To be considered for a license to provide medical or non-medical home health service as a home health agency or nonagency provider, you must submit a completed application and a non-refundable application fee of $250.00.
Option 1 – Electronic (fastest)
If you wish to complete the form electronically and pay by credit card or electronic check, you can go to the below web link and select the “CertLicensure” option.
You will then need to choose the appropriate application. Once you have completed the application, you will then be able to complete the electronic payment.
Option 2 – Mail
To mail the application, supporting documents and payment; you will need to select the “download” option, complete the form, print it and mail all it to:
Ohio Department of Health
Revenue Processing #3506
P.O. Box 15278
Columbus OH. 43215
In accordance with Chapter 3740 of the Ohio Revised Code, the primary owner of the home health agency seeking to obtain a non-medical service home health agency license is required to provide to the Ohio Department of Health their fingerprint impression card, not a criminal record check. You can find a location that provides fingerprinting services on the Ohio Attorney General’s Office website. You will need to contact the location to ensure that the location can provide you with a copy of your fingerprint impressions that are either inked or done electronically. The other option is to reach out to your local law enforcement agency to see if they may be able to provide you with a fingerprint impression card.
Applicants whose business was not in operation, meaning the applicant was not providing direct care on or immediately prior to September 30, 2021, are required to obtain a surety bond issued by a company licensed to do business in this state.
Non-Medical Home Health Services Surety Bond Form in the amount of $20,000.