How to Start a Home Health Agency in West Virginia: Certificate of Need and OHFLAC Licence

If you want to start a home health agency business in West Virginia, forming an LLC and hiring nurses is the easy part. A new agency needs a Certificate of Need (CON) from the Health Care Authority before it can start, and then it needs a licence from the Office of Health Facility Licensure and Certification (OHFLAC) before it can serve patients. This guide lays out the order that works, what to gather before you file, the fees we can confirm, and the points you must check directly with the agency.

This article is informational content, not legal, tax, or medical licensing advice. Rules and fees change, so confirm every figure with the named agency before you spend money or sign a lease. Work with a health care attorney and a CPA who handles home health providers before you choose an entity or commit to a budget.

What You Need Before You Start

Gather these items before you file anything. Several feed into the CON application, so a missing one can push back your timeline.

• A written business plan covering the counties or cities you will serve, the services you will offer, your staffing plan, and a start-up budget
• Entity formation documents: Articles of Organization (Form LLD-1) for an LLC, or Articles of Incorporation (Form CD-1) for a corporation
• A business name that meets West Virginia rules and is not already registered or reserved with the Secretary of State
• A registered agent name and address. West Virginia does not require one, but a health business should have one so legal papers reach you
• $1,500 for the CON application fee, if your project costs up to $1,500,000
• Current nursing licences for every nurse you plan to employ, plus credential files for any aides, therapists, nutrition staff, or medical social workers
• A fixed business address, since each fixed location needs its own Business Registration Certificate
• A calendar reminder for the June 30 annual report
• An account on the WV One Stop Business Portal at https://business4.wv.gov/

Step 1: Confirm Your Business Is a Home Health Agency Under State Law

West Virginia defines a home health agency as a business that provides professional nursing plus at least one of home health aide, therapy, nutrition, or medical social services in the patient's home (W. Va. Code 16-2D-2). That definition decides whether the CON requirement applies, so your service mix matters. If you plan only non-medical companion care with no professional nursing, ask the Health Care Authority in writing whether your model falls under the definition before you assume it does.

Two rules catch new owners off guard. First, establishing a home health agency is reviewable regardless of cost (W. Va. Code 16-2D-8(b)(21); 65 CSR 32). A small start-up still needs the CON. Second, expanding a home health service area is also reviewable. If you already run an agency and want to add counties, that is a CON question too.

Step 2: Form Your Entity and Reserve Your Name

Many agency owners form an LLC because it separates business debts from personal assets and is taxed as a pass-through entity. The filing is Articles of Organization (Form LLD-1). The state filing fee is $100, and you can file through the WV One Stop Business Portal at https://business4.wv.gov/. Standard processing takes 5 to 10 business days. Expedited options are available: in-person same day $25, next business day $25, 2 hour $250, or 1 hour $500, each added to the filing fee. Online filings add a $1.00 portal processing fee.

Your name must contain limited liability company, limited company, or one of the abbreviations LLC, L.L.C., LC, or L.C. (W. Va. Code 31B-1-105). If your owners are licensed professionals forming a professional company, the professional designation rules under W. Va. Code 31B-13-1303 apply instead, so confirm which rule governs with the Secretary of State before you file. The name must be distinguishable from every name already registered or reserved. You can reserve a name for 120 days for $15 at https://sos.wv.gov/reserveregister-business-name, which helps when the CON and lease steps will take months.

A registered agent is optional. Form LLD-1 asks for an agent only if you have one, and the Secretary of State is appointed as attorney-in-fact to accept service for every entity that files organizing documents. Even so, a health agency receives complaints and legal notices, so most owners name a physical agent who can accept them during business hours. Changes to the agent are filed on Form AAO for $15.00.

After formation, the annual report is due each year between January 1 and June 30. It costs $25. Filings after June 30 cost $75 because of a $50 late fee. If you incorporate instead, the filing is Articles of Incorporation (Form CD-1) at $100, and the for-profit annual report late fee is $50.

Step 3: Apply for a Certificate of Need

The CON is the longest and most important step. Follow this sequence.

1. Send a letter of intent at least 10 days before the application. It tells the Health Care Authority that you plan to file. Send it in writing and keep a dated copy.
2. File the application with the fee. The fee is $1,500 for a project up to $1,500,000 under W. Va. Code 16-2D-13. Larger projects pay more: $5,000, $25,000, or $35,000 depending on project size. Confirm which tier your project falls in with the Health Care Authority before you budget. Do not guess the thresholds.
3. Expect public notice. The application is publicly noticed, so competitors and community members can see what you propose.
4. Prepare for a possible hearing. A hearing may be held but is not guaranteed. Have the person who wrote your staffing and financial plan ready to explain it.

Ask the Health Care Authority for the current application form and checklist. Do not rely on an older template or a form from another state. The application must match the services and service area in your business plan, since a mismatch discovered later can cost you months. The Health Care Authority's review period is not set in this guide, so ask how long each stage takes and build that into your lease and payroll planning.

Do not open for patients or commit to a finished start date until the CON is in hand.

Step 4: Apply for Your OHFLAC Licence and Medicare Certification

OHFLAC, now part of the Office of the Inspector General, handles state licensure and conducts the surveys for Medicare certification. The office is at 1 Players Club Drive, Suite 301, Charleston, WV, and the phone number is 304-558-0050.

Here is the cost issue. OHFLAC's 2026 fee schedule, effective June 1, 2026, applies a CPI uplift of 2.6073% to the facility types it covers, but it does not list a home health fee. Do not assume your licence is free or that it falls under a fee you can see on the schedule. Call OHFLAC and ask three questions, and get the answers in writing:

• Which state licence applies to a home health agency?
• What fee applies to that licence?
• Do I need a separate Medicare or Medicaid enrolment in addition to the state licence?

Medicare certification is a separate track from state licensure and changes what the surveyors check. Ask OHFLAC what policies, staff files, and records must exist before a survey, and schedule your hiring so those records are complete before inspection day.

If you also plan hospice, that is a separate licence under 71 CSR 14, and hospice also needs a CON. Do not fold hospice into your home health timeline without checking both requirements.

Step 5: Register With the State and Your City

West Virginia has no general statewide business licence. The closest equivalent is the Business Registration Certificate from the State Tax Division.

• Business Registration Certificate. The one-time fee is $30. The certificate is permanent until your business name, location, or ownership changes, and each fixed location needs its own certificate. Apply at business4.wv.gov or on Form WV/BUS-APP. Registering with the Secretary of State does not replace it.
• Trade name (DBA). If you will operate under a name other than your LLC's legal name, file a DBA with the Secretary of State, not a county clerk. For an LLC, the filing is Form NR-3 at $25.00, plus a $1.00 processing fee if filed online. Details are at https://sos.wv.gov/business/registration-and-waivers/register-trade-name-dba
• City requirements. The state business and occupation (B&O) tax applies only to utilities. The gross receipts tax that reaches service businesses is levied by cities, together with a city business licence and a weekly per-worker city service fee. West Virginia has 55 counties and 230 incorporated places, so your city determines these charges. Call the city clerk or finance office for your address.
• Sales tax. The state rate is 6%. 101 municipalities add a 1% city sales tax today, rising to 107 municipalities from January 1, 2027. Confirm whether your city applies it to any sales you make, such as equipment or supplies.

Step 6: Set Up the Tax Structure

Your entity choice drives your tax picture. An LLC pays no state franchise tax, and because it is a pass-through entity it pays no corporation net income tax. Members report their share on the personal income tax, which runs from 2.11% to 4.58% across five brackets for tax year 2026. A corporation pays a 6.5% corporation net income tax on federal taxable income, apportioned by a single sales factor. These are general descriptions, not a tax plan. Have a CPA model your expected income under each structure before you file.

Step 7: Build Your Clinical Team and Records

Your agency must provide professional nursing plus at least one other covered service. Build that into the staffing plan you submit with the CON application, and do not promise services you cannot staff. Confirm that every nurse's licence is current, and keep a personnel file for each employee and contractor. Surveyors commonly ask for these records, and missing files are one of the easiest findings to avoid.

Expected Results

Following this sequence may help you avoid the most common delays, but no guide can promise an approval date, a survey result, or a patient count. A well-prepared applicant may end up with a clean filing record, a CON application that matches the business plan, and a clear list of what OHFLAC expects to see. Measure your progress against the agency's written checklists rather than against a timeline you hope to hit.

Common Mistakes to Avoid

• Assuming a small agency is exempt from the CON. Cost does not decide reviewability.
• Opening intake, signing a lease for patient care, or hiring clinical staff before the CON is approved
• Treating the Secretary of State filing as your licence. An LLC filing is a filing, not a licence.
• Skipping the $30 Business Registration Certificate or forgetting that each fixed location needs its own
• Filing a DBA with a county clerk. West Virginia DBAs go to the Secretary of State.
• Missing the June 30 annual report and paying $75 instead of $25
• Assuming the OHFLAC fee schedule covers home health. It does not list a home health fee.
• Building your plan on a template or rules from another state
• Skipping the city check, which can add a business licence, a B&O gross receipts tax, and a weekly per-worker fee

Tips for a Smoother Filing

• Call the Health Care Authority and OHFLAC early, and get every answer in writing with the name of the person who gave it.
• Keep a compliance calendar with the June 30 annual report and any registered agent change deadlines.
• Use the West Virginia Small Business Development Center at https://wvsbdc.com/ for planning help, and the SBA's West Virginia district page at https://www.sba.gov/district/west-virginia for federal resources.
• Ask the Health Care Authority to confirm the current CON fee tier before you sign any vendor contract.

When to Bring In Professionals

Bring in a health care attorney for the entity choice, the CON narrative, and any hearing. Bring in a CPA to model the LLC or corporation tax result and your city obligations. Consider a consultant with West Virginia survey experience before OHFLAC arrives. Each of these costs money, but a mistake in the CON filing or the licence application usually costs more in delayed opening and lost revenue.