How to start a private duty nursing agency in Rhode Island

Rhode Island requires a Home nursing care provider license or home care provider license (216-RICR-40-10-17); Medicaid home health providers must also be Medicare-certified from Rhode Island Department of Health (license and CON); Executive Office of Health and Human Services (Medicaid) to operate a private duty nursing agency.

License required

Yes

License

Home nursing care provider license or home care provider license (216-RICR-40-10-17); Medicaid home health providers must also be Medicare-certified

Issuing agency

Rhode Island Department of Health (license and CON); Executive Office of Health and Human Services (Medicaid)

Certificate of need

Required

Regulation

216-RICR-40-10-17; 210-RICR-20-05-1 (Medicaid home care and home health providers); R.I. Gen. Laws §23-17

1. File a letter of intent and Certificate of Need application (with fee) for a new home nursing care or home care provider; Health Services Council review
2. Obtain the RIDOH license after CON approval
3. Obtain Medicare certification as a home health provider (EOHHS home health rule)
4. Obtain an RI Medicaid provider number and EOHHS authorization before serving members

Program

Rhode Island Medicaid (Executive Office of Health and Human Services, EOHHS)

Enrollment portal

RI Medicaid Healthcare Portal (riproviderportal.org) — Enrollment Application

Fiscal agent

Gainwell Technologies

Application fee

Some provider types must pay an application fee. EOHHS publishes the 2026 list of who pays, how much and how to pay ('Updated Provider Application Fees 2026'). Providers already screened by Medicare can rely on Medicare's screening and fee payment but must still complete RI's disclosure statements. 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.

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. The EOHHS enrollment pages we reviewed 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. The EOHHS enrollment pages we reviewed do not describe a separate state site visit process.

Revalidation

EOHHS mails revalidation letters, and the provider has 35 days from the letter date to complete revalidation in the portal. Have an updated W-9 ready and expect the disclosure questions. Not revalidating leads to termination from RI Medicaid. Ordering, prescribing and referring (OPR) providers also revalidate. Federal rule (42 CFR 455.414) requires the state to revalidate every enrolled provider at least once every 5 years.

Full Rhode Island Medicaid enrollment guide →

For this business

Required (licensing source)

CON program

Yes

Program

Certificate of Need (Determination of Need for New Healthcare Equipment and New Institutional Health Services)

Agency

Rhode Island Department of Health (state agency), with review by the Health Services Council

Services covered

• hospitals
• nursing facilities
• home nursing-care providers
• home-care providers
• hospice providers and inpatient hospice facilities
• inpatient rehabilitation centers including drug/alcohol treatment
• freestanding emergency-care facilities
• multi-practice ambulatory surgery centers (single-practice physician/podiatry ASCs exempt unless set up by a medical practice group)
• capital expenditures above $5,250,000 (CPI-adjusted from 2012)
• new services adding $1,500,000+ (CPI-adjusted) in operating expense
• tertiary/specialty services listed in regulation (up to 12 categories)

Rhode Island certificate of need details →

Model

hybrid

State vendor

Sandata

Services in scope

• personal care
• homemaker
• home health

Alternate EVV allowed

Yes

Program

https://eohhs.ri.gov/sites/g/files/xkgbur226/files/2022-11/EVV-FAQ%20Information%20Guide.pdf

Rhode Island EVV requirements →

State minimum wage

$16.00 an hour

Effective

2026-01-01

Scheduled increases

Rises to $17.00 on 2027-01-01 (2025-H 5029A / 2025-S 0125A).

Rate pass-through

Home care: agencies must pass 100% of the shift-differential and behavioral-health-training rate enhancements to the CNAs and homemakers who earned them. Nursing homes: 100% of the 3% base-rate staffing adjustment effective 2025-10-01 must go to direct-care staff compensation or added positions.

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)

54 (as of Sep 13, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

283,863 (as of Jun 1, 2026)

All Rhode Island Private duty nursing Medicaid rates, ranked →

• Rhode Island Comprehensive Demonstration (1115)

Rhode Island waivers and waiting lists →