Maryland residential service agency (RSA) license for in-home personal care

One license covers personal care, nursing and medical equipment

Maryland has no separate personal care or “non-medical” home care license. Under Health-General §19-4A-01, a residential service agency is any nongovernmental business “employing or contracting with individuals to provide home health care for compensation to an unrelated sick or disabled individual in the residence of that individual” ⁠¹¹. COMAR 10.07.05 adds that one service is enough: “at least one home health care service” ⁠¹.

The list of home health care services is broad. It runs from audiology, speech pathology, nursing, physical and occupational therapy and medical social services to home health aide work, drug and laboratory services, invasive medical equipment and home medical equipment ⁠¹. OHCQ’s own description makes the point: some RSAs send nurses and certified caregivers who help with “bathing, grooming, and dressing,” some offer private duty care up to 24 hours a day, seven days a week, some provide therapy, and some deliver hospital beds, CPAP machines and oxygen ⁠¹⁸. A personal care startup and an oxygen supplier hold the same license type. What changes between them is the list of services on their application and the policies OHCQ reviews ⁠¹⁹.

For a personal care business, the service that brings you under the license is home health aide. Maryland’s rule defines activities of daily living as eating, grooming and bathing, oral hygiene, mobility and transfers, toileting and dressing ⁠¹. Hands-on help with any of these is what OHCQ’s RSA rules regulate, and it is what triggers the nurse oversight described below ⁠¹⁰.

The companion and homemaker exemption

COMAR 10.07.05.03B is short: “An agency that provides only household or family support services … does not require licensure” ⁠². The rule defines household or family support services as tasks that supplement a person’s ability to handle either:

• child care for children “who require no medical attention,” or
• instrumental activities of daily living, meaning light housekeeping and home management, meal planning and preparation, and shopping and errands ⁠¹.

So a business that cleans, cooks, shops and runs errands for older adults needs no OHCQ license. Once a worker helps a client bathe, dress, use the toilet, eat or transfer, the agency is providing activities of daily living support and is no longer within the exemption ⁠¹⁠². The regulation does not name companionship as a separate category. If your plan includes sitting, supervision or escort services that are not listed in the exemption, put the question to the RSA team in writing before you open (contact details are at the end of this guide).

Building a homemaker business now and planning to add personal care later? Licensing is not automatic. You file a full RSA application with OHCQ and wait for approval before the first hands-on visit ⁠².

RSA or home health agency?

Maryland separates two in-home license types, and many founders confuse them. Both are licensed by OHCQ, which describes them as its “two home health provider categories” ⁠²⁷.

The statute excludes from the RSA definition any business that is licensed as a home health agency or “required to be licensed” as one ⁠¹¹. That clause matters if you plan to bundle skilled nursing, aides and a therapy under central administration. The application form flags the line and tells applicants unsure which side they fall on to “contact the RSA Team” ⁠¹⁹. The certificate of need route is covered in the Maryland home health agency license guide.

The RSA definition also excludes hospices, hospitals, related institutions, licensed nursing referral service agencies, personal care providers under the Medical Assistance Personal Care Program, individual practitioners working under their own Health Occupations license, groups of practitioners all licensed under the same title who provide only that service, and residential rehabilitation programs ⁠¹¹. A nurse who works alone under their own license is not an RSA. A nurse who hires aides is.

Who can apply

COMAR 10.07.05.04 sets these applicant conditions ⁠³:

• The applicant or corporate representative must be 21 or older.
• You must name every individual or corporate owner of 25 percent or more and complete an ownership addendum.
• You must disclose any earlier denial, suspension or revocation of a license or certification to care for others, any Maryland health licenses you hold, and any criminal charges or convictions or findings that you violated Medicare, Medicaid, Health-General or Health Occupations law.
• Anyone whose license was suspended or revoked by the Department may not own, operate or manage another agency for 10 years unless they show good cause.
• An owner whose existing agency has had sanctions in the last two years and is not back in compliance may not apply for additional agencies.

OHCQ can also deny a license based on a person’s record of RSA violations or a criminal history it considers “potentially harmful to clients” ⁠³.

The statute asks only that you show the agency “will provide appropriate home health care providers to sick or disabled individuals,” and it expressly says you may not be required to obtain a certificate of need ⁠¹². COMAR 10.07.05 sets no capital minimum or bond. Instead, OHCQ judges your financial and administrative ability from the business plan ⁠³.

Assembling the application packet

OHCQ’s application (form dated 06.26.2026) must be typed. Handwritten applications “will be returned,” and the packet is submitted online through the “Submit a License Application” link on the RSA page ⁠¹⁹⁠¹⁸. The same form is used for initial licenses, changes of ownership and adding services ⁠¹⁹.

1. Business entity and SDAT good standing

   The application asks for your FEIN and an official letter of good standing from the Maryland State Department of Assessments and Taxation, ordered through SDAT Business Express ⁠¹⁹.

2. Business plan

   It must include a one-year operating budget, a marketing plan “that identifies the populations to be served,” and a “detailed and specific description of agency services” ⁠³⁠¹⁹.

3. Organizational chart

   ⁠¹⁹.

4. Policies and procedures under COMAR 10.07.05.08B

   These are the core of the review (see the next section). You list on the application which attached document holds each required policy ⁠⁷⁠¹⁹.

5. Workers’ compensation

   Attach your policy declaration page. A corporation or LLC that is not required to carry coverage submits a Certificate of Compliance. A sole proprietorship or partnership with no employees submits a Letter of Exemption from the Maryland Workers’ Compensation Commission ⁠¹⁹.

6. Service selections

   You tick each service you will offer (nursing, home health aide, PT, OT, speech, audiology, respiratory therapy, medical social services, dietary, durable medical equipment), list business hours and an after-hours emergency number, say whether you are accredited, and say whether you will serve adults, children under 18, or both ⁠¹⁹.

7. RSA certification

   Separately, someone with authority over pay or employment practices reads OHCQ’s personal care aide guidance document and completes the online RSA Certification form ⁠¹⁸⁠¹⁴.

If you will supply invasive medical equipment or supplies, such as IV lines, catheters, ventilators, feeding tubes, tracheostomy or ostomy supplies, the form asks whether you already have a 24-hour maintenance or service agreement in place ⁠¹⁹. COMAR requires one ⁠⁷.

OHCQ keeps an incomplete application for 180 days from first receipt. After that it is administratively closed, and you start over with a new application ⁠¹⁹.

The worker classification certification

This step is unusual among state home care licenses. Health-General §19-4A-11 makes the certification a condition of the initial license and of keeping it every three years after that. The signer certifies that they have “read and understood” the Attorney General’s guidance document and that the agency will comply with Maryland’s Labor and Employment Article ⁠¹⁴. OHCQ requires the certification from every applicant, “including those that do not plan to hire personal care aides” ⁠¹⁹.

The guidance document is worth reading before you choose a staffing model. It states that under Maryland’s unemployment insurance law a personal care aide “is presumed to be an employee, not an independent contractor, unless the RSA can satisfy a test called the ‘ABC test’” ⁠²¹. COMAR says the chapter “does not preclude an agency from operating with independent contractors” ⁠². Medicaid is stricter: the Department “may reimburse a residential service agency for personal assistance services only if the personal assistance services are provided by an individual classified as an employee” ⁠¹³. Agencies that receive Medicaid payment for personal care aide services must also report to MDH by October 1 each year how many aides they classify as employees and how many as independent contractors ⁠¹⁴.

Policies OHCQ reviews before it licenses you

Your policies must cover five areas ⁠⁷:

• Administration: scope of services, admission criteria, assessment before acceptance, care coordination with other providers, billing and service records, a quality assurance program, and clinical management (assessment, plans, delegation and supervision).
• Personnel: job descriptions and educational qualifications, skill assessments, and health requirements for employees and contractors.
• Patient care: the criteria for deciding when skilled services are needed, drug administration, enteral and parenteral nutrition, how often clients are monitored, and training for clients and families.
• Informed consent: forms for clients who accept changes to your recommended plan of care, or who accept help from an unlicensed worker with routine treatments or with taking their own medications.
• Environment and safety: infection control, biomedical waste disposal, equipment maintenance, storage of formulas and supplies, and emergency procedures.

If a required policy does not fit your services, a personal-care-only agency’s enteral nutrition policy for example, you can ask OHCQ in writing to waive it and explain why. The application has a section for this ⁠⁷⁠¹⁹. You also need a governing authority that meets with management at least once a year and keeps minutes ⁠⁷, an internal complaint process ⁠²⁸, and written client rights policies that include a statement of costs not covered by insurance and itemized bills on request ⁠³⁰.

Review, inspection and the decision

OHCQ reviews the packet to decide whether you can serve sick or disabled people at home and whether you meet COMAR 10.07.05 ⁠³. Before approving or denying, it “may conduct an announced or unannounced on-site inspection” ⁠³. If you are not ready and OHCQ needs more than one prelicensure visit, it may charge $250 for each additional visit or deny the license ⁠³.

The Secretary has three options ⁠³:

• approve the license with no conditions;
• approve it with conditions, which can include using a management firm approved by the Secretary (for no more than 24 months) or a license term of less than one year; or
• deny it. You get a letter giving the reasons and your appeal rights ⁠¹⁹.

A provisional license is possible when an agency will offer only skilled nursing and home health aide services, or when it is not fully compliant but the problems are not a health or safety hazard and OHCQ has accepted your plan of correction ⁠³. Neither the statute nor COMAR gives OHCQ a deadline for deciding an RSA application.

Fees, as published on 2026-10-12

The $1,000 figure dates from a 2015 rule change that cut the fee from $2,100 every three years ⁠²⁶. OHCQ’s application dated 06.26.2026, however, says “There is no fee to apply for a license” ⁠¹⁹. Neither the application nor COMAR explains the difference, and no Maryland Register notice amending the fee was found as of 2026-10-12. Ask the RSA team in writing whether a license fee is invoiced at approval and at renewal, and budget for $1,000 per three years until they say otherwise.

Staff screening and the nurse’s role

Screening before anyone sees a client

Before an aide can be sent to a client, COMAR 10.07.05.10 requires a State criminal history records check or a private agency background check, verification of any license or certification, a basic health screening that includes tuberculosis, reference and employment history checks, an I-9, identity verification, an in-person interview, and a skills assessment with a demonstration ⁠⁸. State law makes the agency pay for the check and complete it before the worker starts. A private agency check must cover every state where the worker lived or worked in the past seven years, and you must ask the most recent employer about any history of physical abuse ⁠¹⁷.

Certified versus uncertified caregivers

Maryland does not require every aide to be a certified nursing assistant. It does require an agency to send a certified caregiver to any client who needs one for activities of daily living, or who needs medications administered ⁠⁸. An uncertified worker may go only if the client needs no help with activities of daily living, if the supervising nurse judges that ADL-only help carries “no predictable adverse health consequences,” or if the client signs a waiver ⁠⁸. Only a cognitively capable adult client can waive recommended certified care for routine treatments or medication self-administration, or recommended skilled care. A client representative cannot waive certified care ⁠¹⁰.

Registered nurse oversight

For clients who need skilled services or help with activities of daily living, the agency must have a registered nurse who oversees the care plan, delegation, supervision and training ⁠¹⁰. The RN assesses each new client who needs skilled services and ADL help, decides whether a CNA is needed, and helps assign and train staff ⁠¹⁰. Assessments are also due at least annually and at the client’s request. For clients with higher-risk needs such as wound and catheter care, stage 3 or 4 ulcers or infusion therapy, the assessment is due within 48 hours of the start of services, and again within 48 hours after a notified significant change of condition unless the RN documents otherwise and assesses within 7 days ⁠¹⁰.

The agency also needs a 24/7 on-call line. Each inquiry must be answered within one hour and logged ⁠¹⁰.

Training

COMAR’s minimum curriculum covers supervised practice in personal care, recognizing when to call the RN, record keeping, ethics and confidentiality, CPR, standard infection control precautions, and abuse and neglect prevention ⁠⁹. You may train staff yourself. An outside trainer needs written OHCQ approval before training your staff ⁠⁹⁠¹⁸.

Health-General §19-4A-03.1 adds dementia training for direct care and supervisory staff. Each person needs 3 hours within 45 days of starting work and 2 hours of continuing education every calendar year, with a certificate of completion. A new hire with 24 consecutive months of dementia care experience and an earlier certificate is exempt from the initial course. Agencies that only provide durable medical equipment are exempt ⁠¹⁵.

Running the agency after approval

• Advertising. Every ad and marketing piece must show your license number and the sentence “Licensed as a residential service agency by the Maryland Department of Health, Office of Health Care Quality.” You may not imply you are a home health agency, hospice or nursing referral agency without that license ⁠⁵.
• Posting and branches. Post the license near your office entrance. Each agency needs its own license, but a branch office can operate under the parent license if it has the same tax ID, upper-level management and policies and serves the same geographic area ⁠²⁠¹. OHCQ takes new branch notices through an online form ⁠¹⁸.
• Inspections. OHCQ may inspect announced or unannounced during the business hours on your application. Records for current clients, clients discharged in the past 12 months, current staff and quality assurance must be kept on site. Other records must be produced within 24 hours ⁠⁶. After a citation you have 10 calendar days to file a plan of correction, and 10 days to request an informal dispute resolution conference ⁠⁶.
• Records. Keep client records for 5 years after discharge. For minors, keep them until age 21 or for 5 years, whichever is later ⁠²⁹.
• Complaints. Clients must be given OHCQ’s RSA hotline number, (800) 492-6005 ⁠²⁸⁠¹⁸.

Changes, sale and renewal

You cannot add a service, or change your business name, without OHCQ’s approval. To add a service, file a new application with the policies for that service before you offer it ⁠⁴⁠¹⁹. A change of name or address with no change of owner needs an amended license ($50) ⁠⁴. A sale that changes who controls the agency, or a transfer of more than 25 percent of the stock, makes it a new agency. The buyer applies for a new license at least 45 days before the transfer, and the seller gives OHCQ and clients 45 days’ written notice ⁠⁴. The license cannot be sold or assigned ⁠⁴.

Licenses run three years ⁠³. Renewal requires the renewal application and fee, any policies that have changed substantially, valid licenses and certificates for all current employees, and an annual data collection survey ⁠³. The worker classification certification must also be renewed every three years ⁠¹⁴.

Getting paid through Medicaid’s Community First Choice

Licensure alone does not entitle an RSA to payment by any insurer or program ⁠¹³. Maryland Medicaid pays for in-home personal assistance through Community First Choice (COMAR 10.09.84). Its personal assistance providers must be “licensed as a Residential Service Agency under COMAR 10.07.05 to provide Level Two or Level Three home care services” and must employ a registered nurse who assesses participants and delegates nursing tasks ⁠²³. Current COMAR 10.07.05 defines no service levels, and the OHCQ application lists services rather than levels. Ask Medicaid, before you apply to enroll, how “Level Two or Level Three” maps to the services you tick on the RSA application.

Community First Choice adds its own conditions ⁠²²⁠²³⁠²⁴:

• Enroll as a Medicaid provider under COMAR 10.09.36.
• Run a State criminal history records check on all direct service workers, nurses included. A private background check is not enough here.
• Use a certified medication technician to administer medications, and a CNA for other delegated nursing tasks.
• Report incidents within 24 hours and file a written report within 7 days.
• Keep service records for 6 years and collect the participant’s signature at least monthly.
• Bill personal assistance through the Department’s telephonic timekeeping system.
• Do not assign a participant’s representative to care for that participant.

Providers whose principals have had a license suspended or revoked, Medicaid sanctions, or health-and-safety deficiency citations in the past 24 months cannot participate ⁠²².

Recent and pending changes

• March 24, 2026: OHCQ reissued guidance telling hospital and nursing home discharge planners to verify that any RSA they select “is appropriately licensed to provide the services identified in the patient’s discharge plan” ⁠²⁷. Referral sources can check your license in OHCQ’s licensee directory, so the services on your license matter commercially.
• September 24, 2026: OHCQ revised its outside-trainer checklist. It marks several items as a “26 Reg Update”: CPR with a hands-on component taught by a certified instructor every two years, an emergency preparedness plan, and training within 45 days of hire and annually ⁠²⁰. No 2026 Maryland Register notice amending COMAR 10.07.05 was found, and COMAR .11C still lists CPR without these details. Treat these as OHCQ’s stated expectations for trainers, not adopted rule text, and ask the RSA team which version applies to your training.

Penalties for unlicensed operation

Operating an RSA without a license is a misdemeanor, with a fine of up to $1,000 for a first offense and up to $10,000 for each later offense ⁠¹⁶. Licensed agencies face civil money penalties of up to $10,000 per instance or $1,000 per day ⁠²⁵. Breaking the advertising rules can lead to a criminal referral and civil penalties ⁠⁵. OHCQ also takes reports of suspected unlicensed facilities through an online form on its website ⁠¹⁸.

For the RSA team, use the “Contact the RSA Team” form on OHCQ’s RSA page or call OHCQ at (410) 402-8040 ⁠¹⁸. For the other Maryland licenses, see the Maryland state overview and the non-medical home care license overview.

Sources

1. 1
   Maryland Division of State Documents, COMAR 10.07.05.02, Definitions Checked 12 Oct 2026 · Back to text ↑
2. 2
   Maryland Division of State Documents, COMAR 10.07.05.03, License Required Checked 12 Oct 2026 · Back to text ↑
3. 3
   Maryland Division of State Documents, COMAR 10.07.05.04, Licensing Procedures Checked 12 Oct 2026 · Back to text ↑
4. 4
   Maryland Division of State Documents, COMAR 10.07.05.05, Changes in an Agency That Affect the Operating License Checked 12 Oct 2026 · Back to text ↑
5. 5
   Maryland Division of State Documents, COMAR 10.07.05.06, Public Representation Checked 12 Oct 2026 · Back to text ↑
6. 6
   Maryland Division of State Documents, COMAR 10.07.05.07, Inspection by the Department Checked 12 Oct 2026 · Back to text ↑
7. 7
   Maryland Division of State Documents, COMAR 10.07.05.08, Administration Checked 12 Oct 2026 · Back to text ↑
8. 8
   Maryland Division of State Documents, COMAR 10.07.05.10, Employee, Independent Contractor, and Contractual Employee Requirements Checked 12 Oct 2026 · Back to text ↑
9. 9
   Maryland Division of State Documents, COMAR 10.07.05.11, Training Checked 12 Oct 2026 · Back to text ↑
10. 10
    Maryland Division of State Documents, COMAR 10.07.05.12, Services Provided Checked 12 Oct 2026 · Back to text ↑
11. 11
    Maryland General Assembly, Health-General Article § 19-4A-01, Definitions Checked 12 Oct 2026 · Back to text ↑
12. 12
    Maryland General Assembly, Health-General Article § 19-4A-05, Qualifications for license Checked 12 Oct 2026 · Back to text ↑
13. 13
    Maryland General Assembly, Health-General Article § 19-4A-10, Reimbursement Checked 12 Oct 2026 · Back to text ↑
14. 14
    Maryland General Assembly, Health-General Article § 19-4A-11, Personal care aide guidance and certification Checked 12 Oct 2026 · Back to text ↑
15. 15
    Maryland General Assembly, Health-General Article § 19-4A-03.1, Dementia training Checked 12 Oct 2026 · Back to text ↑
16. 16
    Maryland General Assembly, Health-General Article § 19-4A-08, Operating without a license Checked 12 Oct 2026 · Back to text ↑
17. 17
    Maryland General Assembly, Health-General Article § 19-1902, Background checks for adult dependent care programs Checked 12 Oct 2026 · Back to text ↑
18. 18
    Maryland Department of Health, Office of Health Care Quality, Residential Service Agencies Checked 12 Oct 2026 · Back to text ↑
19. 19
    Maryland Department of Health, Office of Health Care Quality, Application for a Residential Service Agency License (06.26.2026) Checked 12 Oct 2026 · Back to text ↑
20. 20
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21. 21
    Maryland Department of Health, Office of Health Care Quality, Residential Service Agencies and Personal Care Aides: guidance document (11.01.2022) Checked 12 Oct 2026 · Back to text ↑
22. 22
    Maryland Division of State Documents, COMAR 10.09.84.05, Community First Choice: Conditions for Provider Participation, General Requirements Checked 12 Oct 2026 · Back to text ↑
23. 23
    Maryland Division of State Documents, COMAR 10.09.84.06, Community First Choice: Specific Conditions for Provider Participation, Personal Assistance Checked 12 Oct 2026 · Back to text ↑
24. 24
    Maryland Division of State Documents, COMAR 10.09.84.24, Community First Choice: Payment Procedures Checked 12 Oct 2026 · Back to text ↑
25. 25
    Maryland Division of State Documents, COMAR 10.07.05.22, Amount of Civil Money Penalties Checked 12 Oct 2026 · Back to text ↑
26. 26
    Maryland Department of Health, Proposed action 16-107-P, COMAR 10.07.05 Residential Service Agencies (Maryland Register, April 29, 2016) Checked 12 Oct 2026 · Back to text ↑
27. 27
    Maryland Department of Health, Office of Health Care Quality, Transmittal: Discharge Planning Requirements and Reporting (March 24, 2026) Checked 12 Oct 2026 · Back to text ↑
28. 28
    Maryland Division of State Documents, COMAR 10.07.05.09, Complaint Process Checked 12 Oct 2026 · Back to text ↑
29. 29
    Maryland Division of State Documents, COMAR 10.07.05.15, Maintenance of Records Checked 12 Oct 2026 · Back to text ↑
30. 30
    Maryland Division of State Documents, COMAR 10.07.05.16, Client’s Rights and Responsibilities Checked 12 Oct 2026 · Back to text ↑
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