Maryland adult medical day care license: the OHCQ letter of interest, staffing and space rules

Maryland licenses the medical model only

Maryland has no general “adult day care” license. The license OHCQ issues covers adult medical day care. These are centers for adults who do not need 24-hour inpatient care but, in OHCQ’s words, “due to their degree of impairment, are not capable of full-time independent living.”⁠⁴ The rules are in COMAR 10.12.04, “Day Care for the Elderly and Adults with a Medical Disability.” OHCQ adopted the chapter in its present form effective December 13, 2014 and last amended the licensing procedure in 2015 and 2016.⁠¹

The licensing threshold comes from two statutes:

• Day care center for the elderly (Health-General §14-201): care, with or without charge, for elderly individuals. That means group care for at least 4, or a family home that cares for 2 or 3.⁠² “Elderly” means 55 or older, living alone or with a spouse, relative or friend, needing part-day supervision in a protective group setting, and having a static physical impairment or a permanent or recurrent mental impairment.⁠²
• Day care center for adults (Health-General §14-301): the same 4-or-more group or 2-to-3 family home test, but for “medically handicapped adults.” Here the minimum age is 16.⁠³

Under COMAR, a participant is a health-impaired adult who does not need 24-hour inpatient care and needs at least 1 day of care per week in a day program.⁠¹ So a family home serving just 2 or 3 such adults is not exempt. It needs the same license.

Who is outside the rule

COMAR 10.12.04.01 excludes a relative, domestic partner, neighbor or friend who cares for someone by mutual agreement. It also excludes nutrition sites, senior centers run under the Department of Aging, and “social model programs that individuals may attend to participate in meals or diversion activities.”⁠¹ OHCQ sends anyone planning a social, non-medical program to the Maryland Department of Aging’s Senior Center Plus program, at (410) 767-1100 or (800) 243-3425.⁠⁴ This guide does not cover Senior Center Plus.

Neighboring licenses come from the same office. Overnight care for 2 or more residents is an assisted living program. Personal care in clients’ homes is a residential service agency. Skilled nursing at home is a home health agency.

Step one: the letter of interest

New operators start with a letter of interest, not the application. COMAR 10.12.04.04A says the Department may not accept an application until it has reviewed and approved the letter.⁠¹ OHCQ’s letter of interest form, which you submit through the “Submit the Letter of Interest” link on the OHCQ page, must include:⁠⁵

1. Ownership

   The individual, individuals or business entity that will own and operate the program.

2. Job descriptions

   A description and qualifications for each position.

3. Operating plan

   Projected hours of operation, daily census, and a staffing plan covering licensed and non-licensed staff.

4. Plans review proof

   Verification that your structural design plans went to the Department’s Plans Review and Approval Unit, in the Office of Capital Planning, Budgeting and Engineering.

5. Policies and procedures

   These must cover medical record completion and retention, medication administration and storage, nutrition services, social work support, employee criminal background checks, transportation of participants, and participant activities.

Everything must be typed. OHCQ returns handwritten documents.⁠⁵ Item 4 means you need a site and drawn plans before OHCQ will look at you. You cannot get a letter approved for a building you have not found yet. Renewals do not need a letter of interest.⁠¹

Write the policies to the rule, because surveyors check them against it. COMAR 10.12.04.09 adds more policies the governing body must adopt: admissions, discharges, fees, health care, hours, personnel, emergencies and epidemics, consultants, relationships with other providers, accounting for medications released into the community, and quality assurance. A registered nurse must help with the annual policy review.⁠¹ The governing body must also adopt an annual budget and give OHCQ a phone number that reaches the center or its representative 24 hours a day, 7 days a week.⁠¹

The building: plans review, space and fixtures

A new center has to meet federal, State and local building, zoning, fire, food, safety and health codes, plus the Americans with Disabilities Act.⁠¹ Zoning and building permits come from your county or city. The state rule simply requires you to meet them. OHCQ wants the center at street level where possible. If yours will not be, you need the Department’s approval before design work proceeds.⁠¹ Fire safety follows COMAR 29.06.01 and the NFPA 101 Life Safety Code, including when the center sits inside a licensed nursing home or hospital.⁠¹

Square footage

COMAR 10.12.04.28D sets minimum activity space at 100 square feet for each of the first five participants, then 60 square feet for each additional participant.⁠¹ Only areas participants commonly use count. Half of the kitchen’s usable area counts if participants use the kitchen in activities. Offices, reception, closets, storage, bathrooms, utility rooms and passageways never count, and you measure the finished interior footprint.⁠¹ OHCQ can require more than the minimum.⁠¹

The space must also include a large room where everyone can gather, smaller group areas, a rest or quiet area with visual privacy, a private conversation space, storage, private staff work space, exterior lockable doors, and an automated alert when participants enter or leave. A staffed reception desk keeping a log can replace the alert at that door.⁠¹ Furniture must include straight-backed chairs with armrests, reclining lounge chairs, and a bed for examinations and for participants who become ill or upset.⁠¹

Fixtures and systems

• Bathrooms: at least 1 toilet and 1 hand-washing sink per 10 participants, no more than 30 feet from the primary activity areas, ADA-accessible, with space for privacy while changing a participant.⁠¹
• Food service: the Department approves plans for food service areas. You need at least one hand sink, a three-compartment sink or commercial dishwasher, and a Class ABC extinguisher in or next to the area. Food made on site or off site must meet COMAR 10.15.03.⁠¹
• Climate: central heat able to hold 75°F and air conditioning able to hold no more than 81°F in participant areas. No space heaters unless the fire authority approves them.⁠¹
• Hot water: between 100°F and 120°F for washing and bathing.⁠¹

If you share a hospital, nursing home, assisted living program, church or school building, you need a written agreement giving the center enough separate space during its hours. Shared rooms such as kitchens need a written agreement too.⁠¹

Staff you must have before the survey

COMAR 10.12.04.14 names the positions:⁠¹

The director’s duties must be limited to the center. A center that is part of another facility needs its own director and staff.⁠¹ One exception: a licensee with two sites within 50 miles of each other, each with fewer than 50 participants, may use an on-site manager instead of a director at one site.⁠¹

On ratios, the 2014 rule set 1 staff to 7 participants for two years after adoption. After that, staffing is set by each participant’s needs as measured in the Adult Day Care Assessment and Planning System (ADCAPS), and must be sufficient at all times.⁠¹ You also need relief staff with comparable licenses and skills for absences.⁠¹

Screening and training

• Background checks. Before hiring, staff may not have a criminal history that suggests behavior potentially harmful to participants, as shown by a criminal history records check.⁠¹ Personnel files must document a check under Health-General §19-1901, freedom from tuberculosis, measles, mumps, rubella and varicella, that the annual flu vaccine was advised, and, for drivers, an official driving record and license copy.⁠¹
• Dementia and mental illness. Staff who give individual care need at least 2 hours of training on cognitive impairment and mental illness within their first 90 days. The training covers early identification, communication and de-escalation.⁠¹
• In-service. At least eight sessions a year, covering infection control, fire and emergency safety, accident prevention, population-specific care, abuse and neglect reporting, and safe food handling.⁠¹
• First aid and CPR. At least one trained staff member must be on site whenever participants are present, and on every outing and transport.⁠¹
• Emergency plan. Staff get oriented to the emergency plan within 24 hours of starting work.⁠¹
• Drivers. Anyone who drives as part of the job gets driver training.⁠¹

Clinical and program rules OHCQ will test

COMAR 10.12.04 also sets the care standards that surveyors check during each visit:

• Hours: open at least 6 hours a day, 5 days a week, with hours posted.⁠¹
• Before admission: a written assessment from the person’s health care provider, reflecting their health within 45 days of admission. It must confirm they are free of communicable disease. You also need a signed service contract listing days, services, discharge conditions, and consents for transportation, treatment, medication, outings, photos and release of records.⁠¹
• Assessment and care plan: an RN completes the ADCAPS within 30 days of admission and every 120 days after that. The plan of care is due within 30 days, and the RN updates it within 7 days of a change in status and at least semiannually.⁠¹ OHCQ posts the ADCAPS form and its completion guidelines on its resources page.⁠⁸
• Medications: only an RN, LPN or certified medication technician manages medications. Only an RN, LPN or authorized provider gives injections. Schedule II drugs go in a locked box inside the locked cabinet, and a licensed nurse inspects storage every 3 months.⁠¹
• Meals: 1 meal and 1 snack for 4 to 6 hours of attendance; 2 meals and 1 snack, or 1 meal and 2 snacks, for 7 to 8 hours; 2 meals and 2 snacks for more than 8 hours. A registered dietitian assesses anyone with a nutritional deficit.⁠¹
• Transportation: you must provide or arrange it. No participant may be dropped at the center when no staff are present. A driver may not leave a participant at home until someone meets them or they go inside.⁠¹
• Discharge: a discharge plan with at least 30 days’ written notice, except for safety or medical emergencies.⁠¹
• Records: keep participant records at least 5 years after discharge.⁠¹

The application and the prelicensure survey

Once OHCQ approves your letter of interest, it tells you to file the Application for an Adult Medical Day Care License. The current form is dated March 13, 2026.⁠⁴⁠⁶ Download the PDF, fill it in with Adobe or another PDF program, and submit it through the link OHCQ sends you.⁠⁴⁠⁶

1. Complete the form

   It asks for the requested number of participant slots, business hours, the director’s and RN’s contacts, and full ownership details. It also asks for disclosures: other OHCQ-licensed facilities you own or owned, any Maryland Department of Health license that was revoked, suspended or denied, any conviction involving Medicare, Medicaid or other Social Security Act programs, and any owner’s felony conviction.⁠⁶

2. Attach two documents

   A letter of good standing from the State Department of Assessments and Taxation (SDAT), and your workers’ compensation declaration page. If you are not required to carry coverage, attach a certificate of compliance or a letter of exemption instead.⁠⁶

3. Keep the file moving

   OHCQ holds an incomplete application for 180 days from first receipt, then closes it. After that you would have to start over with a new application.⁠⁶

4. Prelicensure survey

   After approving the application, OHCQ schedules an on-site survey: a building tour, staff interviews and a records review. The rule also requires an interview with the prospective licensee.⁠¹⁠⁶

5. Decision

   If the survey finds no deficiencies, you receive a Notice of Compliance and the license. If it finds deficiencies, you get a Statement of Deficiencies and have 10 business days to submit a plan of correction. OHCQ issues the license once it accepts the plan. If you cannot correct, OHCQ denies the application with appeal rights.⁠⁶

OHCQ’s resources page posts the tools its surveyors use: a survey checklist, employee record review, staff training review, participant quality-of-care review and transportation checklist (June 2025 versions).⁠⁸ It is worth checking your files against them before the prelicensure visit. OHCQ also runs an in-person new provider orientation. As of 2026-10-12 its page said no date had been set for the next session. Questions go to (410) 402-8217.⁠⁴

OHCQ ran 13, 9, 8 and 9 initial surveys in fiscal years 2022 through 2025. The number of licensed centers was 125 in both FY2024 and FY2025.⁠⁹ The state publishes no processing time.

Fees, as published on 2026-10-12

OHCQ’s letter of interest and the March 13, 2026 application both say: “There is no fee to apply for a license.”⁠⁵⁠⁶ COMAR 10.12.04.05A(1) still says a change of ownership or location needs a new application “with an application fee, as established in Regulation .04A(2).” But .04A(2) contains no fee.⁠¹ The March 13, 2026 form is the one a new owner-operator or a relocating center files, and it has a check box for “Change of Ownership” and “Relocation” next to “Initial.” Its “no fee” statement is not limited to initial applications.⁠⁶ Ask the AMDC team to confirm in writing before you budget for a change of ownership or move.

License term, surveys and enforcement

The license lasts 2 years, covers one premises, and cannot be transferred. You may never exceed the licensed capacity.⁠¹ The license becomes void if the center is sold or leased, changes ownership, moves, or stops operating for more than 30 consecutive days.⁠¹ Increasing capacity or changing your name needs prior approval. OHCQ takes slot changes and name changes through online forms on its resources page.⁠¹⁠⁸

A transfer of more than 25 percent of the stock counts as a sale. The new owner must apply at least 45 days before the transfer, and you must give OHCQ and participants 45 days’ written notice before closing, selling or relocating.⁠¹

OHCQ surveys at least every 2 years and investigates complaints.⁠¹ In June 2026 it said it now runs environmental surveys in the years between biennial surveys.⁠⁹ After a survey you have 10 calendar days to file a plan of correction, and the same 10 days to request informal dispute resolution.⁠¹

Penalties scale with harm. A civil money penalty can be up to $3,000 per instance or $300 per day for a potential-harm deficiency, $5,000 or $1,000 per day for actual harm, and $10,000 or $3,000 per day for a serious and immediate threat.⁠¹ Operating without a license can bring up to $10,000 per offense.⁠¹ OHCQ can also restrict admissions for up to 30 days at a time for a serious health or fire safety problem, appoint a state monitor, or impose a staffing pattern.⁠¹ Hearing requests go to the Office of Administrative Hearings within 30 days.⁠¹

Report communicable disease or foodborne outbreaks, poisonings, deaths, fires, restraint use and similar incidents immediately to OHCQ, the local health officer, the participant and family.⁠¹ Suspected abuse, neglect, self-neglect or exploitation goes to the local police, the Department and the local department of social services.⁠¹ OHCQ’s August 12, 2026 memo says all reportable events must go to OHCQ by email, phone or its online form.⁠¹⁰

Where surveyors find problems

OHCQ’s June 4, 2026 presentation to the MAADS annual meeting listed the deficiencies it cites most often in these centers:⁠⁹

• incomplete personnel records
• Life Safety Code and fire code violations
• first aid and CPR certification and coverage
• sanitation, maintenance and housekeeping
• unsecured chemicals
• missed fire and disaster drills
• grievance rights
• food service areas
• drug storage

The same presentation reported a federal HHS Office of Inspector General audit of 20 Maryland waiver-funded adult day facilities, which found 253 problems. In response, OHCQ raised its sampling of staff records during surveys from 10% to 50%.⁠⁹ Fire drills are due quarterly on all shifts and disaster drills semiannually, with signed documentation kept 2 years. Those are among the easiest citations to avoid.⁠¹

Getting paid through Medicaid

Maryland Medicaid’s medical day care rules (COMAR 10.09.07) require an OHCQ license under 10.12.04.⁠⁷ Medicaid pays only when the participant is enrolled in a home and community-based services waiver and the waiver service plan lists medical day care.⁠⁷ Payment stops at your licensed capacity on any day, and there is no payment for a participant who gets Senior Center Plus, PACE or day habilitation billed the same day.⁠⁷

Medicaid adds conditions beyond licensure:⁠⁷

• You must demonstrate “that a need exists for medical day care in the service area” and that you have the expertise to deliver the service.
• You need a licensed social worker with at least 1 year of experience with adults in a health care setting.
• You need a medical director (full-time, part-time or contractual) with 1 year of experience caring for impaired adults.
• If your director is not an RN, you must designate an RN health director.
• You need a quality assurance program with health care audits and utilization review.

The per diem in COMAR 10.09.07.08 is $116.59 for dates of service on or after July 1, 2024. The rule says it rises 4% each July 1, subject to the State budget.⁠⁷ Medicaid’s July 1, 2024 transmittal PT 05-25 set the $116.59 rate for procedure code S5102 and described that year’s increase as 3 percent, based on budget allocations.⁠¹¹ As of 2026-10-12 the rule text has no figure for later years, and no later medical day care rate transmittal turned up in the Medicaid transmittal library. Ask the Office of Long Term Services and Supports for the rate in effect for your dates of service.

The sources do not say whether Maryland Medicaid is taking new enrollments for provider type 42, Medical Day Care - Adults, and the enrollment pages could not be read on 2026-10-12. COMAR 10.09.07 itself sets conditions for providers but states no enrollment cap.⁠⁷ Ask the Medicaid provider enrollment helpline whether new type 42 applications are being accepted before you build a business plan around Medicaid participants.

Recent changes

• March 13, 2026: OHCQ issued the current application form. It confirms there is no fee, requires an SDAT good-standing letter and workers’ compensation proof, and closes incomplete files after 180 days.⁠⁶
• June 4, 2026: OHCQ announced more staff-record sampling, a COMAR-based provider checklist, and environmental surveys in the years between biennial surveys.⁠⁹
• August 12, 2026: OHCQ memo restating that every reportable event must be submitted to OHCQ.⁠¹⁰

The chapter’s substantive text dates from December 13, 2014. Amendments to the licensing procedure took effect December 21, 2015 and August 29, 2016.⁠¹

Sources

1. 1
   Maryland Division of State Documents, COMAR 10.12.04: Day Care for the Elderly and Adults with a Medical Disability Checked 12 Oct 2026 · Back to text ↑
2. 2
   Maryland General Assembly, Health-General Article §14-201: Day care centers for the elderly, definitions Checked 12 Oct 2026 · Back to text ↑
3. 3
   Maryland General Assembly, Health-General Article §14-301: Day care centers for adults, definitions Checked 12 Oct 2026 · Back to text ↑
4. 4
   Maryland Department of Health, Office of Health Care Quality, Adult Medical Day Care Checked 12 Oct 2026 · Back to text ↑
5. 5
   Maryland Department of Health, Office of Health Care Quality, Letter of Interest for an Adult Medical Day Care License Checked 12 Oct 2026 · Back to text ↑
6. 6
   Maryland Department of Health, Office of Health Care Quality, Application for an Adult Medical Day Care License (March 13, 2026) Checked 12 Oct 2026 · Back to text ↑
7. 7
   Maryland Division of State Documents, COMAR 10.09.07: Medical Day Care Services (Medical Assistance Program) Checked 12 Oct 2026 · Back to text ↑
8. 8
   Maryland Department of Health, Office of Health Care Quality, Adult Medical Day Care Resources Checked 12 Oct 2026 · Back to text ↑
9. 9
   Maryland Department of Health, Office of Health Care Quality, Adult Medical Day Care: OHCQ presentation to the MAADS Annual Meeting (June 4, 2026) Checked 12 Oct 2026 · Back to text ↑
10. 10
    Maryland Department of Health, Office of Health Care Quality, Memo: Reporting Requirements for Reportable Events in Adult Medical Daycare Centers (August 12, 2026) Checked 12 Oct 2026 · Back to text ↑
11. 11
    Maryland Department of Health, Office of Long Term Services and Supports, PT 05-25: Fiscal Year 2025 Rates for Medical Day Care Services (July 1, 2024) Checked 12 Oct 2026 · Back to text ↑

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