On August 8, 2025, the New York State Department of Health (DOH) rolled out a major update to its licensure amendment process for Licensed Home Care Agencies (LHCSAs). The new guidance, DAL: DHCBS 25-03, officially replaces the old DAL 22-02 and moves all submissions into a more centralized and strict procedural framework. These changes will significantly affect how LHCSAs operate, especially when it comes to expansion, and introduce higher compliance burdens and a greater risk of denial.
What's Changed in the Amendment Process?
Moving forward, all Administrative Licensure Amendments (ALAs) have to be emailed to a single address: LHCSA-Amend@health.ny.gov. This new centralized system applies to several key changes:
Adding or deleting services or counties
Opening a new site, closing an existing one, or surrendering a license
Updating an agency or operator's address
Changing a legal or "doing business as" (d/b/a) name
Requesting a license reprint
A complete submission package must include a signed request on agency letterhead (or from the agency's counsel), the filled-out Attachment A Checklist, and all required supporting documents. Be aware that incomplete requests won't even be processed. If the DOH asks for more information (RFAI), agencies have 30 days to respond, or the submission may be administratively withdrawn.
New Cap on Expansion: The 5-LHCSA County Limit
Perhaps the most significant change is the new restriction on expansion. An LHCSA can now only add a new county to its license if fewer than five other LHCSAs are already actively serving patients there. "Actively serving" means having at least one patient with a plan of care who is receiving services in that county. There are a few key exemptions to this five-agency cap. The limit is waived if an agency plans to serve the county exclusively under one of these programs:
Assisted Living Programs (ALPs)
Programs of All-Inclusive Care for the Elderly (PACE)
Nurse-Family Partnerships (NFPs)
Continuing Care Retirement Communities (CCRCs)
The DOH might also require an agency to open a new site if the proposed county is too far from the LHCSA's current regional office to be served effectively16. Keep in mind that amendment requests can also be denied if the agency isn't actively serving patients, has outstanding Plans of Correction (POCs), is out of compliance, or has a poor operational history.
Name and Address Changes Now Require DOH Approval
Changing a legal or d/b/a name is now a two-step approval process:
First, submit the proposed new name along with supporting documents to the DOH for pre-approval.
Once approved, the agency can file the change with the NY Department of State and must then send confirmation back to the DOH.
For address changes, whether for the agency or the operator, agencies must now give the DOH 10 days' advance notice and provide complete, updated contact information.
Why This Matters for Your Agency
DAL 25-03 signals a clear shift by the DOH towards tighter control, increased regulatory scrutiny, and a much more formal amendment process. Whether you're planning to expand into a new county, close a site, rebrand, or change your services, every amendment must now be approached with strategic planning and flawless documentation. Agencies that fail to meet these new standards are far more likely to face delays, denials, or even enforcement actions.
Top Compliance Priorities for LHCSAs:
Check the County Cap: Before anything else, verify that fewer than five agencies are active in a county you want to enter.
Time Your Filings: Avoid submitting amendment requests during or right after a Change of Ownership (CHOW).
Clear Your Record: Make sure any unresolved Plans of Correction (POCs) are fully cleared before you submit a request.
Mind the Deadlines: Keep careful track of and meet all DOH notice timelines, whether they are 10, 30, or 90 days.
Plan for Transitions: If you're deleting a service or closing a site, your submission must include a robust transition plan for every affected patient.
If you have any questions concerning the new LHCSA guidance or require any assistance with the process, we are here to help. We counsel LHCSAs, healthcare operators, and investors on navigating regulatory changes, strategic expansion, and compliance risk under New York's evolving home care framework.
For tailored legal guidance or support with licensure amendments, contact our healthcare team at (212) 668-0200 or info@mdrxlaw.com.
