Home Health Care License in Maryland

There are home health care license requirements in Maryland dependent of Certificate of Need Approval, an Agency will not be allow to apply for licensure unless this is approved. There is however an Alternate License known as a Residential Service Agency (RSA) which will allow Skilled nursing and other services to be provided.

Home Health Care Business
Home Health Care License in Maryland

Home Health Care License & RSA Requirements and Startup Process in Maryland

First impressions are the key to developing good consumer relations. That is why a relatable and unique name is extremely important when starting a Home Health Care Agency/ RSA Agency. Avoid using common names or the use of words such as: always, best, caring, first, and hands (to name a few). Deciding which name is best for your company is ultimately your choice and making this decision can be difficult if you are not flexible. As with many great ideas, there is a chance someone could have come up with it first. Transparency is a great marketing strategy for your Home Health Care Agency/ RSA Agency. Make sure to keep it simple and portray what your business actually does. You do not want someone thinking your business is doing something it is not. Researching to see if a name is available is very important as you do not want to be the subject of a lawsuit, nor do you want to choose something that is too similar to another local business as it can be rejected by the Secretary of State if the name is too similar.

Determine which option is best suited to the wants and needs of the owner(s) of the business. This is a huge decision because whichever choice is made here will determine how the business and the owner(s) are taxed annually. Filing the business under either of these options will determine the additional fees and filings that will be required to keep your home health care business in good standing with the State of Maryland. There are many factors that can come into play when choosing, which is why most people team up with a professional (i.e. Lawyer, consultant, or accountant) to weigh their options out about taxation and other factors.

Strive for success and make your dreams a reality by developing a strategy to get your home health care business off the ground. Develop a budget for your home health care agency / RSA Agency that makes sense. This should include office space, payroll, marketing, and other miscellaneous fees. Sourcing funds is a great start as there are fees and other costs that will require a decent amount of startup capital for your home health care agency to gain momentum. You should be able to operate your home health care / RSA  business for at least 12-18 months. Determining the full scope of services that your home health care agency would like to offer is important. Something as simple as not delivering a specific service or wanting to deliver alternate services could affect what license (i.e. companion care license, personal care license, home care license, home health care license, etc.) is needed and how long the process will take. Researching the local competition’s pricing and the census of the targeted demographic you are trying to serve will greatly help your strategy.

The State of Maryland requires a tangible office space to operate a Home Health Care Agency that is ADA compliant (P.O. Boxes are not acceptable addresses). There is usually a distance requirement for all Home Health Agencies & RSA Agencies which means you can only serve patients within the designated service area without having to open another agency.

Home Health Care Agencies that would like to be certified through Medicare will have to will have to apply for a Certificate of Need Approval after approval the agency will be allowed to apply. Medicare is a 12-18-month process after receiving Certificate of Need (CON) approval to receive reimbursement or payments of any kind from Medicare (if it is available to be applied for as this varies state to state). Medicaid and private insurances often have stipulations that a RSA or home health care agency must be certified to participate in their programs, in some cases, Private Duty Accreditation can be achieved in lieu of Medicare Accreditation. Every Agency that starts out is Private Pay and develops alternate payment sources after they are properly credentialed.

Home Health Care Agencies and RSA have strict requirements for the state of Maryland for the staff which are not negotiable due to the factors of skill and education required to deliver quality care. Owners and key staff must be able to pass a background checking process in the State of Maryland. Home Health Agencies follow requirements are described in the Conditions of Participation and State Operations Manual Appendix B. RSA’s Follow the state guidelines and Regulations assigned to their specific licensure. These regulations are to let perspective owners know how to properly run this type of business and get licensed to protect potential patients. Researching the proper regulations is a must in this industry.

Home Health Agencies and RSA require personnel to be supervised. The State of Maryland requires the following for RSA: 

Admin Requirements:

A professional with two (2) years’ experience in private duty, home care or health related

business and the knowledge, experience and ability to effectively administer the private

home care. Prefer at least one of the two years’ experience as an administrator/supervisor

in a health care setting, preferably home health care.

Must have a Criminal Background Check.

Nursing Director:

A current license to practice professional nursing (RN) in MD.

Prefer a BA degree. In lieu of a BA degree, two (2) years’ experience in a home care


A minimum of two (2) years of nursing experience, one (1) of which has been in a

supervisory or administrative role in a home care setting.

Must have a criminal background check and current CPR certification.

Home Health Agencies following CMS guidelines once they have a Certificate of Need Approval will follow Conditions of Participations. The following supervisory roles must meet the following educational requirements (§ 484.115) Condition of participation: Personnel qualifications.

Administrator and Alternate Administrator

(1) For individuals that began employment with the HHA prior to July 13, 2017, a person who:

(i) Is a licensed physician;
(ii) Is a registered nurse; or
(iii) Has training and experience in health service administration and at least 1 year of supervisory  administrative experience in home health care or a related health care program.

(2) For individuals that begin employment with an HHA on or after July 13, 2017, a person who:

(i) Is a licensed physician, a registered nurse, or holds an undergraduate
degree; and

(ii) Has experience in health service administration, with at least 1 year of supervisory or administrative experience in home health care or a related health care program.

Director of Nursing and Alternate Director of Nursing also known as a Clinical Manager

(1) A person who is a licensed physician, physical therapist, speech-language pathologist, occupational therapist, audiologist, social worker, or registered nurse.

Secretary of State Formation, Employer Identification Number, State Tax ID, and a National Provider Identification number will be needed to get your home care business started. You will need a tangible address to start the agency (P.O. Boxes are not acceptable). This is where a little help from a home health care business consultant will come in handy.  We do all of this for you.

The State of Maryland requires the following for home health care agencies and RSA:

General/Professional liability, and Workman’s Compensation.

The Maryland Health Commission has determined that no agency can apply for licensure to operate a Home Health Care Agency until after a strict review of the Certificate of Need Approval process is completed. This is very limited to the number of Agencies already in existence and the county population. There are several factors that come into play. Certificate of Need

Policies are very important to set the standard for your Home Health Agency or RSA to operate and follow best practices. No Home Health Care Agency or RSA can operate with out qualified key staff as described above. All Key Staff and owner(s) should be able pass a background check. 

Our home health care startup consultants can help with providing best practice standards with customized policies and knowledge of this type of business from inception to operation upon receiving the Certificate of Need (CON) approval for Home Health Agencies.

Residential Service Agency (RSA) 

Application – The State of Maryland requires an application to the Office of Healthcare Quality online. The key staff and owners must show proof of background checks and educational requirements in the application. The RSA application needs to be accompanied with RSA Policies and other key paperwork proving regulation compliance. Processing time for applications is roughly 6-12 Months depending on their work loads after the application is accepted and a letter is issued. 

Temp Licensing – The Office of Healthcare Quality issues a letter for the Agency to prep and start getting client before they request their license in which they give the RSA 180 Days to line everything up. Then they can request a temp license which is only valid for 90 days. 

Initial State Survey- The State of Maryland requires that a survey take place before any RSA’s are granted a license. This process requires 5 patients demonstrating all the disciplines in which they are trying to be licensed.   

License – The permanent license is just what it says it is a permanent license there is no renewal needed for the life of the Agency, However there is a fee and minor paper work to do annually to keep the agency license. This is a mandatory requirement and cannot be bypassed. Preparing for this fast paced task can be very difficult for a new business owner to navigate that why we are ready to help. Please give us a call today.


The county or township may have specific requirements that need to be met with an application for a local license to conduct business in that area. Having an optimal location and the proper office set is important. Make sure all of the proper licenses are in a conspicuous areas.

Your home health care or RSA business will need staff in order to open its doors in Maryland the key staff/managers need to be identified in the initial process. Hiring the staff and making sure they get paid is an important part of starting your home health care business. This process can be done by the home health care or RSA business owners or a professional equipped to handle these situations. The state of Maryland has very specific laws associated with being an employer. This can make or break the agency if they do not follow the letter of the law.

Home Health Agencies once they have an approved Certificate of Need (CON) Approval status are eligible to start enrollment processes for insurances the two most popular are Medicare and Medicaid which are state and federally funded. Medicare is a federal insurance that is for seniors over the age of 65 and individuals who are disabled. Medicaid is the state assisted insurance for all ages and disabilities to reduce costs to all individuals who otherwise could not afford health insurance. Center for Medicare & Medicaid Services (CMS) regulate both and there are specific requirements and regulations that must be met and followed. These government insurance enrollments can be very difficult to navigate and can take 11-18 months before a Home Health Agency receives a billing number for reimbursement on patient claims, if the insurance program is available for enrollment. Private Insurances such as Blue Cross Blue Shield, AETNA, Tufts, United Healthcare, and other PPO / HMO plans can also be used for reimbursement if the Home Health Agency has enrolled with each specified insurance company. All insurances will have separate requirements needed for enrollment.  

Home Health Agency or RSA requirements for enrollment in insurance programs may also include a certification that is issued from a nationally recognized accreditation organization (AO) to participate in their program. Certification for the home health agency not only validated that the agency knows what they are doing but can assure the family and patient a sense of comfort they are in capable hands. Assuring quality care with proof of certification makes insurance companies feel the same and in most cases is part of the requirement for the Home Health Agency to do business with them.

Accreditation requires that a great infrastructure be present with the correct key staff, supporting policies, business paperwork, and an ADA Compliant Office Space.  Creating this optimal environment can be very difficult without proper direction and insight. Accreditation Organizations such as Community Health Accreditation Partner (CHAP) or Accreditation Commission for Health Care (ACHC) have their own fees for their services and processes. Depending on which level of accreditation that fits the need of the Home Health Agency or RSA these fees and processes may vary. Certified Home Health Care Consultants and seasoned registered nurses are standing by with over 10+ Years’ experience to help make any RSA or Home Health Agency  survey ready and deliver sage guidance through this process. 

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