Maryland Healthcare Facility Licensure
A practical navigator for MEP engineers, architects, and construction teams working on Maryland healthcare facilities. Maryland splits healthcare regulation between two state bodies: the Office of Health Care Quality (OHCQ) licenses and surveys facilities, while the Maryland Health Care Commission (MHCC) runs Certificate of Need review for capacity-expanding projects. Knowing which body does what — and which order to engage them in — is the difference between a schedule that works and one that doesn't.
The short version
- Two bodies regulate healthcare facilities in MD. The Office of Health Care Quality (OHCQ) under the Maryland Department of Health handles licensure, surveys, and compliance. The Maryland Health Care Commission (MHCC) handles Certificate of Need (CON) review for capacity and service additions.
- OHCQ licenses hospitals, ambulatory surgical centers (ASCs), comprehensive care facilities (nursing homes), assisted living, and related categories.
- MHCC CON review happens before construction. Certain project categories (new hospitals, nursing home expansions, ASC capacity above threshold) require CON or an exemption determination before construction can proceed.
- COMAR governs the regulations. COMAR 10.05.05 covers freestanding ASC licensure. Other facility types live in other COMAR chapters. Nursing homes are referenced in Health-General Article §19-1401.
- FGI Guidelines + NFPA 99/101 + NEC Article 517 are the construction-standard references, incorporated or referenced by MD regulations.
Where to go — primary sources
- Maryland Office of Health Care Quality (OHCQ) — authoritative hub for facility licensure, surveys, and enforcement.
- OHCQ Freestanding Ambulatory Surgical Centers — ASC-specific licensure information.
- Maryland Health Care Commission (MHCC) — authoritative hub for Certificate of Need review.
- COMAR 10.05.05 — freestanding ASC licensure regulation.
- COMAR 10.24.01 — definitions and changes relevant to health care planning.
- Health-General Article §19-1401 et seq. — comprehensive care facilities (nursing homes) statutory framework.
The OHCQ / MHCC split — what construction teams need to know
Maryland's two-body regulatory structure is the most distinctive healthcare-construction feature in the state. Contractors and design teams must understand which agency governs which question:
- MHCC (Certificate of Need) comes first, when applicable. CON covers new hospitals, hospital bed additions, nursing home capacity expansions, ASC expansions above the threshold, and certain high-cost services. The MHCC review establishes that the project is needed; without CON approval (or an exemption determination) for covered projects, construction cannot proceed.
- OHCQ (licensure) handles facility licensure and construction plan review. Once CON is approved (or determined not to apply), OHCQ handles the facility-licensure application and — for new construction — construction plan review against applicable regulations and referenced standards.
- Both bodies inspect. OHCQ surveys for licensure compliance. MHCC may monitor CON project execution against approved scope.
Facility categories and their regulations
- Hospitals — OHCQ licensure; COMAR chapters governing hospital licensure; MHCC CON typically required for new hospitals or significant bed additions.
- Ambulatory Surgical Centers (Freestanding ASCs) — COMAR 10.05.05 for licensure; MHCC CON required for ASCs above the operating-room threshold (generally two or more ORs triggers CN; verify current threshold).
- Comprehensive Care Facilities (Nursing Homes) — Health-General Article §19-1401 et seq. as statutory basis; COMAR implementing regulations; MHCC CON for capacity changes.
- Assisted Living, Hospice, Home Health, and related categories — each with its own OHCQ licensure framework.
How OHCQ construction plan review works
- Verify CON applicability with MHCC. If CON is required, complete that review before committing significant design.
- Design team develops construction documents per the applicable COMAR chapter and referenced FGI / NFPA standards.
- Submit to OHCQ for construction plan review.
- In parallel, submit to local building department under the Maryland adopted building code (IBC + MD amendments).
- Address comments from both review tracks.
- Construct per approved drawings.
- Complete OHCQ pre-licensure inspection.
- Obtain licensure and Certificate of Occupancy.
MEP-specific considerations for MD healthcare construction
- Ventilation. FGI tables drive OR, procedure, PACU, AII, PE room ventilation. Pressure relationships, ACH, and filtration per the referenced FGI edition.
- Medical gas. NFPA 99 governs. MD facilities follow the same federal standard as neighboring states.
- Essential electrical. NFPA 99 + NEC Article 517.
- Life safety. NFPA 101 hospital occupancy provisions: smoke compartments, corridor widths, fire ratings.
- Chesapeake watershed stormwater overlay. MD's Environmental Site Design (ESD) to MEP requirement applies to healthcare construction the same as other development (see our Maryland Stormwater Navigator).
How Maryland differs from neighboring states
- OHCQ / MHCC split. MD's two-body structure is distinct. DE consolidates under DHCQ; PA under DOH; NJ under DOH (but with its own CN program). MD's split means two separate agency relationships on CON-triggering projects.
- CON scope. MD's CON program is active and applies broadly to capacity additions. Compare with PA (no traditional CON), NJ (active CN), VA (COPN).
- COMAR structure. MD's regulations live in COMAR with facility-type-specific chapters; look up each facility's chapter separately.
- ESD stormwater overlay. MD's stormwater ESD-to-MEP requirement applies at the site level for healthcare construction; factor ESD into site layout for new hospital / ASC campuses.
Common pitfalls
- Starting construction design without confirming CON applicability with MHCC.
- Treating OHCQ licensure as covered by CON approval — they're separate processes.
- Submitting to local building department without parallel OHCQ construction review.
- Using an outdated FGI edition mismatched to OHCQ's current reference.
- Forgetting MD's ESD stormwater requirements for site-layout purposes on new campuses.
The practical workflow
- Determine if the project triggers CON. If yes, engage MHCC. Obtain CON approval or exemption determination before committing design.
- Identify the applicable OHCQ licensure category and COMAR chapter.
- Design MEP systems per FGI + NFPA + COMAR references.
- Submit construction drawings to OHCQ for plan review.
- Submit to local building department (IBC + MD amendments) in parallel.
- Address reviewer comments from both tracks.
- Coordinate MD stormwater ESD work with site design per MD Stormwater Navigator.
- Construct per approved drawings.
- Complete OHCQ pre-licensure inspection.
- Licensure issuance + Certificate of Occupancy.
When to get direct help
CON questions: MHCC. A pre-application consultation with MHCC staff before filing is useful for scope-definition questions. Licensure / construction review questions: OHCQ — the facility-type-specific program within OHCQ. For MEP-specific technical interpretations, OHCQ construction review staff can weigh in during plan review.
Why we built this
MD healthcare construction's two-body regulatory structure (OHCQ + MHCC) is the most common mismatch for out-of-state teams. A timeline built around single-agency review misses the CON process entirely, adding months. This page surfaces the split up front so project schedules account for both agencies from day one.
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