How to start a private duty nursing agency in Massachusetts

Continuous skilled nursing (PDN) — MassHealth: CSN agency, home health agency, or independent nurse.

License

MassHealth continuous skilled nursing (CSN) agency provider (130 CMR 438.000); home health agencies (130 CMR 403.000) and independent nurses (130 CMR 414.000) may also furnish CSN

Issuing agency

MassHealth (Executive Office of Health and Human Services)

Regulation

130 CMR 438.000 (CSN agency services); 130 CMR 403.000; 130 CMR 414.000

1. Meet MassHealth CSN agency eligibility under 130 CMR 438.404 (or enroll as a home health agency or independent nurse)
2. Enroll with MassHealth and comply with 130 CMR 450.000 administrative and billing rules
3. Obtain service authorization for each member

Program

MassHealth (Massachusetts Medicaid and CHIP)

Enrollment portal

MassHealth Provider Application Request Form (FFS) / MassHealth LTSS Provider Portal (LTSS programs); Provider Online Service Center (POSC) for enrolled providers and revalidation

Fiscal agent

MassHealth Provider Enrollment and Credentialing (PEC) unit, run with Maximus (contact pec@maximus.com); MassHealth does not name a separate fiscal agent on its enrollment pages

Application fee

MassHealth charges the fee ($750 for 2026) only to acute, chronic, psychiatric and semi-acute inpatient hospitals, ICF-MR state schools and skilled nursing facilities not in Medicare, unless already paid to Medicare or another state. It is paid online (no paper checks), is non-refundable, and the payment confirmation goes with the application. Federal rule (42 CFR 455.460): the state must collect the CMS application fee from institutional providers that are newly enrolling or re-enrolling; individual physicians and non-physician practitioners are exempt, as are providers already enrolled in (or that already paid the fee to) Medicare or another state's Medicaid/CHIP. CMS set the fee at $750 for calendar year 2026.

Fingerprinting

MassHealth's high-risk types include adult foster care and group adult foster care providers, and newly enrolling continuous skilled nursing agencies, DME, home health, hospice, nursing facility, orthotics, oxygen/respiratory and prosthetics providers, plus any provider meeting federal high-risk criteria. These providers and their 5%+ owners get local and national fingerprint checks after MassHealth notifies them. Federal rule (42 CFR 455.434, 455.450(c)): providers the state places in the 'high' categorical risk level, and anyone owning 5% or more of such a provider, must submit fingerprints for a criminal background check.

Site visit

MassHealth's moderate-risk types (for example, those same agencies once enrolled, independent labs, IDTFs, mental health centers, physical therapists and ambulance providers) may get unannounced site visits from Medicare, MassHealth or both. MassHealth also has CMS-approved enrollment moratoria on new adult foster care (extended July 17, 2026) and adult day health (from May 19, 2026) agencies. Federal rule (42 CFR 455.432, 455.450(b)-(c)): the state must do site visits before and after enrollment for providers in the 'moderate' or 'high' risk levels, and any enrolled provider must allow unannounced on-site inspections.

Revalidation

MassHealth contacts providers when revalidation is due; providers then have 45 days to finish in the POSC, including an online attestation and, for non-Medicare providers, a Federally Required Disclosures Form. Providers that do not finish face sanctions or termination. Federal rule (42 CFR 455.414): every enrolled provider must be revalidated at least once every 5 years.

Full Massachusetts Medicaid enrollment guide →

CON program

Yes

Program

Determination of Need (DoN)

Agency

Massachusetts Department of Public Health, Determination of Need Program

Services covered

• hospitals and clinics
• long-term care facilities, nursing homes, rest homes and charitable homes for the aged
• clinical laboratories
• publicly supported institutions for persons with developmental disabilities or mental illness
• substantial capital expenditures and substantial changes in service
• innovative services and new technology outside a health care facility
• acquisition of existing health care facilities (notice; DoN required if services or beds change)

Massachusetts certificate of need details →

Model

hybrid

State vendor

Sandata (agency-based services); Tempus (fiscal intermediary for the consumer-directed PCA program)

Services in scope

• personal care
• home health
• adult foster care
• certain HCBS waiver services

Alternate EVV allowed

Yes

Program

https://www.mass.gov/info-details/electronic-visit-verification-evv

Massachusetts EVV requirements →

State minimum wage

$15.00 an hour

Effective

2023-01-01

Scheduled increases

No scheduled change found in the official sources reviewed.

Rate pass-through

FY2026 budget line 1599-6903 (Chapter 257 reserve): any human service provider receiving Chapter 257 revenue must use at least 75% of those funds on pay for direct care, front-line and clinical staff; home care workers are eligible, with preference for staff earning under $20/hour.

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)

245 (as of Sep 13, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

1,525,312 (as of Jun 1, 2026)

All Massachusetts Private duty nursing Medicaid rates, ranked →

• Acquired Brain Injury Non-Residential Habilitation (ABI – N) Waiver (1915(c))
• Acquired Brain Injury with Residential Habilitation (ABI – RH) Waiver (1915(c))
• Adult Supports Waiver (1915(c))
• Children's Autism Spectrum Disorder Waiver (1915(c))
• Community Living Waiver (1915(c))
• Frail Elder Waiver (1915(c))
• Intensive Supports Waiver (1915(c))
• MFP Community Living (MFP – CL) Waiver (1915(c))
• MFP Residential Supports (MFP – RS) Waiver (1915(c))
• Traumatic Brain Injury (TBI) Waiver (1915(c))

Massachusetts waivers and waiting lists →