Title 19. Health Care Facilities — Subtitle 4A. Residential Service Agencies
Statutes in effect as of October 1, 2026.
Md. Code Ann., Health-Gen. § 19-4A-01 (2026)
Title 19. Health Care Facilities
Subtitle 4A. Residential Service Agencies
§ 19–4A-01LinkCopy Citation
(a)
In this subtitle the following words have the meanings indicated.
(b)
“Home health care” includes any of the following services:
(1)
Audiology and speech pathology;
(2)
Dietary and nutritional services;
(3)
Drug services;
(4)
Home health aide;
(5)
Laboratory;
(6)
Medical social services;
(7)
Nursing;
(8)
Occupational therapy;
(9)
Physical therapy;
(10)
Provision of invasive medical equipment; and
(11)
Home medical equipment services.
(c)
“Home medical equipment services” means the delivery, installation, maintenance, or replacement of, or instruction in the use of, medical equipment used by a sick or disabled individual to allow the individual to be maintained in a noninstitutional environment.
(d)
“Medical equipment” means technologically sophisticated medical devices including:
(1)
Oxygen and oxygen delivery systems;
(2)
Ventilators;
(3)
Respiratory disease management devices;
(4)
Electronic and computer driven wheelchairs and seating systems;
(5)
Apnea monitors;
(6)
Transcutaneous electrical nerve stimulator (T.E.N.S.) units;
(7)
Low air loss cutaneous pressure management devices;
(8)
Sequential compression devices;
(9)
Neonatal home phototherapy devices;
(10)
Feeding pumps; and
(11)
Other similar equipment as defined in regulations established by the Secretary.
(e)
“Personal care aide” means an individual who provides personal care as defined in § 19–301 of this title.
(f)
(1)
“Residential service agency” means any person that is engaged in a nongovernmental business of employing or contracting with individuals to provide home health care for compensation to an unrelated sick or disabled individual in the residence of that individual.
(2)
“Residential service agency” includes any agency that employs or contracts with individuals directly for hire as home health care providers.
(3)
“Residential service agency” does not include:
(i)
A home health agency that is licensed under the provisions of Subtitle 4 of this title;
(ii)
A person required to be licensed as a home health agency under the provisions of Subtitle 4 of this title;
(iii)
A home–based hospice care program that is licensed under the provisions of Subtitle 9 of this title;
(iv)
A hospital that is licensed under the provisions of Subtitle 3 of this title;
(v)
A related institution that is licensed under the provisions of Subtitle 3 of this title;
(vi)
Personal care providers under the Medical Assistance Personal Care Program;
(vii)
Any person practicing a health occupation that the person is authorized to practice under the Health Occupations Article;
(viii)
A nursing referral service agency that is licensed under Subtitle 4B of this title;
(ix)
A group of persons licensed under the same title of the Health Occupations Article practicing as a business; or
(x)
Residential rehabilitation services providers approved under regulations adopted by the State mental health authority.
Md. Code Ann., Health-Gen. § 19-4A-02 (2026)
Title 19. Health Care Facilities
Subtitle 4A. Residential Service Agencies
§ 19–4A-02LinkCopy Citation
This subtitle does not:
(1)
Limit the right of any person who holds a license under this article to act as authorized by that license; or
(2)
Prohibit the care of an individual who relies on treatment in accordance with the tenets and practices of a recognized church or religious denomination and, with or without compensation, is provided care in accordance with those tenets and practices.
Md. Code Ann., Health-Gen. § 19-4A-03 (2026)
Title 19. Health Care Facilities
Subtitle 4A. Residential Service Agencies
§ 19–4A-03LinkCopy Citation
(a)
The Department shall adopt regulations that set standards for the care, treatment, health, safety, welfare, and comfort of individuals who receive home health care services through a residential service agency.
(b)
The regulations shall provide for the licensing of residential service agencies.
(c)
The regulations shall include provisions that:
(1)
Provide for the establishment of residential service agencies;
(2)
Establish qualifications for licensure;
(3)
Set minimum standards for individuals who provide home health care services through a residential service agency;
(4)
Require the residential service agency to screen and verify the character references of all home health care providers that are employed by the residential service agency; and
(5)
Authorize a residential service agency to provide training to a licensed nurse after hire in accordance with § 19–4A–03.2 of this subtitle.
Md. Code Ann., Health-Gen. § 19-4A-03.1 (2026)
Title 19. Health Care Facilities
Subtitle 4A. Residential Service Agencies
§ 19–4A-03.1LinkCopy Citation
(a)
In this section, “supervisory staff” means an individual who supervises direct care staff in the individual’s clinical role.
(b)
This section does not apply to a residential service agency that only provides durable medical equipment.
(c)
(1)
Except as provided in subsection (d) of this section, beginning July 1, 2022, each residential service agency shall ensure that:
(i)
Within 45 days after an individual’s start of employment as part of the residential service agency’s direct care or supervisory staff, the individual is trained to provide the care required by the clients of the residential service agency by, at a minimum, providing 3 hours of online or in–person training regarding dementia, including training regarding:
(1)
An overview of Alzheimer’s disease and dementia;
(2)
Person–centered care;
(3)
An understanding of the assessment and care planning process;
(4)
Activities of daily living; and
(5)
Alzheimer’s disease and dementia–related behaviors and communication; and
(ii)
Each member of the residential service agency’s direct care or supervisory staff receives 2 hours of online or in–person continuing education training regarding Alzheimer’s disease and dementia each calendar year.
(2)
The training required under paragraph (1) of this subsection may be provided by a supervisory staff member who is responsible for developing an individual’s plan of care and assigning appropriate personnel.
(d)
A residential service agency is not required to provide the training:
(1)
Described under subsection (c)(1)(i) of this section if the individual has:
(i)
Provided Alzheimer’s disease or dementia–related direct care or supervisory services for at least 24 consecutive months before beginning employment with the residential service agency; and
(ii)
Received from a residential service agency or other entity a certificate of completion issued under subsection (e) of this section; or
(2)
Described under subsection (c)(1)(ii) of this section if the individual has completed the training described under subsection (c)(1)(ii) of this section in the immediately preceding 12 months.
(e)
A person providing the training described under subsection (c) of this section shall issue a certificate of completion to each individual who completes the training.
(f)
Each residential service agency shall maintain records that indicate the type of training received by each individual who has received a certificate of completion issued under subsection (e) of this section while employed by the residential service agency.
Md. Code Ann., Health-Gen. § 19-4A-03.2 (2026)
Title 19. Health Care Facilities
Subtitle 4A. Residential Service Agencies
§ 19–4A-03.2LinkCopy Citation
(a)
A residential service agency that provides private duty nursing services may employ a licensed nurse who does not meet the clinical experience requirements established by the Department if the residential service agency provides training and a competency evaluation in accordance with this section.
(b)
A residential service agency that seeks to employ a nurse described under subsection (a) of this section shall:
(1)
Establish and implement a training program designed to ensure safe and competent care based on patient needs;
(2)
Ensure the nurse receives clinical supervision by a registered nurse qualified in private duty nursing services;
(3)
Assign the nurse to a qualified preceptor or clinical supervisor until competency is demonstrated;
(4)
Document satisfactory completion of required competency standards in the nurse’s personnel file; and
(5)
Conduct competency evaluations of the nurse:
(i)
Annually; or
(ii)
For disciplinary purposes, on a more frequent schedule as required by the Department.
(c)
A training program and competency evaluation required under this section are subject to approval by the Department.
(d)
This section may not be construed to affect requirements relating to occupational licensure, scope of practice, or standards of care.
Md. Code Ann., Health-Gen. § 19-4A-04 (2026)
Title 19. Health Care Facilities
Subtitle 4A. Residential Service Agencies
§ 19–4A-04LinkCopy Citation
Except as otherwise provided in this subtitle, a person shall be licensed by the Department before the person may operate a residential service agency.
Md. Code Ann., Health-Gen. § 19-4A-05 (2026)
Title 19. Health Care Facilities
Subtitle 4A. Residential Service Agencies
§ 19–4A-05LinkCopy Citation
To qualify for a license, an applicant:
(1)
Shall show that the residential service agency will provide appropriate home health care providers to sick or disabled individuals who may be provided care in the individual’s residence, instead of in a hospital;
(2)
Shall meet any additional requirements that the Department adopts; and
(3)
May not be required to meet the requirements of Subtitle 1 of this title for certificate of need.
Md. Code Ann., Health-Gen. § 19-4A-06 (2026)
Title 19. Health Care Facilities
Subtitle 4A. Residential Service Agencies
§ 19–4A-06LinkCopy Citation
The Department shall:
(1)
Inspect the operations of each residential service agency to determine whether the agency is meeting the requirements of this subtitle and the regulations adopted under this subtitle; and
(2)
Issue, deny, suspend, or revoke a residential service agency license in accordance with the regulations adopted under this subtitle.
Md. Code Ann., Health-Gen. § 19-4A-07 (2026)
Title 19. Health Care Facilities
Subtitle 4A. Residential Service Agencies
§ 19–4A-07LinkCopy Citation
A person may not operate, attempt to operate, or hold one’s self out as operating a residential service agency, unless the person is licensed under this subtitle.
Md. Code Ann., Health-Gen. § 19-4A-08 (2026)
Title 19. Health Care Facilities
Subtitle 4A. Residential Service Agencies
§ 19–4A-08LinkCopy Citation
A person who operates a residential service agency without a license is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $1,000 for the first offense and not exceeding $10,000 for each subsequent offense.
Md. Code Ann., Health-Gen. § 19-4A-09 (2026)
Title 19. Health Care Facilities
Subtitle 4A. Residential Service Agencies
§ 19–4A-09LinkCopy Citation
A person who operates a residential service agency in violation of the regulations adopted under this subtitle is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $1,000. Each day a violation is continued after the first conviction is a separate offense.
Md. Code Ann., Health-Gen. § 19-4A-10 (2026)
Title 19. Health Care Facilities
Subtitle 4A. Residential Service Agencies
§ 19–4A-10LinkCopy Citation
(a)
Except as provided by federal law, licensure under this subtitle does not entitle a residential service agency to reimbursement by a third party payor.
(b)
The Department may reimburse a residential service agency for personal assistance services only if the personal assistance services are provided by an individual classified as an employee.
Md. Code Ann., Health-Gen. § 19-4A-11 (2026)
Title 19. Health Care Facilities
Subtitle 4A. Residential Service Agencies
§ 19–4A-11LinkCopy Citation
(a)
(1)
On or before December 30, 2021, the Office of the Attorney General, in consultation with the Department and the Maryland Department of Labor, shall produce a guidance document concerning the application of employee protection laws in the Labor and Employment Article, to the use of personal care aides by residential service agencies.
(2)
The guidance document required under paragraph (1) of this subsection shall:
(i)
Describe with specific reference to the residential service care industry:
(1)
Relevant definitions of “employ”, “employee”, “employer”, and “independent contractor”;
(2)
The concept of independent contractor misclassification and the potential for legal liability including monetary damages for employees; and
(3)
Steps a residential service agency may take to ensure compliance with the Labor and Employment Article;
(ii)
Be three pages or fewer and, to the extent feasible, written in plain language; and
(iii)
Be revised and updated on an annual basis.
(b)
(1)
As a condition of obtaining an initial license from the Department to operate as a residential service agency and every 3 years thereafter, a residential service agency shall certify to the Department, on a form developed by the Department and through the signature of an individual with authority over the residential service agency’s pay or employment practices, that:
(i)
The individual has read and understood the guidance document produced under subsection (a) of this section; and
(ii)
The residential service agency will comply with the relevant requirements of the Labor and Employment Article.
(2)
On an annual basis, the Secretary shall provide the most current version of the guidance document to each licensed residential service agency.
(3)
A form developed by the Department for use under paragraph (1) of this subsection shall include a checkbox by which a residential service agency that receives Medicaid reimbursement for the provision of home care or similar services by a personal care aide shall indicate whether the residential service agency uses personal care aides designated as independent contractors.
(c)
On or before October 1 each year, each residential service agency receiving Medicaid reimbursement for the provision of home care or similar services by a personal care aide shall report to the Department, on a form or in an electronic manner developed by the Department, the number of personal care aides classified by the residential service agency as:
(1)
Employees; and
(2)
Independent contractors.
(d)
(1)
On or before July 1 each year, the Department shall use the information reported under subsection (c) of this section to create a report concerning:
(i)
Medicaid reimbursement rates;
(ii)
The cost of delivering services; and
(iii)
Aggregated employment classifications of individuals who provide personal care.
(2)
Data included in the report under this subsection:
(i)
May only be in aggregate; and
(ii)
May not identify a specific residential service agency.
(3)
The Department shall submit each report created under paragraph (1) of this subsection to the Senate Finance Committee and the House Health and Government Operations Committee in accordance with § 2–1257 of the State Government Article.