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Home Health Agency Skilled 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 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 Skilled Services Attestation Form)
  • 2The agency shall neither serve home health agency patients or clients nor establish branch offices beyond 200 miles of the parent location.(Home Health Agency Skilled 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 Skilled Services Attestation Form)
  • 4A Skilled Services HHA License is required to provide skilled services of any kind, including HCBS; some program waivers require additional CMS Certification.(Home Health Agency Skilled Services Attestation Form)
  • 5The agency shall comply with all applicable K.S.A. and 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 Skilled Services Attestation Form)
  • 6The agency shall allow KDHE to conduct survey inspections at any time during normal business hours; failure to allow access is grounds for denial, suspension, or revocation.(Home Health Agency Skilled 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; the attestation is a public record under the Kansas Open Records Act and violations of K.S.A. 65-5101 et seq. are a Class B misdemeanor.(Home Health Agency Skilled Services Attestation Form)

Applies to: personal care

The signed compliance attestation KDHE requires from every Skilled Services home health agency (the license required to deliver HCBS personal care), binding it to the scope, 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.