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Maryland - Skilled Respite Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Maryland Department of Health (MDH) Developmental Disabilities Administration (DDA) funds Respite Care Services through the Community Pathways, Community Supports, and Family Supports waivers, but Maryland does not issue a distinct license for "Skilled Respite." Agencies intending to deploy licensed nurses (RNs or LPNs) to provide respite care must first obtain a Residential Service Agency (RSA) license with a skilled nursing designation from the Office of Health Care Quality (OHCQ) before applying for DDA certification.

Approval requires navigating a sequential process starting with OHCQ licensure, followed by Medicaid enrollment through the ePREP portal, and concluding with DDA provider certification. An applicant cannot submit a DDA provider application for waiver services until they hold the underlying OHCQ license and have an active Maryland Medicaid provider number.

1. Service Definition and Scope

Maryland does not define "Skilled Respite" as a standalone waiver service. Instead, providers deliver DDA Respite Care Services utilizing licensed nursing staff to support participants whose medical needs exceed the scope of unlicensed direct support professionals.

This service provides short-term, temporary relief to a participant's primary caregiver. When delivered by an agency using nurses, the agency must comply with both DDA waiver regulations for respite and OHCQ clinical regulations for skilled nursing.

2. Regulatory and Oversight Agencies

Oversight is bifurcated between the licensing body that regulates the agency's clinical capacity and the waiver operating agency that certifies the provider for HCBS delivery.

Medicaid enrollment and claims processing are managed through centralized state portals that interface with both OHCQ and DDA data.

3. Gatekeeping Prerequisites: Who Can Even Apply

Maryland does not require a Certificate of Need (CON) for Residential Service Agencies, nor does it currently impose a moratorium or closed network on DDA Respite Care providers.

The primary structural precondition is sequential licensure: DDA will not accept a provider application for nursing-level respite unless the entity already holds an active OHCQ RSA license.

4. Licensure and Certification Requirements

Agencies must first apply for an RSA license under COMAR 10.07.05, which requires submitting operational policies and passing an initial OHCQ survey.

Once licensed, the agency submits a DDA provider application, which requires a detailed business plan and a quality assurance plan specific to developmental disabilities.

5. Medicaid Provider Enrollment

All Medicaid enrollment actions in Maryland are processed through the electronic Provider Revalidation and Enrollment Portal (ePREP).

Providers must enroll using their RSA license and link their National Provider Identifier (NPI) to the specific taxonomy codes required for DDA waiver billing.

6. Staffing, Training and Background Checks

Because this service involves skilled care, direct care staff must hold active nursing licenses in Maryland or a compact state.

All staff must clear state and federal background checks before having any direct contact with waiver participants.

7. Documentation, Policies and Records

Providers must maintain dual compliance with OHCQ clinical record requirements and DDA waiver documentation standards.

Service logs must explicitly track the start and end times of respite care to support 15-minute unit billing in LTSSMaryland.

8. Billing, Rates and Claims

Claims are submitted through the LTSSMaryland Provider Portal based on authorizations generated from the participant's Person-Centered Plan (PCP).

Rates are established by the DDA Rate System and vary based on the level of care and whether the service is billed in 15-minute increments or daily rates.

9. Approval Sequence and Timeline

The critical path to becoming a billing provider requires completing each agency's process in a strict sequence.

Attempting to apply for DDA certification before OHCQ licensure is complete will result in immediate rejection.

10. Common Denials and Survey Findings

Applications are frequently delayed when providers fail to submit DDA-specific business and quality assurance plans.

During OHCQ surveys, the most common citations involve incomplete personnel files and lapsed background checks.

11. Key Contacts and Resources

Providers must interact with multiple state portals and division websites to maintain compliance.

Official guidance is updated regularly through DDA transmittals and OHCQ provider alerts.

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