Maryland · Residential Service Agency license · Free checklist
Maryland home care license checklist
Every step to a Maryland RSA license, from checking which license you need and lining up your registered nurse to the five attachments, the Section B policy index, the online RSA Certification, OHCQ’s review, your first workers and clients and what recurs, each with the rule or OHCQ source it comes from. Answer a few questions to tailor it, tick steps off as you go and email it to yourself.
- Rule-verified October 2, 2026
- 51 steps, each cited
- Free, no account
Quick answer
If your business employs or contracts with people to give at least one home health care service, such as hands-on personal care, to sick or disabled people at home, you need a license first: "a person shall be licensed by the Department before the person may operate a residential service agency." (Health-General §19-4A-04) It is the Residential Service Agency (RSA) license from OHCQ (COMAR 10.07.05.02B(25)).
You type OHCQ’s application and upload it with five attachments, including your written policies, indexed item by item for the 23 items in COMAR 10.07.05.08B (application, Section B), so the policies come before you apply, not after. "There is no fee to apply for a license." (application)
Steps that cite COMAR or the Health-General Article come from the rules or the statute. Steps that say "OHCQ asks" or "OHCQ says" come from OHCQ’s application (rev. 06.26.2026) or its RSA page; steps that mention 2018 or 2020 rest on OHCQ guidance that is archived and unconfirmed today. Where we add a reading or advice of our own, the step says "by our reading" or "our suggestion". The application, section by section →
Tailor your checklist
Eight quick questions
Your answers stay in this browser. The checklist below updates as you answer.
Household or family support alone needs no license
An agency that provides only household or family support services does not need an RSA license: light housekeeping and home management, meal planning and preparation, shopping and errands, or child care for children who need no medical attention. Companionship is not named in the rules; by our reading, companion work with no hands-on help needs no license either. Confirm with OHCQ. Any help with bathing, dressing, toileting, eating or transfers needs an RSA license: change your first answer if you will offer it.
COMAR 10.07.05.03BA referral-only business is a nursing referral service agency
A business whose only work is screening and referring caregivers for clients to accept or reject, and which gives no home health care service itself, needs a nursing referral service agency license under COMAR 10.07.07, not an RSA license. This checklist covers the RSA. If you will employ or contract with caregivers and send them to clients, change your first answer.
COMAR 10.07.05.02B(25)(b)(vi)That is a home health agency, which needs a Certificate of Need first
An agency giving skilled nursing, home health aide services and at least one other home health care service, centrally administered, must be licensed as a home health agency, and OHCQ says it must first apply for a Certificate of Need from the Maryland Health Care Commission. This checklist covers the RSA: change your first answer to see it.
Home Health Agencies, Certificate of NeedYour checklist
Showing the steps for a new Maryland residential service agency giving personal care to adults, set up as an LLC with an office it rents or owns, with no help with medication, no tube feeding or IV care, and none of the extras that add steps. Answer the questions above to tailor it.
Set up the agency
Fill in and submit the application
OHCQ’s review
Licensed: your first workers and clients
Every year, and when things change
Email me this checklist
We send the checklist with your answers and a link back to it. Nothing else unless you tick the box.
CareRulebook
Tick off “write and adopt your policies” from your answers
Answer a few questions about your agency and CareRulebook writes its Maryland RSA policy and procedure manual: the 23 policy items COMAR 10.07.05.08B lists, in the order OHCQ’s application lists them, and the rest of OHCQ’s RSA rules, with your details filled in and the rule each policy meets quoted under it. With it comes a Section B index of your page numbers for the application. Your agency’s own registered nurse reads and adopts the clinical policies.
- 33 policies, 102 requirements mapped
- Section B index with your page numbers
- Editable Word and PDF
- 12 months of updates: download again after a rule change
$199CareRulebook founding price for the first 50 Maryland agencies, then $249. Not an OHCQ fee.
Frequently asked questions
What do I need to get a home care license in Maryland?
A Residential Service Agency (RSA) license from the Maryland Department of Health’s Office of Health Care Quality (OHCQ), if your business employs or contracts with people to give hands-on help such as bathing, dressing or toileting at home. Before you apply: the business registered with an SDAT letter of good standing, workers’ compensation, a registered nurse to oversee care, a business plan and organizational chart, and your written policies, indexed item by item. Someone with authority over pay completes OHCQ’s online RSA Certification, and you upload the typed application and attachments through OHCQ’s online form.
Do I send my policies with the Maryland application?
Yes. Policies and procedures as specified in COMAR 10.07.05.08B are attachment 3 of OHCQ’s application, and Section B asks, for each of the 23 items, the name of the document and the page numbers, or N/A where you ask OHCQ to waive an item.
Do I need a nurse to open an RSA in Maryland?
Yes, if any client needs help with activities of daily living. The agency must have a registered nurse overseeing the care plan, delegation, supervision and training for those clients, and the nurse supervises care on site at least every 4 months, every 3 months when staff help with self-administered medication, and every 45 days when staff give medication. The rules do not say whether the nurse must be an employee.
How much does the Maryland license cost?
OHCQ’s application says there is no fee to apply. COMAR 10.07.05.04 still prints $1,000, but Chapter 661 of 2018 struck the statutory fee requirement, so by our reading you pay nothing to OHCQ to apply. Once you hire, a State criminal history check costs $38 per worker fingerprinted in person at the Central Repository; that is a DPSCS fee, not a CareRulebook price.
How long does a Maryland RSA license take?
OHCQ does not publish a current processing time. Its 2018 instructions said 2 to 3 months after all documents arrive. OHCQ holds an incomplete application for 180 days, then closes it, so send a complete set at once.
Can I take clients while my application is pending?
No. A person may not operate, attempt to operate, or hold themselves out as operating an RSA unless licensed. In 2020 OHCQ described a provisional license after approval, under which agencies with nurses and aides admitted their first three clients before an on-site survey; we could not confirm that for 2026, so ask the RSA Team.
Is this checklist free?
Yes. It is free to use and to email to yourself. It is guidance, not legal advice, so check each step against the rule or OHCQ source it links to.
Get Maryland rule-change alerts
OHCQ has signalled a 2026 update to the RSA training rules, and COMAR 10.07.05 still prints the fee and renewal rules Chapter 661 of 2018 took out of the statute. Leave your email and we will tell you when a Maryland change affects your checklist or your policies.
No spam. Only emails about Maryland home care rule changes. How we use your email.
Keep reading
Maryland
How to start a home care agency in Maryland
The full guide behind this checklist.
Maryland
The Maryland license application
OHCQ’s form section by section, the five attachments, Section B and waivers, the review, changes and a sale.
Product
Build your Maryland policy manual
The 23 policy items in the application’s order, with a Section B index. Preview free.
Maryland
Maryland RSA policies and procedures
The 23 items you index in Section B, waivers, and the written duties outside the list.
Maryland
Maryland RSA license cost and timeline
No OHCQ fee to apply, other state fees and each step to the license.
Maryland
The registered nurse in a Maryland RSA
Assessment, the plan of care, delegation and the on-site visits.
Maryland
Maryland caregiver background checks
The CJIS or private check and the reference, before work starts.
Tennessee
Tennessee license checklist
The same tool for a TDMHSAS personal support services agency license.
Virginia
Virginia license checklist
The same tool for a Virginia home care organization license.
North Carolina
North Carolina license checklist
The same tool for a DHSR home care license.
Colorado
Colorado license checklist
The same tool for a CDPHE Class B home care agency license.
Washington
Washington license checklist
The same tool for a DOH in-home services license, home care category.
Indiana
Indiana license checklist
The same tool for an IDOH personal services agency license.
Illinois
Illinois license checklist
The same tool for an IDPH home services agency license.
Georgia
Georgia license checklist
The same tool for a Georgia private home care license.
Texas
Texas license checklist
The same tool for a Texas HCSSA license.
Sources
- COMAR 10.07.05, Residential Service Agencies (Regulations .01 to .28; last amended effective March 13, 2017) · Maryland Division of State Documents, Library of Maryland Regulations (Maryland Department of Health rules) · retrieved October 2, 2026
- Health-General Article, §§19-4A-01 to 19-4A-11 (Residential Service Agencies) · Maryland General Assembly · retrieved October 2, 2026
- Health-General Article, §§19-1901 to 19-1912 (criminal history records checks for adult dependent care programs) · Maryland General Assembly · retrieved October 2, 2026
- Health-General Article, §19-401 (home health agencies: definitions) · Maryland General Assembly · retrieved October 2, 2026
- Family Law Article, §§14-101 and 14-302 to 14-305 (protective services for vulnerable adults: reporting) · Maryland General Assembly · retrieved October 2, 2026
- Family Law Article, §§5-701 to 5-705.1 (child abuse and neglect: reporting) · Maryland General Assembly · retrieved October 2, 2026
- COMAR 10.07.07, Nursing Referral Service Agencies · Maryland Division of State Documents, Library of Maryland Regulations · retrieved October 2, 2026
- COMAR 10.09.84, Community First Choice (Medicaid; provider conditions for personal assistance) · Maryland Division of State Documents, Library of Maryland Regulations · retrieved October 2, 2026
- COMAR 12.15.03, Criminal History Records Check for Individuals Who Work for an Adult Dependent Care Program · Maryland Division of State Documents, Library of Maryland Regulations (DPSCS rules) · retrieved October 2, 2026
- COMAR 10.27.11, Delegation of Nursing Functions (Board of Nursing) · Maryland Division of State Documents, Library of Maryland Regulations · retrieved October 2, 2026
- Chapter 661 of 2018 (SB 108), Regulation of Health Care Programs ... Revisions, with the Department of Legislative Services fiscal and policy note · Maryland General Assembly · retrieved October 2, 2026
- Residential Service Agencies · Maryland Department of Health, Office of Health Care Quality · retrieved October 2, 2026
- Application for a Residential Service Agency License (rev. 06.26.2026) · Maryland Department of Health, Office of Health Care Quality · retrieved October 2, 2026
- OHCQ Review of Training Materials Provided by Outside Source: COMAR 10.07.05.11 Outside Trainer Checklist (revised 09.24.2026) · Maryland Department of Health, Office of Health Care Quality · retrieved October 2, 2026
- Home Health Agencies · Maryland Department of Health, Office of Health Care Quality · retrieved October 2, 2026
- Understanding how Maryland’s employee protection laws apply to residential service agencies (RSAs) and personal care aides (PCAs) (Guidance Document, 11.01.2022) · Office of the Attorney General with the Maryland Department of Health and Maryland Department of Labor (posted by OHCQ) · retrieved October 2, 2026
- Residential Service Agencies: Initial License Process (OHCQ slides, 2020; Internet Archive copy of May 12, 2021) · Maryland Department of Health, Office of Health Care Quality · retrieved October 2, 2026
- Instructions for Completion of Residential Service Agency (RSA) Licensure Application (form approved May 2018; Internet Archive copy of November 28, 2020) · Maryland Department of Health, Office of Health Care Quality · retrieved October 2, 2026
- Reporting Suspected Child Abuse or Neglect · Maryland Department of Human Services · retrieved October 2, 2026
- Adult Protective Services · Maryland Department of Human Services · retrieved October 2, 2026
- Background Checks and Fingerprinting Services (Criminal Justice Information System Central Repository fees) · Maryland Department of Public Safety and Correctional Services · retrieved October 2, 2026