Meal and Nutrition Services in Maryland provide individuals with disabilities, chronic health conditions, or functional limitations access to nutritious meals and dietary counseling that promote wellness and reduce health risks. These services are authorized through various Home and Community-Based Services (HCBS) programs, including the Community First Choice (CFC) program and the Developmental Disabilities Administration (DDA) Waivers: Community Pathways, Community Supports, and Family Supports.

1. GOVERNING AGENCIES

Agency: Maryland Department of Health (MDH)
Role: Oversees Medicaid HCBS programs and clinical nutrition standards

Agency: Developmental Disabilities Administration (DDA)
Role: Authorizes nutritional services and meal delivery under PCP goals

Agency: Office of Long-Term Services and Supports (LTSS Maryland)
Role: Tracks billing and documentation for Medicaid-funded services

Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Ensures compliance with federal HCBS nutritional service requirements

2. MEAL & NUTRITION SERVICE OVERVIEW

Maryland Medicaid may authorize the following under various programs:

A. Meal Services (Home-Delivered or Congregate)

• Ready-to-eat or reheat meals delivered to a participant's home
• May include therapeutic diets (low-sodium, diabetic, renal-friendly)
• Often authorized for individuals unable to prepare meals themselves
• Meals must meet nutritional guidelines and be documented on menus

B. Nutritional Services (Dietitian-Led)

• Nutritional assessments and counseling
• Meal planning assistance based on medical needs
• Family/caregiver education
• Coordination with physicians and support teams

May involve monitoring weight, blood sugar, or dietary adherence

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Meal Services (Home-Delivered Meals):

• Register business with SDAT, obtain EIN and NPI
• Apply for DDA approval or enroll via Medicaid’s ePREP for CFC participants
• Maintain commercial kitchen license or subcontract with licensed caterers
• Comply with local health department food safety standards
• Submit meal samples, menus, and delivery procedures

Nutrition Services (Professional):

• Must employ or contract Licensed Dietitians (LDs) or Registered Dietitians (RDs)
• Apply under DDA for "Nutrition Services" or under Medicaid for therapy/nutritional counseling
• Maintain malpractice insurance and HIPAA-compliant recordkeeping

4. PROVIDER ENROLLMENT & SERVICE AUTHORIZATION

Step 1: Determine service type (Meal Delivery vs. Nutrition Counseling)
Step 2: Apply to DDA or enroll via ePREP under the appropriate waiver
Step 3: Submit required documentation (menus, credentials, policy manual)
Step 4: Receive approval and begin receiving referrals through CCS or CFC case managers
Step 5: Document services in LTSS Maryland

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or LLC paperwork
• EIN and Type 2 NPI
• Local food permit or licensed commercial kitchen agreement (for meal providers)
• DDA or Medicaid approval letter

Policy & procedure manual including:

• Menu templates and dietary labeling
• Delivery logs and temperature control protocols
• RD/LD credentials and service logs
• Participant intake forms and consent documentation
• Nutritional assessment templates
• Infection control and food safety policies
• HIPAA compliance and participant communication protocols

6. STAFFING REQUIREMENTS

Role: Meal Delivery Coordinator
Requirements: Experience with food safety, background check, driver’s license (if delivering)

Role: Registered Dietitian (RD) / Licensed Dietitian (LD)
Requirements: Maryland license, experience with disabilities or chronic disease populations

Role: Food Prep Staff (if meals prepared in-house)
Requirements: Food handler certification, local health inspection compliance

Training Requirements:

• HIPAA and participant confidentiality
• Food safety and sanitation (ServSafe recommended)
• Emergency protocols and temperature control
• Cultural dietary preferences and therapeutic meal planning (for dietitians)

7. MEDICAID WAIVER SERVICES

Meal and Nutrition Services are funded under:

• Community First Choice (CFC) – For adults with functional limitations who qualify for nursing facility level of care
• Community Pathways Waiver – For individuals with intellectual/developmental disabilities
• Community Supports Waiver – For adults needing part-time support
• Family Supports Waiver – For children under 21

Examples of covered services:

• Meal delivery for individuals unable to shop/cook
• Diet counseling related to diabetes, heart disease, or swallowing issues
• Caregiver education to support meal consistency at home
• Coordinated support between RD and care team (e.g., nurse, support planner)

8. TIMELINE TO LAUNCH

Phase: Business Registration and Licensing
Timeline: 1–2 weeks

Phase: Policy Manual and Staff/Contractor Onboarding
Timeline: 2–3 weeks

Phase: Medicaid Enrollment and Approval (DDA or ePREP)
Timeline: 4–8 weeks

Phase: Service Launch and Referral Coordination
Timeline: Ongoing

9. CONTACT INFORMATION

Maryland Developmental Disabilities Administration (DDA)
Website: https://dda.health.maryland.gov
Email: dda.providerapps@maryland.gov

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

​Maryland Board of Dietetic Practice (for RD/LD licensing)
Website: https://health.maryland.gov/bodp

​Maryland Department of Health – Food Protection Program
Website: https://health.maryland.gov/phpa/OEHFP/OFPCHS

​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)
• Local food license or dietitian credential review
• Medicaid or DDA provider application support
• Menu templates and nutrition assessment forms
• Delivery tracking and food safety policies
• Staff onboarding documents and HIPAA checklists
• Referral networking with CCS and CFC case managers