The short answer Maryland licenses non-medical and private-duty care as Residential Service Agencies (RSAs) through OHCQ, while Medicare-style home health agencies are separately licensed with CON.
What Maryland requires
Maryland
Licensing agency. The Maryland Department of Health, Office of Health Care Quality (OHCQ), licenses Residential Service Agencies under Md. Code, Health-Gen. § 19-4A-01 et seq. and COMAR 10.07.05, and home health agencies under § 19-401 et seq. and COMAR 10.07.10.
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RSA license. The RSA license covers personal care, companion, and private-duty nursing services — the workhorse license for home care in Maryland since new home health agency licenses require a Certificate of Need.
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Surveys. OHCQ conducts initial licensure surveys and periodic/complaint surveys with plan-of-correction requirements; RSA licenses are issued on a three-year cycle with a $1,000 nonrefundable license fee.
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Recent scrutiny. Maryland has increased RSA enforcement in recent years (staffing-agency lookalikes and Medicaid personal-assistance fraud), so expect closer application vetting and more complaint-driven surveys.
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The federal baseline (applies in every state)
Federal
No federal home care license. There is no federal license for home care or home health agencies. Licensure is a state function: each state (and DC) decides whether and how to license home health agencies and non-medical personal care/companion agencies, so requirements vary dramatically by jurisdiction.
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Medicare certification (42 CFR Part 484). Agencies that bill Medicare for skilled home health must be certified as meeting the Medicare Conditions of Participation at 42 CFR Part 484 (patient rights, comprehensive assessment, QAPI, skilled professional services, home health aide standards, and more), on top of any state license.
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Accreditation with deemed status. Most new Medicare home health agencies obtain certification through a CMS-approved accrediting organization with deeming authority — ACHC, CHAP, or The Joint Commission — whose surveys substitute for the state agency's Medicare certification survey.
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State survey agencies enforce both. State survey agencies (usually the state health department) operate under agreements with CMS to survey Medicare-certified agencies, and most also run the state licensure survey program — initial surveys, renewal/recertification surveys, complaint investigations, and plan-of-correction enforcement per the CMS State Operations Manual.
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