Selling a home care agency in Maryland

Home health: CON to open, notice to acquire

The Maryland Health Care Commission requires a certificate of need to establish a new home health agency, which limits new entrants. For an acquisition, the rules are lighter: the parties file a Notice of Acquisition at least 60 days before the change, and the acquisition does not go through CON review.

That combination is good for sellers. Buyers who cannot easily get a new CON in a jurisdiction can enter by acquiring, and the 60-day notice is a predictable step rather than a contested review.

Residential service agencies: a new license 45 days ahead

Most personal care, companion, and similar home care businesses in Maryland operate as residential service agencies licensed by OHCQ under COMAR 10.07.05. No one may operate an RSA without that license. On a change of ownership, the future owner applies for a new license at least 45 days before the proposed change, using OHCQ's RSA license application. MHCC has no role in RSA licensing, so no CON is needed.

Build the 45-day lead time into the purchase agreement and make sure the buyer's application is complete early, since an incomplete application can push the closing date.

What moves value for a Maryland agency

The items buyers price most heavily in Maryland:

CON-protected home health

Home health licenses in jurisdictions where new entry needs a CON.

Licensing timeline

The 60-day acquisition notice or the 45-day RSA application.

Caregiver supply

Fill rate, turnover, and wages in a market that competes with DC and Virginia.

Payer mix

Medicare, Medicaid waiver services, and private pay.