Maryland - Day Habilitation Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Maryland Department of Health (MDH) Developmental Disabilities Administration (DDA) authorizes Day Habilitation services under the Community Pathways and Community Supports waivers to fund structured daytime programming for individuals with intellectual and developmental disabilities. This service focuses on building self-help, socialization, and adaptive skills in non-residential, community-integrated settings.

Prospective agencies must first secure DDA programmatic approval by submitting a comprehensive Provider Application and passing a readiness review before they are permitted to submit a Medicaid enrollment application through the state's ePREP portal. Facility-based day programs must also secure a license from the Office of Health Care Quality (OHCQ) prior to delivering services.

1. Service Definition and Scope

In Maryland, Day Habilitation is defined as a structured program that assists individuals in acquiring, retaining, and improving the self-help, socialization, and adaptive skills necessary to reside successfully in community settings. Services must be delivered in accordance with the individual's Person-Centered Plan (PCP).

The service can be provided in a facility-based setting or directly in the community, but all settings must fully comply with the federal HCBS Settings Rule, ensuring individuals have access to the broader community to the same degree as individuals not receiving Medicaid HCBS.

• Target Population: Individuals with intellectual and developmental disabilities enrolled in the Community Pathways or Community Supports waivers.
• Service Focus: Skill development in areas such as communication, self-care, and community integration.
• Setting Requirements: Must comply with the CMS HCBS Settings Rule, promoting integration and autonomy.
• Exclusions: Cannot be billed concurrently with Supported Employment or residential services for the same hours.
• Delivery Models: Can be facility-based (requiring OHCQ licensure) or community-based.

2. Regulatory and Oversight Agencies

The Maryland Department of Health (MDH) is the single state Medicaid agency, but the Developmental Disabilities Administration (DDA) directly manages the waivers and programmatic approval for Day Habilitation. The Office of Health Care Quality (OHCQ) handles the physical licensure of facility-based programs.

Medicaid provider enrollment is processed through the electronic Provider Revalidation and Enrollment Portal (ePREP), which is managed by MDH.

• Maryland Department of Health (MDH): The overarching state Medicaid authority (https://health.maryland.gov).
• Developmental Disabilities Administration (DDA): Manages waiver operations, provider applications, and programmatic oversight (https://health.maryland.gov/dda).
• Office of Health Care Quality (OHCQ): Licenses facility-based day programs and conducts health and safety surveys (https://health.maryland.gov/ohcq).
• ePREP Portal: The mandatory online system for Maryland Medicaid provider enrollment (https://eprep.health.maryland.gov).
• LTSSMaryland: The state's case management and billing system for HCBS waivers (https://health.maryland.gov/mmcp/ltss).

3. Gatekeeping Prerequisites: Who Can Even Apply

Maryland does not require a Certificate of Need (CON) for Day Habilitation programs. However, the state utilizes a strict sequential approval process where DDA programmatic approval acts as the primary gatekeeper.

An applicant cannot simply apply for Medicaid enrollment or OHCQ licensure; they must first submit a DDA Provider Application, undergo a DDA readiness review, and receive an official DDA approval letter. Only with this letter can the provider proceed to OHCQ for licensure (if facility-based) and ePREP for Medicaid enrollment.

• DDA Provider Application: Mandatory first step requiring submission of business plans, policies, and financial statements to the DDA.
• Readiness Review: DDA conducts a thorough review of the applicant's operational readiness before granting programmatic approval.
• OHCQ Licensure Prerequisite: Facility-based programs must obtain an OHCQ license before ePREP enrollment, which requires the prior DDA approval.
• No Certificate of Need: Maryland does not require a CON for HCBS Day Habilitation services.
• Waiver Capacity: Enrollment is subject to the availability of waiver slots, though willing and qualified providers are generally accepted if they pass the DDA review.

4. Licensure and Certification Requirements

Providers operating a physical facility where individuals congregate for Day Habilitation must be licensed by the Office of Health Care Quality (OHCQ) under COMAR 10.22.02. This involves physical plant inspections, fire marshal approvals, and policy reviews.

Providers offering exclusively community-based Day Habilitation without a central congregating facility may not require a traditional facility license but must still maintain DDA certification and comply with all COMAR regulations regarding service delivery and HCBS Settings Rule alignment.

• COMAR Citation: Governed by Code of Maryland Regulations (COMAR) Title 10, Subtitle 22 (Developmental Disabilities).
• Fire Safety: Facility-based programs must pass a local Fire Marshal inspection prior to OHCQ licensure.
• Physical Plant Inspection: OHCQ conducts an initial on-site survey to ensure the facility meets ADA and safety standards.
• HCBS Settings Alignment: Facilities must demonstrate they do not have institutional characteristics and allow for community integration.
• License Renewal: OHCQ licenses are typically renewed annually or biennially based on survey performance.

5. Medicaid Provider Enrollment

Once DDA approval and any necessary OHCQ licenses are obtained, the agency must enroll as a Maryland Medicaid provider using the electronic Provider Revalidation and Enrollment Portal (ePREP).

The ePREP application requires the upload of the DDA approval letter, OHCQ license, ownership disclosures, and a valid National Provider Identifier (NPI) tied to the specific service location.

• System: electronic Provider Revalidation and Enrollment Portal (ePREP).
• Required Documentation: DDA approval letter, OHCQ license (if applicable), IRS W-9, and ownership disclosure forms.
• NPI Requirement: Must obtain an NPI specific to the agency and service type before applying in ePREP.
• Application Fee: Subject to the CMS institutional provider application fee unless waived by Medicare enrollment.
• Revalidation: Providers must revalidate their Medicaid enrollment through ePREP every five years.

6. Staffing, Training and Background Checks

Direct Support Professionals (DSPs) delivering Day Habilitation must meet strict background and training requirements outlined by the DDA. Agencies are responsible for maintaining comprehensive personnel files demonstrating compliance.

All staff must complete a criminal history records check through the Maryland Criminal Justice Information System (CJIS) before providing unsupervised care, alongside mandatory DDA-specific training modules.

• Background Checks: Mandatory fingerprint-based state and federal background checks via Maryland CJIS.
• Basic Qualifications: DSPs must be at least 18 years old, possess a high school diploma or GED, and have a valid driver's license if transporting participants.
• First Aid/CPR: All direct care staff must maintain current in-person CPR and First Aid certification.
• DDA Mandated Training: Staff must complete DDA-approved training on incident reporting, behavioral supports, and the HCBS Settings Rule.
• Medication Administration: Staff administering medications must complete the Certified Medication Technician (CMT) training approved by the Maryland Board of Nursing.

7. Documentation, Policies and Records

Providers must maintain detailed records that align with the individual's Person-Centered Plan (PCP) developed by their Coordinator of Community Services (CCS). Documentation must clearly link the daily activities to the specific goals outlined in the PCP.

Agencies must also implement robust internal policies for incident management, grievance procedures, and quality assurance, which are subject to review during DDA and OHCQ audits.

• PCP Alignment: Daily service notes must reflect activities that directly support the goals in the participant's Person-Centered Plan.
• Attendance Logs: Providers must maintain accurate daily attendance and time-in/time-out records for billing verification.
• Incident Reporting: Critical incidents must be reported to the DDA and OHCQ within 24 hours using the state's incident management system.
• Policy Manual: Must maintain comprehensive policies covering participant rights, emergency preparedness, and abuse/neglect prevention.
• Record Retention: Medicaid records must typically be retained for a minimum of six years from the date of service.

8. Billing, Rates and Claims

Day Habilitation claims are processed through LTSSMaryland, the state's comprehensive system for HCBS waiver management and billing. Providers must ensure that services are prior-authorized in the system before delivery.

Rates are established by the DDA and are typically tiered based on the individual's assessed level of need. Providers must consult the current DDA fee schedule for exact reimbursement amounts.

• Billing System: Claims are submitted and processed through the LTSSMaryland portal.
• Prior Authorization: Services must be authorized in the participant's approved PCP within LTSSMaryland before billing.
• Rate Structure: Rates are set by the DDA and vary based on the participant's assigned support need level.
• Unit of Service: Typically billed in 15-minute increments or per diem, depending on the specific waiver definition and authorization.
• Fee Schedule: Providers must refer to the official DDA Rate Chart published annually on the MDH website for current rates.

9. Approval Sequence and Timeline

The pathway to becoming a billable Day Habilitation provider in Maryland is strictly sequential and can take 6 to 12 months to complete, depending on facility readiness and state processing times.

Applicants must not sign a lease or purchase a facility until they understand the DDA and OHCQ requirements, as physical plant modifications may be necessary to pass the initial survey.

• Step 1: Submit the DDA Provider Application and required business/policy documentation.
• Step 2: Pass the DDA readiness review and receive the official DDA programmatic approval letter.
• Step 3: (If facility-based) Apply for OHCQ licensure, pass Fire Marshal inspection, and pass OHCQ initial on-site survey.
• Step 4: Submit the Medicaid enrollment application through the ePREP portal with all prior approvals attached.
• Step 5: Receive Medicaid ID, gain access to LTSSMaryland, and begin accepting participant referrals from CCS agencies.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied at the DDA review stage due to generic policies that do not reflect Maryland's specific COMAR regulations or the HCBS Settings Rule.

During OHCQ surveys, common citations involve incomplete staff background checks, lapsed CPR certifications, and failure to document how daily activities tie back to the participant's PCP goals.

• Policy Deficiencies: Submitting generic, non-Maryland-specific policy manuals during the DDA application phase.
• Settings Rule Violations: Facilities that appear institutional or isolate participants from the broader community.
• Personnel File Gaps: Missing CJIS background checks or lapsed mandatory training certificates.
• Documentation Errors: Service notes that fail to describe the specific skill-building activities related to the PCP.
• Life Safety Code: Failure to pass local Fire Marshal inspections due to inadequate egress or alarm systems in facility-based programs.

11. Key Contacts and Resources

Prospective providers should rely on the official Maryland Department of Health websites for the most current applications, fee schedules, and regulatory updates.

The DDA Regional Offices are the primary point of contact for the initial provider application process and ongoing programmatic support.

• DDA Provider Enrollment: Information and application materials (https://health.maryland.gov/dda/Pages/providers.aspx).
• ePREP Portal: Medicaid enrollment system (https://eprep.health.maryland.gov).
• OHCQ Developmental Disabilities Unit: Licensure information for facility-based programs (https://health.maryland.gov/ohcq/dd/Pages/home.aspx).
• LTSSMaryland: System access and training resources (https://health.maryland.gov/mmcp/ltss).
• COMAR Online: Access to Title 10, Subtitle 22 regulations (http://www.dsd.state.md.us/COMAR/ComarHome.html).

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