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Maryland - Case Management Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Maryland Department of Health (MDH) Office of Long Term Services and Supports (OLTSS) and the Developmental Disabilities Administration (DDA) fund case management under distinct program names, primarily Supports Planning for general waivers and Coordination of Community Services (CCS) for DDA waivers like the Community Pathways Waiver. Agencies seeking to provide these services cannot simply submit a Medicaid enrollment application; they must first win a competitive procurement contract issued by the state during designated Request for Proposals (RFP) cycles.

Once awarded a contract, prospective Supports Planning Agencies or CCS providers must enroll through Maryland's Medicaid provider portal, which is transitioning from ePREP to a new system in October 2026. Approved agencies are responsible for conducting assessments, developing person-centered plans, and monitoring service delivery using the state's LTSSMaryland tracking system.

1. Service Definition and Scope

In Maryland's HCBS waivers, case management is formally designated as Supports Planning (for OLTSS programs like the Community Options Waiver) or Coordination of Community Services (for DDA programs). The service encompasses comprehensive assessment, person-centered service plan (PCSP) development, service coordination, and ongoing monitoring of the participant's health, safety, and goal progression.

Providers act as the central hub for waiver participants, ensuring that all authorized services are delivered according to the PCSP. They do not provide direct care services to avoid conflicts of interest, focusing strictly on advocacy, referral, and oversight.

2. Regulatory and Oversight Agencies

The Maryland Department of Health (MDH) is the single state Medicaid agency responsible for overall program administration. Within MDH, specific divisions oversee case management depending on the target population and waiver authority.

The Office of Long Term Services and Supports (OLTSS) manages Supports Planning for older adults and individuals with physical disabilities, while the Developmental Disabilities Administration (DDA) oversees CCS providers for individuals with intellectual and developmental disabilities.

3. Gatekeeping Prerequisites: Who Can Even Apply

Maryland strictly controls the number and geographic distribution of HCBS case management providers through competitive procurement. Supports Planning Agencies and CCS providers are not open-enrollment provider types; an agency cannot apply for Medicaid enrollment for these services without an underlying state contract.

Access to the provider network is restricted to open Request for Proposals (RFP) windows published on the state's eMMA (eMaryland Marketplace Advantage) portal. If there is no active RFP for Supports Planning or CCS, new agencies are structurally blocked from entering the market.

4. Licensure and Certification Requirements

Maryland does not issue a standard facility or agency "license" for HCBS case management. Instead, the state utilizes a certification and contract-approval model. Agencies must demonstrate compliance with the programmatic standards outlined in the RFP and the specific waiver appendices.

For DDA CCS providers, agencies must complete DDA-specific provider orientation and maintain compliance with DDA's quality enhancement standards. OLTSS Supports Planning Agencies must meet the certification standards detailed in the Code of Maryland Regulations (COMAR) for Medical Assistance programs.

5. Medicaid Provider Enrollment

Once an agency holds the necessary state contract, it must enroll as a Medicaid provider. Currently, this is done through the electronic Provider Revalidation and Enrollment Portal (ePREP).

Providers must be aware that Maryland Medicaid is transitioning from ePREP to a new Medicaid Provider Enrollment portal scheduled for October 2026. Agencies must ensure all ownership disclosures and contract documentation are uploaded accurately to avoid processing delays.

6. Staffing, Training and Background Checks

Maryland sets strict educational and experiential baselines for the individuals performing case management. Agencies must verify and maintain documentation of these credentials for all hired Supports Planners or Community Service Coordinators.

All staff must undergo criminal history records checks and complete state-mandated training modules, including training on the LTSSMaryland system, person-centered planning, and incident reporting.

7. Documentation, Policies and Records

Agencies are required to use LTSSMaryland, the state's comprehensive IT system, for all participant documentation. This includes entering assessments, developing the PCSP, and logging all contact notes.

Internal agency policies must cover conflict of interest mitigation, participant rights, grievance procedures, and critical incident reporting. Records must be maintained in accordance with COMAR regulations, typically for a minimum of six years.

8. Billing, Rates and Claims

Billing for Supports Planning and CCS is typically conducted through the LTSSMaryland system, which interfaces with the state's Medicaid Management Information System (MMIS) for payment generation.

Rates are established by MDH and are generally structured as monthly or quarterly milestone payments, contingent upon the provider logging the required minimum contacts and completing the annual PCSP within the required timeframes.

9. Approval Sequence and Timeline

The timeline to become a provider is entirely dependent on the state's procurement schedule. Agencies must monitor eMaryland Marketplace Advantage (eMMA) for RFP releases.

Once an RFP is published, the proposal preparation, submission, state review, and award process typically takes 6 to 9 months. Post-award, Medicaid enrollment through ePREP and subsequent LTSSMaryland onboarding adds an additional 60 to 90 days.

10. Common Denials and Survey Findings

Because entry is gated by procurement, the most common reason for denial is failing to score high enough during the competitive RFP evaluation process. Technical proposals that lack specific, actionable plans for meeting state mandates are routinely rejected.

For established providers, state audits frequently cite issues related to documentation timeliness. Failing to complete annual PCSP updates before the expiration date or missing required monthly monitoring contacts can result in payment clawbacks.

11. Key Contacts and Resources

Prospective providers should regularly check the eMaryland Marketplace Advantage (eMMA) website for procurement opportunities and review the MDH OLTSS and DDA websites for program manuals and waiver appendices.

For Medicaid enrollment technical assistance, providers must utilize the ePREP support resources, keeping in mind the system transition planned for October 2026.

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