Tools & Insights for
Serious Operators

Processing times vary significantly by state — from as little as 30 days in some states to 6+ months in others. On average, our clients receive their licenses within 60–90 days of submitting a complete application. States like California, New York, and Illinois tend to take longer due to volume and review requirements.

For home health agencies, yes — you typically need both a state license and Medicare certification (either through a CMS-approved accrediting organization or a state survey). Non-medical home care agencies generally only need a state license and do not bill Medicare. Hospice agencies require both licensure and Medicare certification as well.

A Certificate of Need is a state-level approval required before opening certain healthcare facilities or services in some states. As of 2025, roughly 35 states have CON laws that may apply to home health or hospice agencies. CON requirements can add 6–18 months to your launch timeline. TBOSC helps clients navigate CON applications in states where they are required.

All three are CMS-approved Deemed Status accrediting organizations for home health and hospice, meaning accreditation from any of them substitutes for a state survey for Medicare certification. CHAP and ACHC are home care specialists and are generally preferred for their industry focus and support. The Joint Commission is broader in scope and better recognized across all healthcare settings, which can be advantageous if you plan to pursue hospital contracts.

Startup costs vary widely by state, service line, and business model. For non-medical home care, total startup costs typically range from $15,000–$75,000 including licensing fees, insurance, staffing, and working capital. For home health agencies pursuing Medicare certification, costs are typically $50,000–$150,000+ when you factor in the additional regulatory requirements, policies, and staffing. Download our free Startup Cost Estimator for a state-specific breakdown.

Absolutely. A significant portion of our work is with existing agencies — updating outdated policies and procedures, preparing for re-surveys or annual reviews, responding to deficiency citations, and building QAPI programs. If you've received a survey deficiency or are concerned about an upcoming review, contact us as soon as possible so we can assess the situation and build a response plan.