Maryland · Step-by-step licensing guide
How to start a home care agency in Maryland
To start a home care agency in Maryland, you need a Residential Service Agency (RSA) license from the Maryland Department of Health, Office of Health Care Quality, under COMAR 10.07.05. The path: form the entity with SDAT, complete the worker-classification certification, write the policy manual the application indexes page by page, file the free application, and pass the prelicensure review.
Informational summary of Maryland regulations, not legal advice. We are not affiliated with any state agency. Verify current requirements with the Maryland Department of Health, Office of Health Care Quality (OHCQ).
Step 1: What legal entity do you need to form?
Form the business with the Maryland State Department of Assessments and Taxation (SDAT): the Articles of Organization for a Maryland LLC is $100 per SDAT's Corporate Charter fee schedule, with a $50 expedited-service fee where it applies. Two SDAT-adjacent documents are required application attachments: the SDAT Letter of Good Standing and proof of workers' compensation coverage or exemption.
- File the Articles of Organization with SDAT; the domestic filing fee is $100 per the published Corporate Charter fee schedule, plus $50 for expedited service where it applies.
- Order the Letter of Good Standing once the entity is active; OHCQ requires it in the application packet along with workers' comp proof.
- There is no Certificate of Need for RSAs; CON applies to Maryland home health agencies under COMAR 10.07.10, a different license.
Step 2: What pre-license requirements do you have to meet?
Before filing, complete the mandatory online RSA Certification on personal-care-aide worker classification under Health-General §19-4A-11, required for every applicant even if you never plan to hire personal care aides, and set up the caregiver screening system of COMAR 10.07.05.10: criminal history check, licensure verification, TB and health screening, references, employment history, identity verification, an in-person interview, and a skills assessment before referral.
- The RSA worker-classification certification (Health-General §19-4A-11) renews every 3 years and applies to every applicant; Maryland actively polices aide misclassification.
- Independent-contractor caregivers are expressly permitted (COMAR 10.07.05.03E), but every contractor goes through the identical .10B screening.
- Plan the nursing line now: ADL assistance runs through certified nursing assistants performing RN-delegated tasks, with RN supervisory visits at 45-day to 4-month intervals depending on medication involvement (COMAR 10.07.05.10E, .12E). Most personal-care RSAs retain a part-time or contract delegating RN.
- Prepare the business-plan attachments the application requires: a one-year operating budget, marketing plan, and service description (COMAR 10.07.05.04A(2)(h)).
Step 3: What goes in the written policy and procedure manual?
Maryland is unusually explicit: COMAR 10.07.05.08B enumerates the required policy set, and the RSA application form makes you index each required policy to the document name and page number in your own manual, roughly 23 line items surveyors then check against the rules. Genuinely inapplicable items, like biomedical waste for a non-skilled agency, can be waived in writing (.08B(2)). Every mandated policy, with its citation:
Administrative policy set: scope of services, care-coordination delineation and client notification, admission criteria, pre-acceptance assessment, billing and service records, and the quality assurance program
COMAR 10.07.05.08B(1)(a)
Clinical management: assessment, plans of care, delegation and supervision, the RN-oversight policy that anchors the staffing model
COMAR 10.07.05.08B(1)(a)(viii)
Personnel policies: job descriptions with educational qualifications, skill assessments, and health requirements for every employee and contractor
COMAR 10.07.05.08B(1)(b)
Patient-care policies: service provision with criteria for identifying the need for skilled services, drug administration, client-monitoring frequency, and client/family training
COMAR 10.07.05.08B(1)(c)
Informed-consent policies with signed forms: plan-of-care changes, and nonlicensed assistance with routine treatments or medication self-administration
COMAR 10.07.05.08B(1)(d)
Environment and safety: supply preparation and storage, infection control, biomedical-waste disposal (waivable if inapplicable), equipment maintenance, and emergency procedures
COMAR 10.07.05.08B(1)(e)
Employee and contractor screening: criminal history check, licensure/certification verification, TB and health screening, references, employment history, I-9 and identity verification, an in-person interview and a skills assessment before referral
COMAR 10.07.05.10A-B
Internal client complaint process with investigation protocols, non-disruption of services, and the state complaint-hotline notice
COMAR 10.07.05.09
Client rights and cost disclosures: itemized cost estimate, caregiver names and supervisor contact, 24/7 phone number, subcontract disclosure, plus the dignity, participation, refusal, privacy and complaint rights statement
COMAR 10.07.05.16C-D
Client representative recognition and documentation (guardians, powers of attorney, surrogates)
COMAR 10.07.05.13
Clinical records, with the simplified non-skilled record set (nursing assessment, plan of care, services provided, significant changes) and care notes at admission, weekly, and on significant change
COMAR 10.07.05.14
Record retention and confidentiality: 5 years after discharge (longer for minors), complete record within 30 days of discharge
COMAR 10.07.05.15
The 7-topic training program: personal-care instruction with supervised practice, RN-referral triggers, recordkeeping, ethics and confidentiality, CPR, standard precautions, and abuse/neglect prevention; outside trainers need OHCQ written approval
COMAR 10.07.05.11B-C
Governing authority that convenes at least annually to review policies, with minutes recording participants, agenda and actions
COMAR 10.07.05.08A
Advertising compliance: every ad carries the license number and the exact statement “Licensed as a residential service agency by the Maryland Department of Health, Office of Health Care Quality”
COMAR 10.07.05.06
Every policy above, written out to COMAR 10.07.05 (Health-General Title 19, Subtitle 4A) with the citation beside it:
Step 4: How do you submit the application?
Through OHCQ's online license-application portal, typed, since handwritten forms are rejected, with no application fee. The packet must include the indexed policy manual, the one-year budget and marketing plan, the organizational chart and ownership disclosures, the SDAT Letter of Good Standing, and workers' comp proof. Incomplete applications are administratively closed after 180 days, so assemble the full packet before filing.
- There is no fee to apply; the license fee is $1,000, nonrefundable, per 3-year term (COMAR 10.07.05.04A(2)(k)).
- The 180-day completeness clock is real: OHCQ closes stale applications, and you start over.
Step 5: What happens at the prelicensure review, and after?
OHCQ reviews the packet and conducts announced or unannounced prelicensure inspection (COMAR 10.07.05.04D, .07), checking the manual against the rules it was indexed to. A failed prelicensure compliance visit costs $250 per additional visit (.04K). OHCQ publishes no statutory deadline, and practical reports run roughly 4 to 6 months from filing to license.
- The license runs 3 years (.04H); renewal requires updated policies, employee credentials, and the annual data survey (.04I).
- The controllable variable is filing complete: the finished manual, business plan, good-standing letter, and workers' comp proof in one packet.
What it costs to start a home care agency in Maryland
| Item | Cost | Where the figure comes from |
|---|---|---|
| State application fee | $0 | Maryland charges nothing to apply for the RSA license; OHCQ application materials. |
| License fee | $1,000 | Nonrefundable, per 3-year term, COMAR 10.07.05.04A(2)(k). Older guides still quote a stale $500 figure. |
| Entity formation (Maryland LLC, Articles of Organization) | $100 | SDAT Corporate Charter fee schedule, domestic filing; $50 more for expedited service where it applies. |
| Failed prelicensure re-visit | $250 per visit | Charged for each additional on-site visit after a failed prelicensure compliance review (COMAR 10.07.05.04K). |
| Caregiver screening and delegating RN | Varies, see your vendors | Per-worker checks under COMAR 10.07.05.10 and the RN retainer most personal-care RSAs carry are priced by the vendor, not the rule. |
| Policy & procedure manual | $149 | Our made-to-order COMAR 10.07.05 manual, pre-organized to the citations the application indexes; start-up consultants charge $1,000 to $4,000 for the same document. |
Only the figures with a citation are verified; “varies” cells are set by the named program or vendor, not by COMAR 10.07.05. Fees change, so confirm each with OHCQ and SDAT before relying on it.
Common mistakes that stall Maryland applications
Filing before the packet is complete
OHCQ administratively closes applications still incomplete after 180 days, and practical reports already run 4 to 6 months when you file clean. A missing good-standing letter, budget, or policy index entry quietly burns the clock.
Skipping the worker-classification certification
The online RSA Certification under Health-General §19-4A-11 is required for every applicant, even agencies that never plan to hire personal care aides, and renews every 3 years. It is a named prerequisite, not a formality Maryland waives.
Assuming “non-medical” means no nurse
Maryland routes ADL assistance through certified nursing assistants performing RN-delegated tasks, with RN supervisory visits at least every 4 months even without medications (COMAR 10.07.05.10E, .12E). Budgeting no delegating RN is the cost surprise most out-of-state guides never mention.
Bringing a manual the index table can't map
The application makes you cite each COMAR 10.07.05.08B policy by document name and page number in your own manual. A generic national template organized to no citation scheme turns that table into a research project, and surveyors then check the manual against the rules line by line.
A fraction of the start-up consultant’s price.
Start-up consultants charge $1,000–$4,000 to assemble these documents by hand, and instant template shops are instant because they sell everyone the same generic document. Every manual is made to order: built from your agency details, organized to your state's rules, and delivered within 3 business days, with a full refund anytime before delivery. Founding pricing is limited to the first 25 agencies; after that the State P&P Manual is $199.
Delivered within 3 business days, with a full refund anytime before delivery. This is a self-prepared operational document you adopt for your own agency, not legal advice, and not a guarantee of license approval.
Maryland licensing FAQ
How much does it cost to start a home care agency in Maryland?
There is no fee to apply; the RSA license fee is $1,000, nonrefundable, per three-year term under COMAR 10.07.05.04A(2)(k), plus $250 per additional on-site visit if you fail the prelicensure compliance review. Forming a Maryland LLC costs $100 with SDAT. Budget separately for caregiver screening, a delegating RN, and the indexed policy manual.
How long does it take to get an RSA license in Maryland?
OHCQ publishes no statutory deadline. Incomplete applications are administratively closed after 180 days, and practical reports run roughly 4 to 6 months from filing to license. The controllable variable is filing complete: the finished policy manual, business plan with one-year budget, good-standing letter, and workers' comp proof in one packet.
Do I need a policy and procedure manual in Maryland?
Yes, and the application proves it: COMAR 10.07.05.08B enumerates the required policy set, and the RSA application form makes you index each policy to the page number in your own manual, roughly 23 line items. OHCQ surveyors then check the manual against the rules during the prelicensure review.
Can I use a generic template manual?
You can try, but the application's index table demands a manual organized to the COMAR 10.07.05 citations, and surveyors verify Maryland-specific content: the .10 screening protocol, the .11B seven-topic training program, the .16C-D client-rights and cost disclosures, and the .06 advertising statement with your license number. Generic templates map to none of that.
Do I need a license for companion-only care in Maryland?
Not if you provide only household or family support services, the IADL-only model with no hands-on personal care, which is exempt under COMAR 10.07.05.03B. The moment staff assist with bathing, dressing, transfers, feeding, or toileting, the Residential Service Agency license is required.
Comparing states? Fees, timelines, and mandated policies for every state we cover, side by side.
Home care license requirements by state →Sources
- health.maryland.gov/ohcq/Pages/Residential-Service-Agencies.aspx
- regs.maryland.gov/us/md/exec/comar/10.07.05.08
- health.maryland.gov/ohcq/docs/Applications/APPLICATION_RSA-License-06.26.2026-A.pdf
- mgaleg.maryland.gov/mgawebsite/Laws/StatuteText?article=ghg§ion=19-4A-11
- dat.maryland.gov/businesses/documents/fees.pdf
Last verified: July 15, 2026. Informational summary, not legal advice; not affiliated with any state agency. Regulations and fees change, so confirm current requirements with the Maryland Department of Health, Office of Health Care Quality (OHCQ) before relying on them.
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