1. Program Definition and Services 

Home Care Services in Maryland focus on providing non-medical assistance to individuals, such as seniors or people with disabilities, to help them maintain independence and quality of life within their homes. Services include: 

• Assistance with activities of daily living (ADLs) such as bathing, dressing, grooming, and eating 

• Light housekeeping, meal preparation, and laundry 

• Medication reminders 

• Companionship and supervision 

• Transportation for errands or appointments 

• Respite care for family caregivers 

These services are flexible and can range from a few hours per week to comprehensive daily support, depending on the individual's needs 

2. Regulations 

Home Care Services in Maryland are governed by COMAR 10.07.05 (Residential Service Agencies), which outlines the standards for agencies providing non-medical care. If skilled medical care is involved, it falls under COMAR 10.09.04 or COMAR 10.07.10 for Home Health Agencies 

3. Licensing or Certification 

Providers must obtain a Residential Service Agency (RSA) license if offering non-medical home care services (COMAR 10.07.05). If the agency provides skilled nursing or medical services, a Home Health Agency (HHA) license is required under COMAR 10.07.10. 

Key distinctions: 

• RSA License: Covers non-medical services such as personal care and homemaking. 

• HHA License: Covers skilled medical services like nursing and therapy, requiring a Certificate of Need (CON) from the Maryland Health Care Commission (MHCC)  

4. Responsible State Agency 

The Maryland Department of Health's Office of Health Care Quality (OHCQ) oversees licensing for both RSA and HHA providers 

5. Application Process 

The application process varies based on the type of license: 

• For RSA License: 

• Submit an application to the OHCQ. 

• No Certificate of Need (CON) is required. 

• For HHA License: 

• Obtain a CON from the Maryland Health Care Commission (MHCC) before applying for licensure with OHCQ. 

• Follow the CON review schedule and submit a letter of intent and application as per COMAR 10.24.01 

6. Required Documentation 

Providers must prepare the following documentation: 

• Business plan detailing services offered 

• Policies and procedures for service delivery 

• Proof of liability insurance 

• Staff qualifications, including certifications for aides or nurses 

• Emergency preparedness plans 

• Compliance with health and safety regulations 

• For HHAs: CON approval documentation from MHCC 

7. Timeline for Approval 

The timeline depends on the type of license: 

• RSA License: Approval typically takes several weeks after submission to OHCQ. 

• HHA License: The CON process can take several months due to review schedules and requirements by MHCC before licensure approval 

8. Pre-Application Process 

For HHAs, a pre-application process involves obtaining a Certificate of Need (CON) from MHCC: 

• Submit a letter of intent with details about your proposed services. 

• Await approval before proceeding with the formal application process. 

• There is no pre-application process required for RSA licenses 

9. Pre-Application Training 

While specific pre-application training is not mandated, providers should ensure staff are trained in: 

• Personal care techniques 

• First aid and CPR certification 

• Infection control practices 

• HIPAA compliance for handling client information 

10. Additional Notes 

• Home care services are generally not covered by Medicare unless they fall under skilled medical care provided by an HHA. 

• Medicaid may cover some home care services through waiver programs like Community First Choice (CFC). 

• Providers offering both non-medical and skilled services must obtain both RSA and HHA licenses. 

• Agencies must maintain records for at least six years as per COMAR regulations