Starting a Maryland Home Health or Residential Service Agency?

This page presents three common startup paths:

• Maryland Medicare Home Health Agency — skilled home health services with Maryland approval and federal Medicare certification.
• Maryland Residential Service Agency — Medical — one or more approved home health care services, including skilled nursing or therapy, without Medicare HHA status.
• Maryland Residential Service Agency — Personal Care — personal care and related home care services provided in a client's residence.

Maryland separately licenses Home Health Agencies under COMAR 10.07.10 and Residential Service Agencies under COMAR 10.07.05. The agency type and approved services determine the requirements that apply.

The Maryland Department of Health, Office of Health Care Quality (OHCQ), licenses and oversees Residential Service Agencies. The principal RSA regulations are COMAR 10.07.05.

The June 26, 2026 OHCQ application states that there is no fee to apply. Current COMAR 10.07.05.04 separately states a $1,000 nonrefundable license fee for a three-year license. Because the application and regulation describe different charges, confirm the amount due directly with OHCQ before submission.

Requirements depend on the applicant, ownership structure, location, and proposed services. The application process generally requires:

• The typed OHCQ RSA License Application and service selections.
• A one-year operating budget, marketing plan, and detailed description of services.
• An organizational chart and COMAR 10.07.05.08B policies and procedures.
• An official Maryland SDAT letter of good standing.
• Workers' Compensation coverage or the applicable compliance or exemption document.
• Ownership, disclosure, office, branch, personnel, and professional-license information.
• The online worker-classification RSA Certification required for every applicant.

An RSA must have a governing authority responsible for policy, management, operations, and financial liability. A medical RSA must also use appropriately licensed clinical personnel. Skilled services are provided by or under the supervision of a registered nurse and in accordance with the plan of treatment.

The RSA application identifies the business address and routine business hours. The agency must post its license, remain open to OHCQ inspection during stated hours, and maintain current-client, recent-discharge, current-staff, recent-staff, and quality-assurance records on site. Local zoning, lease, occupancy, privacy, and business requirements also apply.

Processing time varies with application completeness, document review, applicant readiness, inspection scheduling, and correction of deficiencies. Medicare certification or accreditation adds separate steps. Home Health Forms does not guarantee a state or federal processing time.

The current RSA application allows applicants to request nursing, home health aide, physical therapy, occupational therapy, speech therapy, audiology, respiratory therapy, medical social services, dietary and nutritional services, and durable medical equipment services.

An RN must assess each new client who needs skilled services and assistance with activities of daily living, participate in the care plan and assignment of personnel, and determine whether certified caregivers are required. For clients needing skilled services or ADL assistance, the RSA must have an RN oversee care-plan implementation, delegation, supervision, and training.

On-site RN supervision is required at least every 45 days when staff administer medications, every three months when staff assist with self-administration, every four months when neither applies, or more often when clinically necessary.

COMAR 10.07.05.03 states that an agency providing only household or family support services does not require RSA licensure. Those services include certain instrumental activities such as light housekeeping, meal planning and preparation, shopping, and errands. Hands-on ADL assistance, certified care, or skilled services can change the licensing analysis.

Not solely because it holds Maryland licensure. An organization planning to seek federal certification must first obtain Maryland state licensure and then complete the applicable Medicare certification and enrollment process. Medicare-certified agencies must also comply with applicable federal Home Health Conditions of Participation.

Yes. The RSA application requires applicants to identify the document and page number for the policies listed in COMAR 10.07.05.08B, including administration, personnel, patient care, informed consent, environment, safety, infection control, clinical management, and quality assurance. Home Health Foms offers policies and procedures that meet regulatory requirements to ensure your success.

Customized policy manuals, forms, and related digital documents are generally emailed within five business days after Home Health Forms receives all company information needed to complete the customization. Other package components may have separate production timelines.

Cancellation and refund eligibility depends on the work already completed, customized materials produced, digital products delivered, third-party expenses paid, printing ordered, and other services already performed.