Maryland - Medical Supply Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

In Maryland, Durable Medical Equipment (DME) and Disposable Medical Supplies (DMS) for waiver participants are governed by the Maryland Department of Health (MDH) under Code of Maryland Regulations (COMAR) 10.09.12 and 10.09.18. These services provide essential equipment and consumable supplies to support the independence of individuals enrolled in programs such as the Community Pathways Waiver and the Brain Injury Waiver.

Before a prospective provider can submit an enrollment application through Maryland's electronic Provider Revalidation and Enrollment Portal (ePREP), they must first secure Medicare DMEPOS accreditation from a CMS-approved accrediting organization. This federal accreditation serves as the primary structural precondition for Medicaid enrollment, ensuring the provider meets baseline quality and safety standards before the state will authorize them to bill for waiver supplies.

1. Service Definition and Scope

Medical Supply Services in Maryland encompass the provision, fitting, and servicing of equipment and supplies that support a waiver participant's health and independence in their home or community. The state divides these services into distinct categories, primarily Durable Medical Equipment (DME), Disposable Medical Supplies (DMS), and Oxygen (OXY) services.

Providers must ensure that all items are medically necessary and directly related to the participant's plan of care. Preauthorization is heavily utilized to manage utilization and confirm medical need before items are dispensed.

• Durable Medical Equipment (DME): Reusable items such as wheelchairs, hospital beds, and mobility aids.
• Disposable Medical Supplies (DMS): Consumable, single-use items including incontinence products and wound care supplies.
• Oxygen Services (OXY): Respiratory equipment and oxygen delivery systems.
• Preauthorization Requirement: Medical necessity reviews are conducted by Telligen prior to dispensing.
• Applicable Waivers: Includes the Community Pathways Waiver, Brain Injury Waiver, and other HCBS programs.

2. Regulatory and Oversight Agencies

The Maryland Department of Health (MDH) is the single state agency responsible for overseeing Medicaid provider enrollment and policy. Within MDH, the Division of Community Support Services manages the specific policies for DME and DMS.

MDH contracts with Telligen to act as the utilization control agent. Telligen operates the Qualitrac portal, which providers must use to submit preauthorization requests for equipment and supplies.

• Maryland Department of Health (MDH): Oversees all Medicaid operations (https://health.maryland.gov).
• MDH Division of Community Support Services: Manages DME/DMS policy (https://health.maryland.gov/mmcp/pages/provider-information.aspx).
• ePREP Portal: The official system for Medicaid provider enrollment (https://eprep.health.maryland.gov).
• Telligen: The state's utilization control agent for preauthorizations (https://www.telligen.com).

3. Gatekeeping Prerequisites: Who Can Even Apply

Maryland does not allow entities to enroll as Medicaid DME/DMS providers without first meeting strict federal and state prerequisites. The state relies heavily on Medicare's vetting process to establish a provider's legitimacy.

An application submitted to ePREP without these structural preconditions already in place will be immediately rejected.

• Medicare DMEPOS Accreditation: Applicants must hold active accreditation from a CMS-approved accrediting organization.
• National Provider Identifier (NPI): Must be obtained via the NPPES registry prior to application.
• Application Fee: Institutional providers must pay the ACA-mandated application fee during ePREP enrollment.
• Physical Location: Providers must maintain a verifiable physical business address; P.O. boxes are not accepted for the service location.

4. Licensure and Certification Requirements

Maryland does not issue a distinct "HCBS Medical Supply License" through a state health facility licensing board. Instead, the state uses Medicare DMEPOS accreditation as the functional equivalent of a license for Medicaid enrollment purposes.

Providers must also maintain standard commercial business licenses and meet any local jurisdictional requirements for operating a retail or warehouse facility.

• DMEPOS Accreditation: Serves as the primary certification of quality and safety standards.
• State Business License: Issued by the Maryland Comptroller or local county government.
• Surety Bond: Required as part of the Medicare enrollment process, which precedes Medicaid approval.
• Out-of-State Providers: Must meet the licensure requirements of their home state if shipping supplies into Maryland.

5. Medicaid Provider Enrollment

All Medicaid provider enrollment in Maryland is processed electronically through the electronic Provider Revalidation and Enrollment Portal (ePREP). Paper applications are not accepted.

Providers must enroll under the specific provider type for DME/Medical Supplies and must link their enrollment to an active NPI.

• System: ePREP (electronic Provider Revalidation and Enrollment Portal).
• Provider Type: Must select the specific DME/Medical Supply provider taxonomy.
• Revalidation: Providers must revalidate their enrollment at least every five years.
• Ordering/Referring/Prescribing (ORP): Claims must list an attending physician who is actively enrolled as a Maryland Medicaid ORP provider.

6. Staffing, Training and Background Checks

While DMS delivery may only require basic logistics staff, DME providers must employ qualified personnel capable of fitting, calibrating, and servicing complex equipment.

All owners and managing employees are subject to federal and state background screening during the ePREP enrollment process.

• Criminal Background Checks: Required for all owners with a 5% or greater interest and managing employees.
• Exclusion Screening: Providers must check staff monthly against the OIG LEIE and Maryland Medicaid exclusion lists.
• Specialized Technicians: Custom equipment (e.g., complex rehab wheelchairs) requires certified professionals like Assistive Technology Professionals (ATPs).
• Delivery Staff: Must be trained in basic equipment setup, safety instructions, and obtaining valid proof of delivery.

7. Documentation, Policies and Records

Strict documentation is required to survive MDH audits and Telligen utilization reviews. Providers must maintain a clear paper trail from the physician's order to the final delivery.

Records must be retained in accordance with Maryland Medicaid regulations and made available upon request.

• Physician Orders: Must be signed and dated by an enrolled Maryland Medicaid ORP provider.
• Proof of Delivery: Signed and dated delivery tickets are mandatory for every item billed.
• Record Retention: Records must be kept for a minimum of 6 years.
• Maintenance Logs: Providers must track servicing, repairs, and warranties for durable equipment.

8. Billing, Rates and Claims

Reimbursement for DME and DMS is based on the Maryland Medicaid fee schedule, utilizing standard HCPCS codes. Claims are submitted through the state's MMIS.

Providers are strictly prohibited from balance billing Medicaid participants for any covered service or for missed appointments.

• Fee Schedule: Published by MDH on the Medicaid Provider Program Resources page.
• Coding: Standard HCPCS codes and modifiers are required.
• Prior Authorization: Must be obtained via Telligen's Qualitrac portal before billing.
• Balance Billing: Explicitly prohibited by Maryland Medicaid regulations.

9. Approval Sequence and Timeline

Becoming a fully approved provider is a multi-step process that spans several months, largely due to the prerequisite Medicare accreditation.

Once accreditation is secured, the state-level ePREP process is relatively streamlined but still requires careful attention to detail.

• Step 1: Obtain Medicare DMEPOS Accreditation (typically takes 3-6 months).
• Step 2: Secure an NPI and register the business entity in Maryland (1-2 weeks).
• Step 3: Submit the ePREP application and pay the ACA fee (MDH review takes 30-60 days).
• Step 4: Register with Telligen's Qualitrac portal for preauthorizations (1-2 weeks post-enrollment).

10. Common Denials and Survey Findings

Applications and claims are frequently delayed or denied due to administrative errors or failure to adhere to strict ORP rules.

Audits often target missing documentation, particularly regarding proof of delivery and medical necessity.

• Missing ORP Enrollment: Claims deny if the ordering physician is not enrolled in Maryland Medicaid.
• Lapsed Accreditation: ePREP enrollment will be suspended if Medicare DMEPOS accreditation expires.
• Incomplete Proof of Delivery: Missing participant signatures or dates on delivery tickets leads to clawbacks.
• Unapproved Substitutions: Delivering a different brand or item than what Telligen authorized results in claim denial.

11. Key Contacts and Resources

Prospective providers should utilize official MDH resources and portals to navigate the enrollment and authorization processes.

Maintaining contact with the Division of Community Support Services is crucial for policy updates.

• MDH Division of Community Support Services: 410-767-7283 (https://health.maryland.gov/mmcp/pages/provider-information.aspx).
• ePREP Portal: For enrollment and revalidation (https://eprep.health.maryland.gov).
• Telligen Qualitrac Portal: For preauthorizations (https://www.telligen.com).
• Medicaid Provider Fee Schedules: (https://health.maryland.gov/mmcp/pages/provider-information.aspx).

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