1. GOVERNING AGENCIES

Agency: Maryland Department of Health (MDH)
Role: Administers Medicaid-funded home health care under CFC and waiver programs

Agency: Office of Health Care Quality (OHCQ)
Role: Licenses and inspects Residential Service Agencies (RSAs) that provide home health services

Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Regulates federal HCBS standards and supports person-centered home care delivery

Agency: Maryland Board of Nursing / Board of Physical Therapy / Other Boards
Role: Licenses clinical professionals delivering services in the home

2. HOME HEALTH CARE SERVICE OVERVIEW

Services may include any combination of the following, as authorized by a physician and documented in a Plan of Care:

• Skilled nursing care (RN/LPN)
• Home health aide services (personal care, grooming, toileting, feeding)
• Physical, occupational, or speech therapy
• Medical social work
• Medication administration and monitoring
• Caregiver education and coordination
• Wound care, catheter care, and chronic condition management

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

To operate as a home health provider in Maryland, agencies must:

• Register the business with the Maryland Department of Assessments and Taxation (SDAT)
• Obtain an EIN and Type 2 NPI
• Apply to become a licensed Residential Service Agency (RSA) with OHCQ
• Meet staffing requirements, including hiring a Nursing Administrator (RN)
• Develop and submit a policy and procedure manual, sample care plans, and staffing plans
• Maintain liability and malpractice insurance
• Enroll with Maryland Medicaid via ePREP for reimbursement

4. OHCQ LICENSING PROCESS

Step 1: Business Formation and Pre-Application

• Register your LLC, secure an office, and obtain basic credentials

Step 2: Submit RSA Application to OHCQ

• Include nurse administrator resume, operating procedures, sample forms, and clinical protocols
• Select levels of care: Skilled, Unskilled, or Both

Step 3: Pass OHCQ Inspection

• Includes review of clinical documentation, patient rights policies, and staff files

Step 4: Medicaid Enrollment via ePREP

• Register for billing under CFC, Community Options Waiver, or Model Waiver

5. REQUIRED DOCUMENTATION

• Articles of Incorporation / LLC registration
• IRS EIN and Type 2 NPI documentation
• OHCQ RSA application and license
• Medicaid provider number and ePREP approval

Policy & procedure manual including:

• Admission and discharge criteria
• Physician order and care plan templates
• RN supervision, home visit logs, and aide documentation forms
• Infection control and emergency preparedness protocols
• Medication administration record (MAR) and incident reporting
• HIPAA compliance and client confidentiality standards
• Staff training records and credentialing files

6. STAFFING REQUIREMENTS

Role: Registered Nurse (RN)
Requirements: Valid MD license, CPR, experience with in-home care, supervises clinical team

Role: Licensed Practical Nurse (LPN)
Requirements: Works under RN supervision, provides delegated care

Role: Home Health Aide / Certified Nursing Assistant (CNA)
Requirements: Active Maryland certification, trained in personal care, transfers, and hygiene

Role: Therapists (PT, OT, ST) – if offering rehab services
Requirements: Licensed by respective MD Boards

Role: Medical Social Worker (if applicable)

Training Requirements:

• HIPAA, infection control, and emergency response
• Delegation and supervision protocols
• Documentation standards and incident reporting
• CPR/First Aid
• Annual continuing education and skills checks

7. MEDICAID WAIVER SERVICES

Home Health Care services are reimbursed under:

• Community First Choice (CFC) – For individuals needing assistance with ADLs and nursing
• Community Options Waiver – For adults with physical disabilities or the elderly
• Model Waiver – For medically fragile children under age 22
• Increased Community Services (ICS) – For those transitioning from nursing facilities

Covered services may include:

• Skilled nursing (intermittent or continuous)
• Home health aide support (e.g., bathing, grooming, meals)
• Medication administration and IV therapy
• Therapy (PT/OT/ST) services as ordered
• Caregiver training and supervision

8. TIMELINE TO LAUNCH

Phase: Business Registration and Office Setup
Timeline: 1–2 weeks

Phase: RSA Application Development and Policy Manual
Timeline: 2–4 weeks

Phase: OHCQ Review and Inspection
Timeline: 6–8 weeks

Phase: Medicaid Enrollment and Participant Referrals
Timeline: 4–6 weeks

9. CONTACT INFORMATION

Maryland Office of Health Care Quality (OHCQ)
Website: https://health.maryland.gov/ohcq
Phone: (410) 402-8217
Regulations: COMAR 10.07.05

​Maryland Medicaid Provider Enrollment (ePREP)
Website: https://eprep.health.maryland.gov

​Maryland Board of Nursing
Website: https://mbon.maryland.gov

​Maryland Department of Assessments and Taxation (SDAT)
Website: https://egov.maryland.gov/BusinessExpress

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10. SCOPE OF WORK

• Business registration (LLC, EIN, NPI)
• OHCQ RSA license application development
• Full policy & procedure manual customized for skilled and unskilled care
• Care plan templates, delegation logs, and staff supervision tools
• Staff hiring and credentialing tracker
• Medicaid billing prep via LTSS Maryland
• Intake forms, MAR logs, and incident documentation templates
• HIPAA-compliant communication system setup
• Referral networking tools and outreach materials