Maryland Residential Service Agency Licensing Readiness

Last updated: November 2026

Maryland residential service agency (RSA) licensing applies to agencies within the definition in COMAR 10.07.05.02, subject to its exclusions and the household-or-family-support-only exemption in COMAR 10.07.05.03 (pages opened 2026-11-05). For owners starting an agency, adding services or changing ownership, Integral Healthcare Solutions (IHS) drafts the business plan, policies and application packet and conducts a mock survey. Your organization approves the documents, files the application and handles contact with the Office of Health Care Quality (OHCQ).

What is a Maryland residential service agency license?

It is the license COMAR 10.07.05.03 (page opened 2026-11-05) requires, along with compliance with the chapter, before a person or entity conducts or operates an agency in Maryland. COMAR 10.07.05.01 (page opened 2026-11-05) states the chapter's purpose: minimum standards for licensure of residential service agencies that conduct business in Maryland. COMAR 10.07.05.02 (page opened 2026-11-05) defines an RSA as a nongovernmental business that employs or contracts with individuals to provide at least one home health care service for compensation to an unrelated sick or disabled individual in that individual's residence, or an agency that employs or contracts with individuals directly for hire as home health care providers. Home health care includes any of eleven listed services. The OHCQ Residential Service Agencies page (page opened 2026-11-05) gives examples, including skilled nursing, help with bathing and dressing, therapy and durable medical equipment.

Who needs an RSA license, and who does not?

An agency needs one when it fits the definition and is not excluded. Two groups fall outside it.

• Household or family support only. COMAR 10.07.05.03 says an agency that provides only household or family support services does not require licensure. COMAR 10.07.05.02 defines those as child care for children who need no medical attention, or instrumental activities of daily living such as light housekeeping, meal preparation and shopping.
• Excluded entities. The definition does not include a home health agency licensed under Health-General Title 19, Subtitle 4, or an entity required to be licensed as one, among others.

Settle RSA versus home health agency first. The OHCQ application (page opened 2026-11-05) says a home health agency provides skilled nursing services, home health aide services, and at least one other home health care service, that are centrally administered. We did not open the home health agency statute, so your counsel and OHCQ should answer what makes an entity required to hold that license before you file.

Three events start this work: a new agency, a licensed RSA adding a home health care service (it completes the initial application, with policies for the new service), and a change of ownership. For a sale, a change of ownership, a stock transfer in excess of 25 percent, or any stock transfer that changes who controls the agency, the OHCQ page says the licensee notifies OHCQ in writing at least 45 days ahead and the future owner applies for a new license at least 45 days before the change.

What does the Maryland RSA application require?

COMAR 10.07.05.04 (page opened 2026-11-05) and the OHCQ Application for a Residential Service Agency License (page opened 2026-11-05) set the list. The application also requires an organizational chart, a Maryland Department of Assessments and Taxation (SDAT) letter of good standing and a workers' compensation declaration page. Corporations and LLCs not required to carry coverage submit a Certificate of Compliance; sole proprietorships and partnerships submit a Letter of Exemption only if they have no employees and are not required to carry coverage. An individual with authority over pay or employment practices also completes an online RSA Certification on worker classification of personal care aides, which applies to every applicant. The form asks whether the agency is accredited and, if so, by whom and when.

COMAR 10.07.05.08 (page opened 2026-11-05) says an agency shall develop and implement policies and procedures, including but not limited to administration, personnel, patient care, informed consent, and environment and safety. The Department may waive a required policy on the agency's written explanation that it is inappropriate or unnecessary to the agency's specific operation.

How does OHCQ decide, and what can the outcome be?

COMAR 10.07.05.04 says the Department reviews each application to decide whether the applicant can provide appropriate services to sick or disabled individuals who require care in their residence and meets the chapter's requirements.

• Inspection. Before approving or denying, the Department may conduct an announced or unannounced on-site inspection. If an agency fails to comply with the chapter and the Department needs more than one on-site prelicensure visit, COMAR 10.07.05.04K permits a charge of 250 dollars per additional visit or license denial. Verify current fees with OHCQ.
• Decision. The Secretary approves unconditionally, approves conditionally or denies. Conditions may include, among others, a management firm approved by the Secretary (required for no more than 24 months) or a licensure term of less than 1 year.
• Provisional license. Under COMAR 10.07.05.04J, headed "Licenses for Less than 1 Year," the Department may issue a provisional license if the agency intends to provide only skilled nursing and home health aid services; or, for an agency not in full compliance, if the Department considers the noncompliance no safety or health hazard and the applicant or licensee submits a Department-acceptable plan correcting each deficiency within a Department-acceptable timeframe. A provisional license cannot be extended beyond expiration.
• Term. A license is valid for 3 years from issuance unless surrendered, suspended, revoked or provisional.

What has OHCQ circulated for changes to this chapter?

OHCQ posts Residential Service Agency (RSA) Targeted Regulation Change 10.07.05, dated September 9, 2026 (page opened 2026-11-05). The document is labeled a working draft; that document alone does not establish adoption or formal proposal status. It would require orientation before the initial application and at least one Maryland branch office for an out-of-state parent agency. Its withdrawal provision requires missing information that prevents a determination, plus three documented unsuccessful contact attempts or three documented notices without the applicant supplying completed information. Check current requirements before filing.

How IHS helps

IHS prepares the documents and the rehearsal, and your organization makes every decision and filing. Thomas G. Goddard, JD, PhD, founder of IHS and former URAC Chief Operating Officer and General Counsel, leads the engagement personally.

What IHS drafts

• A gap review against COMAR 10.07.05 and the current OHCQ application, and the application packet with an evidence map to your files.
• The business plan, built from your figures and decisions.
• The policy and procedure set across those areas, with clinical content drafted for your clinicians to approve.
• A mock survey with a findings list and drafted corrections.

What you supply

You supply ownership documents, the administrator and clinical lead, the service list, staffing and credentials, insurance and financial records, and clinical sign-off on every clinical policy.

The real limit

IHS does not decide whether OHCQ will license your agency. IHS does not file your application and does not contact OHCQ for you. Your organization files and handles all contact.

What to have ready

Use COMAR 10.07.05 and the OHCQ application as posted on the pages opened 2026-11-05:

1. Resolve license classification with counsel using COMAR 10.07.05.02B(25); a written legal opinion is an IHS preparation suggestion, not a stated application requirement.
2. Prepare ownership disclosures under COMAR 10.07.05.04A(2)(d)–(e) and OHCQ application Section D: the regulation uses 25 percent; the form also asks corporations for every direct or indirect owner or investor holding at least 2 percent.
3. Document age eligibility, prior denials, suspensions or revocations of a license or certification to provide care to third parties, and any license or certification the applicant holds under the Health Occupations or Health-General Article, including prior or current operation of a similar health care program, under COMAR 10.07.05.04A(2)(b), (c), (f).
4. Prepare criminal and regulatory disclosures under COMAR 10.07.05.04A(2)(g).
5. Prepare the business plan, 1-year budget, population-specific marketing plan and detailed services description under COMAR 10.07.05.04A(2)(h).
6. Prepare the organizational chart and SDAT good-standing letter required by the OHCQ application, page 1.
7. Map policies to COMAR 10.07.05.08B and list document names, page numbers and any explained waiver request in application Section B.
8. Prepare workers' compensation evidence or the applicable entity-specific exception described above, following the OHCQ application, page 1.
9. Have an individual with authority over pay or employment practices complete the online RSA Certification required by the OHCQ application, page 1.
10. Prepare for a possible prelicensure inspection under COMAR 10.07.05.04D; an inspection readiness plan is an IHS preparation suggestion.

If you want us to compare your documents with this list, schedule the free introductory call below.

How it compares

A home health agency license is a different license, which OHCQ's application describes.

• Accreditation. A private body's review. We did not review how OHCQ treats it. Our home health and hospice accreditation page covers accreditation for home health providers.
• Other states. Our California home care organization licensing page covers that state.

What it costs

• The reviewed sources describe fees differently. COMAR 10.07.05.04 lists a nonrefundable license fee of 1,000 dollars for 3 years. The OHCQ application says, "There is no fee to apply for a license." Ask OHCQ which applies to your application. Verify current fees with OHCQ.
• IHS scopes each engagement after a free introductory call.

What this is not

• It is not legal advice. IHS is a consulting firm, not a law firm.
• It is not a guarantee that OHCQ will license your agency. The Department decides.
• It is not filing or liaison work. IHS does not submit to OHCQ and does not contact it for you.

Frequently asked questions

Do I need a license to start a home care agency in Maryland?

If your business fits the RSA definition, COMAR 10.07.05.03 says you may not operate it without first obtaining a license from the Secretary and complying with the chapter. An agency that provides only household or family support services does not require licensure.

What is the difference between an RSA and a home health agency in Maryland?

The OHCQ application says a home health agency provides skilled nursing services, home health aide services, and at least one other home health care service, that are centrally administered. The RSA definition excludes a licensed home health agency. Ask OHCQ's RSA Team and your counsel which license fits.

What must a Maryland RSA business plan include?

COMAR 10.07.05.04 requires information demonstrating financial or administrative ability to operate the agency in compliance with the chapter. At minimum, the business plan must include a 1-year operating budget, a marketing plan identifying the populations to be served, and a detailed and specific description of agency services.

How much does a Maryland RSA license cost?

COMAR 10.07.05.04 lists a nonrefundable license fee of 1,000 dollars for 3 years, while the OHCQ application says there is no fee to apply. The reviewed sources do not explain how these statements fit together; ask OHCQ which fee applies to your application. Verify current fees with OHCQ. IHS scopes each engagement after a free introductory call.

How long does Maryland RSA licensing take?

The sources we opened give no decision timeline. The OHCQ application says OHCQ holds an application for 180 days from the date of initial receipt, after which it is deemed inactive and administratively closed.

Will OHCQ inspect before issuing an RSA license?

COMAR 10.07.05.04 allows the Department to conduct an announced or unannounced on-site inspection before approving or denying an application. The provision permits an inspection; it does not say every applicant will receive one.

Can OHCQ approve an RSA application with conditions?

Yes. COMAR 10.07.05.04 allows conditional approval, including a Secretary-approved management firm or a license term under 1 year, among other conditions. The Secretary cannot require the management firm for more than 24 months.

Has Maryland proposed changes to the RSA regulation?

OHCQ posts Residential Service Agency (RSA) Targeted Regulation Change 10.07.05, dated September 9, 2026 (page opened 2026-11-05). It is labeled a working draft; that document alone does not establish adoption or formal proposal status.