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Maryland - Home Health Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-08-16

In Maryland, Home Health Services provide intermittent skilled nursing, physical therapy, occupational therapy, and speech-language pathology to homebound individuals under a physician-ordered plan of care. These services are heavily regulated and require licensure as a Home Health Agency (HHA) through the Maryland Department of Health's Office of Health Care Quality (OHCQ), distinct from the lower-acuity Residential Service Agency (RSA) license.

The single biggest structural barrier to entry for a new Home Health Agency in Maryland is the Certificate of Need (CON). Before an applicant can even submit a licensure application to OHCQ, they must first prove geographic necessity and obtain an approved CON from the Maryland Health Care Commission (MHCC), a highly competitive and strictly scheduled gatekeeping process.

1. Service Definition and Scope

Maryland defines a Home Health Agency (HHA) under COMAR 10.07.10 as an organization that provides skilled nursing and other therapeutic services to patients in their places of residence. These services must be prescribed by a licensed physician and follow a strict, periodically reviewed clinical plan of care.

This licensure category is specifically for medical, skilled, and Medicare-certified home health care. It is structurally distinct from a Residential Service Agency (RSA), which provides unskilled personal care or non-Medicare skilled nursing and does not require a Certificate of Need.

2. Regulatory and Oversight Agencies

The Maryland Department of Health (MDH) serves as the primary umbrella agency for Medicaid and health regulation. Within MDH, the Office of Health Care Quality (OHCQ) is responsible for the direct licensing, certification, and surveying of Home Health Agencies.

Additionally, the Maryland Health Care Commission (MHCC) acts as the state's health planning agency, controlling market entry through the Certificate of Need program. Medicaid enrollment and billing are managed by the MDH Medical Care Programs (Medicaid) division.

3. Gatekeeping Prerequisites: Who Can Even Apply

Maryland operates a strict Certificate of Need (CON) program for Home Health Agencies. You cannot submit a licensure application to OHCQ unless you have already been granted a CON by the Maryland Health Care Commission (MHCC).

The MHCC acts as an absolute gatekeeper. They publish a State Health Plan that projects the need for home health services by jurisdiction. If the MHCC does not project a need in a specific county, no applications are accepted. When a need is projected, applicants must submit a Letter of Intent and compete in a scheduled review cycle.

4. Licensure and Certification Requirements

Once a CON is secured, the provider must apply for state licensure through the OHCQ using the official Application for a Home Health Agency License. This process is governed by COMAR 10.07.10 and requires the submission of comprehensive operational policies.

After the application is accepted, OHCQ conducts an initial on-site survey to verify compliance with state health and safety standards. Because Medicaid requires Medicare certification for this service type, the agency must also undergo a federal certification survey.

5. Medicaid Provider Enrollment

Medicaid enrollment in Maryland is processed entirely online through the electronic Provider Revalidation and Enrollment Portal (ePREP). Providers cannot begin this process until they have their OHCQ license, Medicare certification, and National Provider Identifier (NPI).

Enrolling as a Home Health Agency allows the provider to bill for services under traditional Medicaid as well as specific waiver programs like Community First Choice (CFC) or the Community Options Waiver, provided they meet the specific criteria for those programs.

6. Staffing, Training and Background Checks

Home Health Agencies require specialized clinical leadership to ensure patient safety and regulatory compliance. Maryland mandates that every HHA employ a qualified Administrator and a Registered Nurse (RN) to serve as the Director of Nursing (DON).

All personnel with direct patient access must undergo stringent background checks. Maryland law requires state and federal criminal history records checks through the Department of Public Safety and Correctional Services (DPSCS) before an employee can provide care.

7. Documentation, Policies and Records

During the OHCQ application process, providers must submit a comprehensive policy and procedure manual. This manual must detail how the agency will comply with COMAR regulations regarding patient rights, clinical care, and emergency preparedness.

Once operational, strict clinical documentation is required. Every patient must have a physician-signed plan of care, and all interventions must be documented in clinical notes that align exactly with the ordered treatments.

8. Billing, Rates and Claims

Approved Home Health Agencies submit claims through the Maryland Medicaid Management Information System (MMIS). Reimbursement rates for skilled nursing, therapy, and aide visits are established by the Maryland Department of Health and published in the Medicaid fee schedule.

Because many Maryland Medicaid recipients are enrolled in managed care, HHAs must also undergo credentialing and contracting with individual HealthChoice Managed Care Organizations (MCOs) to be reimbursed for those patients.

9. Approval Sequence and Timeline

The timeline for becoming a Home Health Agency in Maryland is exceptionally long due to the Certificate of Need requirement. The CON process alone can take 6 to 12 months or more, depending on the MHCC review cycle and competing applications.

After CON approval, the OHCQ licensure review, initial survey, Medicare certification, and ePREP Medicaid enrollment add another 6 to 12 months. Providers should plan for an 18 to 24-month process from initial intent to billing the first claim.

10. Common Denials and Survey Findings

The most common point of failure for new applicants is the MHCC Certificate of Need phase. Applications are frequently denied if the provider cannot quantitatively prove a need for services in the requested jurisdiction based on the State Health Plan.

During OHCQ surveys, citations frequently involve clinical documentation errors. Surveyors strictly penalize agencies that fail to obtain timely physician signatures on care plans or allow staff to provide care before background checks are fully cleared.

11. Key Contacts and Resources

Prospective Home Health Agencies must coordinate with multiple state entities. The Maryland Health Care Commission (MHCC) is the starting point for the CON, followed by the Office of Health Care Quality (OHCQ) for licensure.

Providers should bookmark the ePREP portal for Medicaid enrollment and the Division of State Documents for the most current COMAR regulations governing home health operations.

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