0902G.S. 131E-136NC DHSR: Certified home health agencies10A NCAC 13J .1108
Home infusion nursing
Home infusion nursing
Verified“Infusion nursing services” are a listed home care service. The rules require an RN with infusion training, a physician-signed plan of care and 24-hour on-call infusion nursing (10A NCAC 13J .1108).
In practice: Confirm the license category before staffing infusion visits in this state.
Source: 10A NCAC 13J .1108
Staffing and nurse licensure
Nurse licensure (compact)
VerifiedMember of the Nurse Licensure Compact, implemented. A nurse with a multistate license from another compact state may practice here; the agency still needs this state’s own authority to operate.
In practice: Check each nurse’s license against the patient’s state, not the agency’s.
Detailed state rules for staffing agencies in this state are being added.
Medicare, hospice and VA programs in this state
North Carolina is one of the six states in CMS’s Review Choice Demonstration for home health (Illinois, Ohio, Texas, North Carolina, Florida, Oklahoma). Medicare home health agencies here choose pre-claim review or postpayment review; an agency that reaches a 90% provisional affirmation rate may move to lighter review options. The earlier minimal-review choice with a 25% payment reduction was removed. The demonstration was extended five years from June 1, 2024.
Source: CMS: Review Choice Demonstration for Home Health Services
North Carolina is not one of the six states (Arizona, California, Nevada, Texas, Georgia, Ohio) where CMS applies its provisional period of enhanced oversight to newly enrolling hospices.
Source: CMS Medical Review: Hospice
Certificate of need (hospice)
VerifiedNorth Carolina’s State Medical Facilities Plan sets need determinations for hospice home-care offices and inpatient beds (Tables 13G and 13H).
Source: NCDHHS State Medical Facilities Plan, Table 13G (2025 draft)
VA Community Care Network region
VerifiedNorth Carolina is in Community Care Network Region 1, administered by Optum. Agencies join by contracting with the regional third-party administrator, not with VA. VA has re-procured the network as CCN Next Generation with two regions, East and West; which administrator serves which region from 2027 was not announced in the sources reviewed.
Time-sensitive. Region assignments change with CCN Next Generation; recheck VA’s announcements during 2027.
Source: VA: Community Care Network
Federal rules that apply in every state
Medicare certification
VerifiedMedicare certification under the home health Conditions of Participation (42 CFR Part 484) is a federal step for agencies that bill Medicare home health. It is separate from the state license. Where a state ties entry to certification, that state’s findings say so.
In practice: A branch serving a portion of the parent’s area is supervised and administered by the parent agency (42 CFR 484.2).
Source: 42 CFR 484.2
For a Medicare-certified agency, “its personnel must be qualified in all States in which they provide services” (State Operations Manual § 2184).
In practice: Nurse licensure follows the patient’s state.
Medicare’s home infusion therapy benefit is a separate Part B supplier benefit, not a home health benefit. It pays an accredited, qualified home infusion therapy supplier for professional services tied to specific parenteral drugs given through a pump that is durable medical equipment (42 CFR Part 486, Subpart I).
In practice: Most pharmacy-dispensed home infusion is not billable under this benefit; nursing for those patients is usually paid by other payers or under contract.
Compared with Texas
Like Texas, every premises is licensed. A certificate of need applies to Medicare-certified agencies.
Other service lines
State rules for these lines are being added to the guide: Medicare home health, Medicare home infusion therapy benefit, Infusion pharmacy, Hospice, Private duty nursing, Personal care and Medicaid HCBS, VA community care, Infusion suites.
Look up a licensed provider
- DHSR Licensed Facilities VerifiedNorth Carolina DHHS, Division of Health Service Regulation, Acute and Home Care Licensure & Certification Section
XLSX lists of home care, home health, hospice and nursing pool licensees.
National lookups
- Medicare Care Compare — Home health
Medicare-certified home health agencies with quality ratings and services offered.
- Medicare Care Compare — Hospice
Medicare-certified hospices with quality measures.
- CMS Provider Data Catalog — Home Health Care Agencies (6jpm-sxkc)
All Medicare-registered home health agencies with CCN, address, ownership, services, certification date and quality measures, as CSV and an unauthenticated API.
- CMS Provider Data Catalog — Hospice – General Information (yc9t-dgbk)
Medicare-certified hospices with CCN, address, county, ownership type and certification date, as CSV and an unauthenticated API.
- CMS QCOR — HHA 2567 Statements of Deficiencies
Federal survey statements of deficiencies for home health agencies, filterable by state, survey type, tag and CCN, with a full-dataset XLSX download.
- CMS QCOR — Hospice 2567s
Federal survey statements of deficiencies for hospices.
- NPPES NPI Registry
National Provider Identifier records with addresses, authorized official and taxonomies, with a public API.
- HHS-OIG List of Excluded Individuals/Entities (LEIE)
Individuals and entities excluded from federal health care programs, with a monthly downloadable database.
- SAM.gov Exclusions
Federal exclusion records across agencies.
- Nursys QuickConfirm
Nurse license status, discipline / board-issued alerts and expiry, free to employers and the public.
Associations
- Association for Home & Hospice Care of North Carolina (AHHC)home health, hospice
Offers resources, education, advocacy and leadership, licensure applicant training, a home care rules refresher, a provider directory and webinars.
Official sources
About this guide. Published and maintained by Paloma Health Technologies; Findings are cited to official sources, dated and status-labelled; see the editorial policy. Educational summary, last reviewed October 17, 2026. Not legal advice — confirm with the state licensing agency or counsel.