How to Apply for a Maryland Residential Service Agency License

To operate a Maryland Residential Service Agency license, you file an application with the Office of Health Care Quality (OHCQ) at the Maryland Department of Health, attach a business plan, workers’ compensation documentation, written policies, and a worker classification certification, clear background checks on your staff, and pass an on-site inspection. There is no application fee.¹ Everything else in the process flows from those pieces.

Who Needs This License

Maryland law defines a residential service agency as any nongovernmental person or entity that employs or contracts with individuals to provide home health care for compensation to an unrelated sick or disabled person in that person’s residence.² “Home health care” reaches nursing, home health aide work, occupational therapy, physical therapy, audiology and speech pathology, dietary and nutritional services, drug services, medical social services, laboratory services, provision of invasive medical equipment, and home medical equipment services.³ Provide even one of those services through employed or contracted staff and the license applies.

A few provider types are excluded. Home health agencies licensed under a separate subtitle of the Health-General Article, licensed hospice programs, hospitals and related institutions, personal care providers under the Medical Assistance Personal Care Program, and individuals independently practicing a licensed health occupation all fall outside the RSA framework.² A common misread: a nurse staffing agency that only places licensed professionals in clients’ homes still needs an RSA license. The exclusion is for the individual licensee practicing on their own, not for the business that contracts them out.

What to Prepare Before You Apply

Gather every required attachment before submitting anything. OHCQ holds an incomplete application for 180 days from the date it first arrives; miss that window and the application closes, and you start over.¹

You will need:

A business plan showing financial and administrative capacity to run the agency, including a one-year operating budget, a marketing plan identifying the populations you intend to serve, and a description of the services you will provide.
An organizational chart showing reporting relationships across management, clinical staff, and support personnel.
Written policies and procedures covering administration, personnel, patient care, informed consent, and environment and safety, as required under COMAR 10.07.05.08B, along with billing and service records, client confidentiality, quality assurance, and complaint handling.
A Letter of Good Standing from the Maryland Department of Assessments and Taxation (SDAT), obtained through its Business Express portal.
Proof of workers’ compensation coverage. Submit the declaration page from your policy. Corporations and LLCs not required to carry the coverage submit a Certificate of Compliance instead. Sole proprietors and partnerships with no employees submit a Letter of Exemption.
A completed online RSA Certification form on worker classification, signed by someone with authority over pay or employment practices, confirming that personal care aides are properly classified.
Background check compliance for staff through the Criminal Justice Information System (CJIS). You cannot employ or contract with anyone whose criminal history indicates behavior potentially harmful to clients, and that obligation carries forward to every new hire.¹

The worker classification form is easy to overlook. Misclassifying employees as independent contractors draws scrutiny from both OHCQ and the Maryland Department of Labor, and the certification exists so that the state has your sworn attestation on file from day one.

How the Application Moves Through OHCQ

After you submit the application and attachments, OHCQ reviews your business plan, financial documentation, policies, and staff qualifications. Expect requests for additional information or clarification during that review. If the paperwork meets the requirements, OHCQ schedules an on-site inspection to assess your operational readiness.¹

Falsifying any part of the application is treated seriously. The certification language on the form warns that falsification can lead to criminal prosecution, civil money penalties, and revocation of any license that has been issued.

Staffing and Supervision the Inspector Will Check

If your clients will receive skilled services or help with activities of daily living, a registered nurse must oversee care plan implementation, delegation of tasks, supervision, and training. The RN’s on-site supervision visits follow a schedule tied to medication involvement: every 45 days if staff administers medications to the client, every three months if staff assists the client with self-administering medications, and every four months if staff has no involvement with medications.⁴ The RN can increase frequency based on the client’s condition. For clients needing skilled care, assessment must happen within 48 hours of the start of services unless the RN determines otherwise.

Skilled services must be provided by or under the supervision of a registered nurse and follow a plan of treatment. A cognitively capable adult client may waive skilled care or certified care services, but the waiver has to be signed and kept in the client’s record.⁴

Training can be delivered by your own staff or by outside trainers, but the agency is responsible for staff competency either way, and performance evaluations must be documented and available for OHCQ review.⁵

After You Are Licensed

Compliance with COMAR 10.07.05 is continuing.⁵ Keep current records of client interactions, care plans, and outcomes. Maintain billing and service records for each client, with specific obligations for clients served through managed-care plans or third-party payers.¹

Run a quality assurance program with internal audits and client feedback, and when problems come up, document the corrective action, not just the acknowledgment. Every RSA has to provide clients with OHCQ’s hotline number so they can report complaints about services the agency provided or failed to provide.⁵ Inspectors check for it.

Billing Medicaid Is a Separate Step

An RSA license lets you operate. It does not let you bill Medicaid. To receive Medicaid reimbursement you enroll separately as a participating provider through Maryland Medicaid’s Electronic Provider Revalidation and Enrollment Portal (ePREP).⁶ Maryland Medicaid is transitioning from ePREP to a new system called the Maryland Provider Registration and Information Management Enterprise (MPRIME) portal in October 2026, so check which system is active when you enroll.

Penalties for Operating Without a License

Operating a residential service agency without a license is a misdemeanor in Maryland. A first offense carries a fine of up to $1,000, and each subsequent offense can bring a fine of up to $10,000.⁷

For licensed agencies that fall out of compliance, OHCQ can deny an application, suspend or revoke an existing license, or issue a provisional license while the agency corrects deficiencies. Suspension or revocation is most likely when non-compliance directly threatens client safety or when an agency has a pattern of repeated violations without meaningful corrective action.¹ Agencies facing enforcement action are entitled to a formal hearing before a final decision is made.

1
Maryland Department of Health. Application for a Residential Service Agency License Instructions
2
Maryland General Assembly. Maryland Code Health-General 19-4A-01
3
Legal Information Institute (LII) / Cornell Law School. Maryland Code Regs. 10.07.05.02 – Definitions
4
Legal Information Institute (LII) / Cornell Law School. Maryland Code Regs. 10.07.05.12 – Services Provided
5
Maryland Department of Health. Residential Service Agencies
6
Maryland Department of Health. Provider Enrollment
7
New York Codes, Rules and Regulations. Maryland Code Health-General 19-4A-08