Maryland - I/DD Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Maryland Department of Health's Developmental Disabilities Administration (DDA) approves providers to deliver services under three 1915(c) HCBS waivers: the Community Pathways, Community Supports, and Family Supports waivers. Prospective agencies must first submit a DDA Qualified Provider Application and pass a rigorous programmatic review before they are permitted to enroll in the state's Medicaid system.

Approval requires demonstrating compliance with COMAR 10.22.02 standards, including submitting comprehensive operational policies, passing background checks, and completing mandatory DDA orientation. Once DDA issues the Qualified Provider approval letter, the agency uses this credential to execute a Medicaid Provider Agreement through the ePREP portal and bill via LTSSMaryland.

1. Service Definition and Scope

Maryland's DDA waiver programs fund a continuum of services for individuals with intellectual and developmental disabilities. The service array spans from intermittent personal supports and meaningful day services to comprehensive residential habilitation and supported living.

Services are designed to promote community integration and independence, aligning with the federal HCBS Settings Rule.

• Waiver Authorities: Community Pathways Waiver (CPW), Community Supports Waiver (CSW), and Family Supports Waiver (FSW)
• Residential Services: Includes Supported Living, Community Living-Group Home, and Shared Living
• Day Services: Includes Community Development Services, Day Habilitation, and Career Exploration
• Support Services: Includes Personal Supports, Respite Care, and Assistive Technology
• Target Population: Individuals with intellectual and developmental disabilities meeting ICF/IID level of care

2. Regulatory and Oversight Agencies

The Maryland Department of Health (MDH) serves as the Single State Medicaid Agency, while the Developmental Disabilities Administration (DDA) operates the waivers and conducts provider certification. The Office of Health Care Quality (OHCQ) conducts licensing surveys and incident investigations for facility-based and residential services.

Medicaid enrollment and claims processing are managed through distinct state portals overseen by the MDH Office of Long Term Services and Supports.

• Operating Agency: Developmental Disabilities Administration (DDA) (https://health.maryland.gov/dda)
• Medicaid Authority: MDH Office of Long Term Services and Supports (OLTSS) (https://health.maryland.gov/mmcp)
• Licensing & Survey: MDH Office of Health Care Quality (OHCQ) (https://health.maryland.gov/ohcq)
• Enrollment Portal: Maryland Medicaid electronic Provider Revalidation and Enrollment Portal (ePREP) (https://eprep.health.maryland.gov)
• Claims System: LTSSMaryland (https://ltssmaryland.health.maryland.gov)

3. Gatekeeping Prerequisites: Who Can Even Apply

Maryland does not currently impose a Certificate of Need or a closed-network moratorium on general DDA waiver services. However, an agency cannot enroll in Medicaid or bill for services until it successfully completes the DDA Qualified Provider (QP) application process, which serves as the primary structural gate.

Applicants must prove financial viability and attend mandatory state-led training before their application will be reviewed.

• Mandatory Orientation: Applicants must attend a DDA Provider Applicant Orientation session before submitting the QP application
• Business Entity Registration: Must be registered and in good standing with the Maryland State Department of Assessments and Taxation (SDAT)
• Financial Viability: Must submit a detailed business plan and financial statements demonstrating the capacity to operate without Medicaid revenue for at least 90 days
• Federal Settings Rule: All new providers must demonstrate compliance with the CMS HCBS Settings Rule prior to approval
• NPI Requirement: Must obtain a Type 2 National Provider Identifier (NPI) specific to the agency before applying

4. Licensure and Certification Requirements

Provider certification is governed by the Code of Maryland Regulations (COMAR) Title 10, Subtitle 22. Depending on the specific services offered, providers may need a formal license from OHCQ or DDA certification for non-facility-based supports.

The application process requires the submission of extensive operational policies and procedures for state review.

• Governing Regulations: COMAR 10.22.02 (Developmental Disabilities - General Provider Standards)
• Residential Licensure: Community Living-Group Home providers must be licensed by OHCQ under COMAR 10.22.06
• Medical Day Care: Providers offering Medical Day Care must be licensed under COMAR 10.12.04
• Application Form: DDA Qualified Provider Application (submitted via the DDA Provider Portal)
• Renewal Cycle: Providers must submit a renewal application at least 60 days before the expiration of their existing DDA approval

5. Medicaid Provider Enrollment

After receiving the DDA Qualified Provider approval letter, agencies must enroll as Maryland Medicaid providers. This process is conducted entirely online through the ePREP system.

Providers must link their DDA approval to their Medicaid enrollment to activate their billing privileges.

• Enrollment System: electronic Provider Revalidation and Enrollment Portal (ePREP)
• Required Credential: The DDA Qualified Provider approval letter must be uploaded into ePREP
• Provider Type: Enrolls under specific DDA provider types (e.g., Provider Type 84 for DDA Community Based Services)
• Application Fee: Subject to the federal Medicaid institutional provider application fee unless waived or paid to Medicare
• Agreement Execution: Must sign the Maryland Medical Assistance Provider Agreement within ePREP

6. Staffing, Training and Background Checks

DDA mandates strict background screening and competency-based training for all Direct Support Professionals (DSPs) and administrative staff. Clearances must be obtained before any staff member provides direct care.

Training requirements are standardized across the state and must be documented in the provider's personnel files.

• Criminal Background: State and federal fingerprint-based background checks via the Maryland Criminal Justice Information System (CJIS)
• Registry Checks: Mandatory screening against the Maryland Medicaid Exclusion List and federal OIG LEIE
• Child Protective Services: CPS clearances are required for staff supporting children or transitioning youth
• Mandatory Training: Staff must complete DDA-approved training in CPR, First Aid, and Person-Centered Thinking (PCT)
• Behavioral Supports: Staff implementing behavior plans must be trained in Mandt or another DDA-approved physical intervention curriculum

7. Documentation, Policies and Records

The DDA Qualified Provider application requires the submission of a comprehensive policy manual. Providers must maintain detailed records of service delivery, incident management, and quality assurance to comply with COMAR and waiver requirements.

Electronic Visit Verification (EVV) is mandatory for specific in-home services.

• Policy Manual: Must submit policies covering incident reporting, human rights, grievance procedures, and quality enhancement
• Person-Centered Plans: Services must be delivered and documented in accordance with the participant's Person-Centered Plan (PCP) in LTSSMaryland
• Incident Management: Must utilize the DDA's Policy on Reportable Incidents and Investigations (PORII) and report via the state system
• Record Retention: Financial and programmatic records must be retained for a minimum of six years from the date of payment
• EVV Compliance: Personal Supports and Respite services require compliance with Electronic Visit Verification (EVV) using the state's ISAS system or an approved alternate

8. Billing, Rates and Claims

DDA waiver services are billed through the LTSSMaryland system, which integrates service authorizations, person-centered plans, and claims processing. Rates are established by the MDH and are standardized across the state based on the service type and provider tier.

Providers must ensure that all billed services are supported by corresponding attendance or EVV data.

• Billing System: Claims are generated and submitted through LTSSMaryland based on approved service authorizations
• Rate Methodology: DDA utilizes a fee-for-service prospective payment system with rates published annually in the DDA Rate Chart
• Attendance Tracking: Day and residential services require daily attendance documentation in LTSSMaryland to generate claims
• EVV Integration: Claims for EVV-mandated services are only paid if matching clock-in/clock-out data is present
• Payment Cycle: Clean claims are processed by the MMIS and paid on a weekly Medicaid check run

9. Approval Sequence and Timeline

Becoming a DDA provider is a multi-step process that typically takes 6 to 12 months from initial orientation to Medicaid enrollment. The timeline depends heavily on the completeness of the applicant's policy submissions and the speed of OHCQ licensure if applicable.

Delays in securing a physical location or passing fire marshal inspections can extend the timeline for residential providers.

• Step 1: Attend the mandatory DDA Provider Applicant Orientation
• Step 2: Submit the DDA Qualified Provider Application with all required policies and financial documents
• Step 3: DDA Regional Office and Headquarters review the application (typically 60-90 days)
• Step 4: Obtain OHCQ licensure (if applying for facility-based or residential services)
• Step 5: Submit Medicaid enrollment via ePREP using the DDA approval letter (30-60 days for processing)

10. Common Denials and Survey Findings

Applications are frequently delayed or denied due to incomplete policy manuals or failure to demonstrate financial viability. Post-enrollment, OHCQ and DDA surveys often cite providers for documentation gaps and training deficiencies.

Strict adherence to the approved Person-Centered Plan is a major focus of state audits.

• Financial Inadequacy: Denials often occur if the business plan fails to show sufficient capital to operate without immediate Medicaid revenue
• Policy Deficiencies: Applications are returned if policies do not explicitly align with COMAR 10.22.02 or the HCBS Settings Rule
• Training Lapses: Surveyors frequently cite providers for expired CPR/First Aid or missing Person-Centered Thinking training certificates
• PCP Non-Compliance: Citations are common for delivering services outside the scope or frequency authorized in the Person-Centered Plan
• Background Check Violations: Severe penalties apply if staff are found working before CJIS results and registry checks are fully cleared

11. Key Contacts and Resources

Prospective providers should utilize the official MDH and DDA websites for the most current applications, rate charts, and policy manuals. The DDA Regional Offices serve as the primary point of contact during the application phase.

Technical assistance for enrollment and billing is provided through dedicated state helpdesks.

• DDA Headquarters: https://health.maryland.gov/dda
• ePREP Portal: https://eprep.health.maryland.gov
• LTSSMaryland Portal: https://ltssmaryland.health.maryland.gov
• OHCQ Developmental Disabilities Unit: https://health.maryland.gov/ohcq/dd
• COMAR Online: http://www.dsd.state.md.us/COMAR/ (Title 10, Subtitle 22)

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