Maryland - Respite Care Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

Under COMAR 10.21.27 and the Developmental Disabilities Administration (DDA) Community Pathways Waiver, Maryland defines Respite Care Services as short-term community-based relief provided to individuals to temporarily free their primary unpaid caregiver. The service is funded through Maryland Medicaid and administered primarily by the DDA for individuals with developmental disabilities, and the Behavioral Health Administration (BHA) for individuals with mental health needs.

Approval to bill Maryland Medicaid for this service requires navigating distinct pathways depending on the target population. For behavioral health respite, applicants face a strict structural prerequisite: they must already hold approval as an Outpatient Mental Health Clinic (OMHC), Psychiatric Rehabilitation Program (PRP), or Mobile Treatment Services (MTS) provider before an application to add respite services will even be accepted.

1. Service Definition and Scope

Maryland defines Respite Care Services as temporary supports that give a person and their family, or other primary caregiver, a break from daily routines. It is designed to support an individual to remain in their home by providing enhanced support or a temporary alternative living situation.

The service can be planned in advance or used in an emergency situation to resolve or ameliorate a problem in the living situation. It does not cover routine daycare, and Medicaid funds cannot be used for recreational facility memberships or travel.

• Service Types: In-home respite (in the individual's place of residence) and out-of-home respite (partial day or overnight).
• Target Populations: Adults with serious and persistent mental illness, children with serious emotional disturbance, or individuals with developmental disabilities.
• Delivery Settings: A person's home, a respite care provider's home, a licensed residential site, or a State-certified camp.
• Excluded Costs: Membership fees at recreational facilities, community activities, travel, or insurance.

2. Regulatory and Oversight Agencies

The Maryland Department of Health (MDH) is the single state Medicaid agency responsible for overall program administration. Within MDH, specific administrations oversee respite care depending on the waiver and target population.

The Office of Health Care Quality (OHCQ) is the regulatory agency that conducts licensing surveys and issues certificates for out-of-home facility-based respite settings.

• Maryland Department of Health (MDH): Administers the state Medicaid program (https://health.maryland.gov).
• Developmental Disabilities Administration (DDA): Oversees the Community Pathways Waiver and certifies DDA providers (https://health.maryland.gov/dda).
• Behavioral Health Administration (BHA): Regulates community mental health programs including behavioral health respite (https://health.maryland.gov/bha).
• Office of Health Care Quality (OHCQ): Conducts site surveys and issues facility licenses (https://health.maryland.gov/ohcq).

3. Gatekeeping Prerequisites: Who Can Even Apply

Maryland imposes strict structural preconditions on agencies attempting to provide Respite Care Services. Standalone agencies cannot simply apply to provide behavioral health respite; they must be embedded within an existing, approved mental health program.

For DDA waiver respite, providers must complete mandatory state-led orientations before an application is accepted. All applicants must be legally registered to do business in the state prior to initiating the Medicaid enrollment process.

• BHA Prerequisite: Under COMAR 10.21.27.03, a program must already be approved as a Mobile Treatment Services (MTS) provider, Outpatient Mental Health Clinic (OMHC), or Psychiatric Rehabilitation Program (PRP) to be eligible to provide mental health respite.
• DDA Prerequisite: Prospective DDA providers must attend a mandatory DDA Provider Applicant Orientation before submitting a provider application.
• Business Registration: Applicants must be registered and in good standing with the Maryland State Department of Assessments and Taxation (SDAT).
• NPI Requirement: Agencies must obtain a National Provider Identifier (NPI) specific to their organization before applying through the state portal.

4. Licensure and Certification Requirements

Providers must meet the specific regulatory standards outlined in the Code of Maryland Regulations (COMAR). The exact licensure path depends on whether the respite is provided in-home or out-of-home, and which population is served.

Out-of-home respite requires the physical location to be licensed or certified by OHCQ based on the age of the individuals and whether the respite includes overnight stays.

• Mental Health Regulation: Providers must comply with COMAR 10.21.27 (Community Mental Health Programs - Respite Care Services).
• DDA Regulation: Providers must meet certification standards under COMAR 10.22.02 for developmental disability services.
• Facility Licensure: Out-of-home respite locations must hold an appropriate OHCQ license or registration for residential sites or state-certified camps.
• Policy Submission: Applicants must submit written policies covering service delivery models, incident reporting, and client rights for state review.

5. Medicaid Provider Enrollment

Once programmatic approval or licensure is obtained, agencies must enroll as Maryland Medicaid providers. This process is handled entirely online through the state's electronic portal.

Providers must link their NPI, licensure data, and tax information to receive a Medicaid Provider Identification Number (PID), which is required to submit claims.

• Enrollment Portal: Applications must be submitted through the electronic Provider Revalidation and Enrollment Portal (ePREP) (https://eprep.health.maryland.gov).
• Tax Documentation: A completed IRS W-9 form must be uploaded into ePREP.
• Liability Insurance: Providers must upload proof of general and professional liability insurance meeting state minimums.
• Provider Agreement: Applicants must sign the Maryland Medical Assistance Provider Agreement within the ePREP system.

6. Staffing, Training and Background Checks

Maryland requires rigorous background screening and baseline training for all direct care staff providing respite services. Agencies must maintain documentation of these clearances in personnel files.

If the respite care involves personal care tasks (such as bathing or feeding), the staff member may need specific clinical credentials.

• Background Checks: All direct care employees must undergo fingerprint-based criminal background checks through the Maryland Criminal Justice Information System (CJIS).
• Basic Certifications: Staff providing in-home care must hold current CPR and First Aid certifications.
• Clinical Qualifications: Certified Nursing Assistants (CNAs) are required if the respite worker is performing delegated nursing or personal care services.
• DDA Training: Staff serving waiver participants must complete DDA-mandated basic training modules prior to delivering services.

7. Documentation, Policies and Records

Approved providers must maintain comprehensive records to justify Medicaid billing and demonstrate compliance during state audits. Documentation must tie directly to the individual's authorized care plan.

Agencies must also implement and enforce state-approved policies for handling emergencies and grievances.

• Care Plans: Services must be documented in accordance with the individual's Person-Centered Plan (PCP).
• Service Logs: Providers must maintain logs showing the dates, times, and duration of respite provided, signed by the caregiver or participant.
• Incident Reporting: Agencies must follow MDH and OHCQ critical incident reporting procedures for any adverse events during service delivery.
• Grievance Procedures: Providers must maintain a written policy detailing how clients and families can file grievances without retaliation.

8. Billing, Rates and Claims

Respite services are billed to Maryland Medicaid using specific procedure codes and modifiers that denote the setting and duration of the service. Rates are standardized and published by the state.

Services cannot be billed unless they are explicitly authorized in the participant's approved plan of care prior to delivery.

• Claims System: Claims are submitted electronically through the Maryland Medicaid Management Information System (MMIS).
• Billing Increments: In-home respite is typically billed in 15-minute increments, while out-of-home overnight respite is billed at a per diem rate.
• Rate Publication: DDA and BHA publish updated fee schedules and rate charts annually on the MDH website.
• Prior Authorization: Providers must verify that respite hours are authorized in the state system before rendering services to avoid claim denials.

9. Approval Sequence and Timeline

Becoming a fully enrolled respite provider in Maryland is a multi-step process that can take several months. Agencies must secure programmatic approval before Medicaid enrollment can begin.

Delays in submitting required policies or passing facility inspections will significantly extend the timeline.

• Step 1: Complete the mandatory DDA orientation or verify existing BHA OMHC/PRP/MTS licensure.
• Step 2: Submit the programmatic provider application and operational policies to DDA or BHA (typically a 30-60 day review).
• Step 3: Pass an OHCQ site survey if operating an out-of-home facility-based respite location.
• Step 4: Submit the Medicaid enrollment application via ePREP (processing takes up to 90 days).

10. Common Denials and Survey Findings

Applications are frequently delayed or denied due to administrative errors or failure to meet structural prerequisites. State surveyors also cite providers for failing to maintain continuous compliance.

Ensuring staff credentials remain current is a primary area of focus during OHCQ and DDA audits.

• Missing Prerequisites: Applications for mental health respite are immediately denied if the agency is not an approved OMHC, PRP, or MTS.
• Incomplete ePREP: Applications are returned if the W-9 or liability insurance documents are missing or mismatched in the portal.
• Lapsed Certifications: Surveyors frequently cite agencies for allowing direct care staff to work with expired CPR/First Aid or missing CJIS checks.
• Policy Deficiencies: Applications are delayed when submitted incident reporting policies do not align with current Maryland regulations.

11. Key Contacts and Resources

Prospective providers should utilize official state portals and administration websites to access current regulations, fee schedules, and application materials.

Help desks are available for technical assistance with the Medicaid enrollment portal.

• Maryland Department of Health (MDH): Main portal for Medicaid information (https://health.maryland.gov).
• Developmental Disabilities Administration (DDA): Waiver program rules and provider applications (https://health.maryland.gov/dda).
• Office of Health Care Quality (OHCQ): Facility licensing and survey information (https://health.maryland.gov/ohcq).
• ePREP Portal: The electronic system for Medicaid provider enrollment (https://eprep.health.maryland.gov).

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