Maryland - Residential Care Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Maryland Department of Health (MDH) Developmental Disabilities Administration (DDA) funds 24-hour residential care under the title Residential Habilitation, primarily through the Community Pathways Waiver. This service is delivered in provider-owned or leased homes, categorized by capacity as either Alternative Living Units (ALUs) or Group Homes.

Prospective agencies must first secure programmatic approval through a formal application to their DDA Regional Office before they are permitted to apply for site licensure from the Office of Health Care Quality (OHCQ). Once licensed, providers enroll via the ePREP portal to receive authorizations and bill through the LTSSMaryland system.

1. Service Definition and Scope

In Maryland, Residential Habilitation provides 24-hour supervision, personal care, and skills training to individuals with developmental disabilities. Services are delivered in community-based residential settings owned or leased by the provider agency.

The service is designed to help individuals acquire, retain, and improve the skills necessary to reside successfully in the community, while ensuring their health and safety.

• Service Name: Residential Habilitation
• Funding Authority: DDA Community Pathways Waiver
• Setting Types: Alternative Living Units (1-3 individuals) or Group Homes (4+ individuals)
• Included Supports: Personal care, habilitation, medication administration, and 24-hour supervision
• Excluded Costs: Room and board expenses are not billable to Medicaid and must be covered by the individual's resources

2. Regulatory and Oversight Agencies

Multiple divisions within the Maryland Department of Health (MDH) oversee Residential Habilitation providers. The DDA manages the waiver program and authorizes services, while OHCQ licenses the physical locations.

Medicaid enrollment and claims processing are handled by the Medical Care Programs division and the LTSSMaryland system.

• Operating Agency: Developmental Disabilities Administration (DDA) (https://health.maryland.gov/dda)
• Licensing Authority: Office of Health Care Quality (OHCQ) (https://health.maryland.gov/ohcq)
• Medicaid Agency: MDH Medical Care Programs (https://health.maryland.gov/mmcp)
• Background Checks: Maryland Department of Public Safety and Correctional Services CJIS (https://dpscs.maryland.gov/publicservs/bgchecks.shtml)

3. Gatekeeping Prerequisites: Who Can Even Apply

Maryland utilizes a strict sequential approval process for DDA services. A provider cannot simply lease a home and apply for an OHCQ license; they must first be approved as a DDA provider.

This requires passing a comprehensive programmatic review by the DDA Regional Office governing the county where the provider intends to operate.

• DDA Pre-Application: Mandatory attendance at a DDA Provider Orientation is required before an application will be accepted
• Business Registration: The agency must be registered and in good standing with the Maryland State Department of Assessments and Taxation (SDAT)
• DDA Regional Office Approval: The provider application must be submitted to and approved by the specific DDA Regional Office (Central, Eastern, Southern, or Western) based on the service area
• NPI Requirement: Applicants must obtain a Type 2 National Provider Identifier (NPI) prior to submitting the DDA application

4. Licensure and Certification Requirements

Once DDA programmatic approval is granted, the provider must obtain site-specific licensure from OHCQ. The physical home must meet strict life-safety and environmental standards.

Licensure is governed by the Code of Maryland Regulations (COMAR) specific to Developmental Disabilities Administration providers.

• Regulatory Citation: COMAR 10.22.02 (Licensee Requirements for DDA Providers)
• Site Inspections: OHCQ conducts initial and annual unannounced life-safety and programmatic surveys of the residential sites
• Fire Marshal Approval: A local jurisdiction fire marshal inspection and approval is required for the physical address before licensure
• Capacity Limits: Alternative Living Units (ALUs) are licensed for up to 3 individuals; Group Homes are licensed for 4 or more individuals

5. Medicaid Provider Enrollment

After obtaining OHCQ licensure, the agency must enroll as a Medicaid provider to bill for services. Maryland currently uses the ePREP system for all Medicaid provider enrollments.

The state has announced a transition to a new enrollment system, MPRIME, scheduled for late 2026.

• Enrollment Portal: ePREP (Electronic Provider Revalidation and Enrollment Portal) (https://eprep.health.maryland.gov)
• Future Portal: Transitioning to the Maryland Provider Registration and Information Management Enterprise (MPRIME) in October 2026
• Application Fee: Subject to the ACA institutional provider application fee unless a waiver is granted or the fee was paid to Medicare
• Revalidation: Providers must revalidate their Medicaid enrollment every 5 years through the ePREP system

6. Staffing, Training and Background Checks

Direct support professionals working in Residential Habilitation must meet stringent training and background requirements before providing care. Maryland places a heavy emphasis on safe medication administration.

All staff must clear state and federal background checks through the Maryland Criminal Justice Information System (CJIS).

• Criminal Background: Fingerprint-based state and FBI background checks via Maryland CJIS are mandatory for all direct care staff
• Medication Administration: Staff administering medication must complete the Medication Technician Training Program (MTTP) approved by the Maryland Board of Nursing
• Basic Certifications: Current CPR and First Aid certifications are required for all direct support professionals
• DDA Mandated Training: Staff must complete DDA-approved training on behavioral principles, incident reporting, and choking prevention

7. Documentation, Policies and Records

Providers must maintain comprehensive records demonstrating compliance with DDA regulations and the individual's Person-Centered Plan (PCP).

Agencies are required to have robust internal policies covering incident management, quality assurance, and human rights.

• Care Planning: Services must be delivered and documented in strict accordance with the DDA Person-Centered Plan (PCP) developed with the Coordinator of Community Services (CCS)
• Incident Reporting: Mandatory reporting of critical incidents must be submitted via the DDA Incident Management System
• Financial Records: Providers must maintain separate, auditable accounting for client room and board payments versus Medicaid service billing
• Policy Manual: A comprehensive policy manual including grievance procedures, abuse prevention, and quality assurance must be approved during the DDA application phase

8. Billing, Rates and Claims

Maryland utilizes the LTSSMaryland system for DDA service authorizations and billing. Providers do not submit traditional fee-for-service claims for Residential Habilitation.

Instead, billing is driven by documented service delivery and attendance within the LTSSMaryland portal.

• Billing System: LTSSMaryland (Long Term Services and Supports system)
• Rate Structure: DDA establishes regional and tier-based daily rates for Residential Habilitation based on the individual's assessed level of need
• Authorization: Services must be prior-authorized in LTSSMaryland based on the approved Person-Centered Plan
• Claim Submission: Claims are generated automatically in LTSSMaryland based on the provider's documentation of service delivery and daily attendance

9. Approval Sequence and Timeline

Becoming a Residential Habilitation provider in Maryland is a lengthy, multi-step process. It requires sequential approvals from DDA, OHCQ, and Medicaid.

Prospective providers should anticipate a timeline of 6 to 12 months from initial orientation to final Medicaid enrollment.

• Step 1: Register for and attend the mandatory DDA Provider Orientation
• Step 2: Submit the comprehensive DDA Provider Application to the appropriate Regional Office (review typically takes 90-120 days)
• Step 3: Secure a physical location, pass fire marshal inspection, and apply for OHCQ site licensure
• Step 4: Complete Medicaid enrollment through the ePREP portal (processing typically takes 30-60 days)

10. Common Denials and Survey Findings

OHCQ and DDA strictly enforce life-safety regulations and medication administration rules. Deficiencies in these areas frequently lead to delayed approvals or survey citations.

Incomplete initial applications are the most common reason for DDA application rejection.

• Medication Errors: Failure to maintain current MTTP certifications for staff or failing to document medication administration correctly
• Life Safety: Expired fire extinguishers, blocked egress routes, or lack of required fire drills during OHCQ surveys
• Incomplete Applications: Missing SDAT registration, inadequate policy manuals, or lack of financial reserves in the DDA application
• Background Check Gaps: Allowing staff to begin working prior to receiving cleared CJIS background check results

11. Key Contacts and Resources

Providers must regularly consult official Maryland Department of Health resources to maintain compliance and stay updated on system transitions.

The following portals and agency pages are essential for Residential Habilitation providers.

• DDA Provider Page: https://health.maryland.gov/dda/Pages/providers.aspx
• OHCQ Developmental Disabilities Unit: https://health.maryland.gov/ohcq/dd/Pages/home.aspx
• ePREP Enrollment Portal: https://eprep.health.maryland.gov
• Maryland Board of Nursing (MTTP Information): https://mbon.maryland.gov

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