• What is a Residential Service Agency?
• What is the difference between a home health agency and a residential service agency?
• How do I apply for an RSA license?
• How long does the application process take?
• Why do I need a registered nurse (RN)?
• If I am a durable medical equipment company (DME), why must I have licensed employees?
• How do I get clients?
• How much do I charge patients/clients?
• What is included in the employee file?
• What do I do if our office moves?
• Where can I obtain additional information about RSAs?

Q. What is a Residential Service Agency?

A. A residential service agency is a business entity that provides at least one home health care service. This may include such services as aides only, nursing and aide services or home medical equipment. Residential service agencies may not provide comprehensive services as described in question #3.

Q. What is the difference between a home health agency and a residential service agency?

A. The most important differences in these two agencies are:

• Home health agencies must provide at a minimum-skilled nursing services, home health aides, and one or more other services such as physical therapy, occupational therapy, medical social services, and home medical equipment.
• Residential services agencies cannot provide skilled nursing, home health aides & one other services. (if these services are provided, you are defined as a home health agency). Services such as aides only, or skilled nursing and aides, or home medical equipment only may be provided.
• Home health agencies can participate in the Medicare program. Residential service agencies cannot be Medicare providers.
• Home health agencies require a certificate of need (CON) prior to licensure. Residential service agencies do not require CON approval.

Q. How do I apply for an RSA license?

A. Call the Office of Health Care Quality (OHCQ) at 410-402-8267 or write to

Ambulatory Care Unit
Office of Health Care Quality
55 Wade Avenue
Bland Bryant Building
Catonsville, MD 21228.

If you have indicated to the Office of Health Care Quality (OHCQ) that you are interested in obtaining a Residential Services Agency (RSA) license for skilled nursing with aides you must complete the following:

Prior to completion of the licensure process, which will include an on-site survey of your agency; the following items must be completed and submitted to OHCQ before requesting a provisional license and admitting patients:

• An organizational chart that includes all positions with the name of the person in that position.
• Hiring of a registered nurse who will be responsible for the oversight of the skilled nurses and aides. The job description, resume and contract for this person must be submitted prior to receipt of the provisional license.
• Development of policies and procedures as required by COMAR 10.07.05, RSA regulations.
• Assembly of a sample personnel file.
• Assembly of a sample patient file for adult patients and pediatric patients, if applicable.
• The Scope of Services to be provided by the agency, including services to be provided, geographic area of services, accepted referral sources, and accepted payer sources.

Q. How long does the application process take?

A. The approval process takes up to 6 months. Each applicant’s policies and procedures and application are given up to 3 reviews. After the 3rd review, if you still have missing/incomplete and/or inconsistent information, your application for RSA will be denied.

Q. Why do I need a registered nurse (RN)?

A. If the RSA provides aides to perform personal care such as bathing, dressing, hair care, nail care, ambulation and range of motion, the RN must perform an initial assessment of each patient/client to determine their individual needs. The RN then formulates a care plan and selects the type of aide services that each person requires. Refer to the Maryland Nurse Practice Act, COMAR Title 10, Subtitle 27, for the scope of services of the RN.

Q. If I am a durable medical equipment company (DME), why must I have licensed employees?

A. The DME needs medical licensed employees if the DME is providing services that can only be performed by a healthcare professional that must be licensed under the Health Occupations Article, Annotated Code of Maryland.

Q. How do I get clients?

A. The OHCQ does not provide a client list to providers. You may advertise in the local paper, phone book, or by others means.

Q. How much do I charge patients/clients?

A.The OHCQ does not set the rate nor provide rates that are charged to patients/clients. How much you charge an individual is determined and agreed upon by the RSA provider and patient/client.

Q. What is included in the employee file?

A. The personnel file for each employee includes, but is not limited to, the individual’s employment application, proof of criminal background check, signed job description, a skills assessment by the RN, a written competency test by the aide, evidence of completed in-service requirements, and compliance with health requirements.

Q. What do I do if our office moves?

A. Submit a letter to OHCQ documenting any changes (address, phone number, etc.).

Q. Where can I obtain additional information about RSAs?

A. Code of Maryland Regulations COMAR 10.07.05 Residential Service Agencies contains state licensure requirements and standards. The regulation booklet may be purchased from OHCQ for $5.00 each, prepaid. Add the link for the website page that lists our regulations.

Web sites with useful information:

Business License Information System (BLIS) - www.blis.state.md.us. You may perform a keyword search or search on an industry to learn about the permits and licenses that a Maryland business may need.

Medicare for DMEs - www.palmettogba.com. The National Supplier Clearinghouse (NSC) is the national entity contracted by the Centers for Medicare & Medicaid Services (CMS) that issues Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) supplier authorization numbers.

Maryland Board of Nursing (BON) - www.mbon.org. The mission of the Board of Nursing is to assure safe competent nurses and nursing care for the citizens of Maryland by: determining qualifications for licensure, facilitating licensure examinations, issuing licenses to practice, developing and implementing regulations, monitoring nursing practice, enforcing standards of practice and education, and educating the community. The Board gets its authority from Health Occupations Article, Section 8, Annotated Code of Maryland. The Board regulates the practice of registered nurses, licensed practical nurses, nurse anesthetists, nurse midwives, nurse practitioners and nursing assistants.

Maryland Division of State Documents (DSD) - www.dsd.state.md.us. The DSD publishes and compiles all state regulations in the Code of Maryland Regulations. Regulations may be downloaded and printed from the DSD website. Printed regulations are available for reference use at most public libraries in Maryland.

Maryland General Assembly (MGA) – www.mlis.state.md.us. The MGA website provides online access to the Annotated Code of Maryland (state laws). Laws may be downloaded and printed from the website. The Code is available for reference use at all public libraries in Maryland.