How to Get an RSA License in Maryland
A Residential Service Agency (RSA) license is how most new home care businesses in Maryland get the right to operate. Here's exactly what it is, what the application requires, and how we get you licensed — without the back-and-forth.
- What it covers
- Home health care services delivered to clients in their own residence
- Who licenses it
- Maryland Dept. of Health, Office of Health Care Quality (OHCQ)
- Governing regulation
- COMAR 10.07.05
- Certificate of Need?
- Not required
- RN involvement
- Required for oversight of care
What is a Residential Service Agency?
In Maryland, a Residential Service Agency is a business that employs or contracts with people to provide at least one home health care service — for pay — to a sick or disabled person in that person's home. It's the license behind most non-medical and limited-skilled home care agencies in the state.
The RSA is a Maryland-specific license, created under state law and overseen by the Office of Health Care Quality. That's an important detail: rules and requirements you read about for other states don't apply here, which is exactly why a generic, out-of-state policy template so often gets an application sent back.
Most RSA services are paid privately or, for certain skilled levels, through Maryland's Medicaid waiver program. With one exception (durable medical equipment), RSA services are generally not billed to Medicare.
You likely need an RSA license if your agency will…
- Provide personal care — bathing, dressing, grooming, help with daily activities
- Send caregivers or aides into clients' homes for compensation
- Offer skilled services like nursing or therapy in the home (under the right license type)
- Provide companionship or supervision as a paid service to unrelated clients
Not sure whether an RSA is the right fit for what you're planning? That's the most common question we get, and it's exactly what a free consultation sorts out.
The two RSA license types
Maryland issues RSA licenses in two forms. The one you need depends on whether you'll use aides for hands-on personal care.
RSA — Skilled Nursing & Aides
For agencies providing hands-on personal care and activities of daily living, with skilled nursing oversight. This is the most common path for new home care agencies.
- Personal care & ADL support
- Skilled nursing under RN supervision
- Offered across three service levels (below)
RSA — Other
For skilled disciplines provided by licensed staff without aide services.
- Physical, occupational & speech therapy
- Medical social services
- Skilled nursing (RN/LPN only)
- Durable medical equipment (DME) — may qualify for Medicare Part B
The three RSA service levels
Skilled Nursing & Aides licenses are issued at one of three levels, based on the complexity of care you'll provide.
What your RSA application needs
OHCQ reviews a complete packet — and incomplete packets are the number one cause of delays. At a high level, an RSA application typically includes:
- A completed RSA license application
- Policies & procedures compliant with COMAR 10.07.05
- An organizational chart with roles and key staff
- Sample personnel files and sample patient/client files
- Your scope of services: service area, referral sources, payer sources
- A Letter of Good Standing from Maryland SDAT
- Workers' compensation coverage (or an exemption certificate)
- Background checks and required clearances (request these early)
- A designated administrator and nursing supervisor (RN)
- Your business formation (LLC/corporation) and EIN
After your packet is submitted, OHCQ schedules an on-site survey before issuing your license. The strongest predictor of how fast you're approved is how complete and consistent that first submission is — which is the whole point of working with us.
We get you from idea to licensed RSA
We don't hand you a checklist and wish you luck. We build the documents, organize the packet, and stay with you through the survey.
Free consultation
We confirm RSA is the right license and the level you need.
We build your documents
Custom COMAR-compliant policies, procedures, and sample files.
We assemble & submit
A complete packet to OHCQ, with help responding to any questions.
You pass survey
We prep you for the on-site survey and the path to approval.
RSA licensing FAQ
Maryland's OHCQ currently lists no application fee for an RSA license, but you should budget for other startup costs — business formation, insurance, background checks, and your policies and procedures. We'll walk you through the full picture on your consultation, and confirm current fees, since state requirements can change.
It varies, and typically runs several months. The biggest factor is whether your application goes in complete and consistent the first time — incomplete packets are the main cause of delays. Getting it right up front is exactly what we do.
Yes. Maryland requires RN involvement for oversight of care, particularly for the Skilled Nursing & Aides license. We'll help you understand the staffing structure you need before you apply.
RSAs licensed at Level 2 or Level 3 may be eligible to bill through Maryland's Medicaid waiver program. RSAs generally cannot bill Medicare — the main exception being durable medical equipment, which may qualify for Medicare Part B.
No — an RSA does not require a Certificate of Need, which keeps it a faster, simpler path to launch.
A full set of operational policies compliant with COMAR 10.07.05 — covering care delivery, personnel, client rights, recordkeeping, quality, and more. Surveyors check these closely, and writing them correctly for Maryland is the core of what we do.
Ready to Start Your RSA?
Book a free consultation and we'll confirm the right license and level, then map out exactly what it takes to get you approved.
Request a free consultation
Tell us about your plans and we'll be in touch.