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Home Health Agency Non-Medical Supportive Care Services Attestation Form

Kansassub_regulatoryKansas Department of Health and Environment (KDHE), Bureau of Facilities and Licensing

What this rule requires your agency to do

  • 1The agency shall neither serve home health agency clients nor establish branch offices beyond 200 miles of the parent location.(Home Health Agency Non-Medical Supportive Care Services Attestation Form)
  • 2Nursing services of any kind are prohibited under a Supportive Care Services license (including a nurse providing supervision, assignment, delegation, oversight, medication administration/set-up, wound care, treatments, or assessments); CNA/Home Health Aide skilled services are excluded — such staff may work only as supportive care workers.(Home Health Agency Non-Medical Supportive Care Services Attestation Form)
  • 3The agency shall notify KDHE Bureau of Facilities and Licensing in writing within five days of changes in the agency's name, address, administrator, ownership, geographic area served, or other material circumstances including closure.(Home Health Agency Non-Medical Supportive Care Services Attestation Form)
  • 4The agency shall comply with all applicable Kansas Statutes Annotated (K.S.A.) and Kansas Administrative Regulations (K.A.R.) related to a home health agency in Kansas, and if owned by a corporation or LLC it must be registered with the Kansas Secretary of State's Office.(Home Health Agency Non-Medical Supportive Care Services Attestation Form)
  • 5The agency shall allow KDHE to conduct survey inspections at any time during normal business hours; failure to allow access constitutes grounds for denial, suspension, or revocation of the license.(Home Health Agency Non-Medical Supportive Care Services Attestation Form)
  • 6The agency shall appoint and utilize an administrator and an alternate administrator who meet K.A.R. requirements, and shall comply with the employee background check provisions of the K.S.A.(Home Health Agency Non-Medical Supportive Care Services Attestation Form)
  • 7If the annual renewal application is not filed and the annual fee is not paid within 30 calendar days of the renewal expiration date, the license is automatically canceled.(Home Health Agency Non-Medical Supportive Care Services Attestation Form)
  • 8The attestation is a public record subject to the Kansas Open Records Act, and violations of any provision of K.S.A. 65-5101 et seq. constitute a Class B misdemeanor.(Home Health Agency Non-Medical Supportive Care Services Attestation Form)

Applies to: personal care

The signed compliance attestation KDHE requires from every non-medical supportive care (personal-care) home health agency, binding it to the scope limits, 200-mile branch limit, background-check, notification, survey-access, and annual-renewal obligations of the Kansas Home Health Licensure Law.

Regulatory information, not legal advice — always confirm against the cited official source. Verification reduces error; it does not certify compliance.