Maryland's corporate-practice-of-medicine doctrine has never been explicitly embraced by the courts; it emerges opaquely from statutes and from positions of the Board of Physicians and the Attorney General, and it centers on the practice of medicine. Behavior analysts are licensed (Health Occupations Article, Title 17; Board of Professional Counselors and Therapists), but Maryland has no PLLC, so an ABA practice uses a Professional Corporation (licensee-owned) (Corporations and Associations Article, Title 5) or a standard LLC, which the Maryland LLC Act allows to render professional services. Because the doctrine is soft outside medicine, a standard LLC is generally workable, so an MSO is usually a structuring choice.
The nine criteria at a glance
- Why Maryland's corporate-practice doctrine is murky
- ABA is a licensed profession in Maryland
- No PLLC: the LLC-versus-PC decision
- Who is allowed to own the practice
- What a management services organization actually is
- When you would still want an MSO in Maryland
- How Maryland would evaluate your arrangement
- Fee design and fee-splitting
- Keeping clinical judgment with the clinician
- How this connects to the rest of your compliance stack
- Setting it up in Maryland: the sequence
- Maryland MSO variables at a glance
- Frequently asked questions
- Where professional advice is essential
Why Maryland's corporate-practice doctrine is murky
Maryland is neither clearly strict nor clearly permissive. Its courts have never explicitly adopted a corporate-practice-of-medicine doctrine. Instead the idea emerges opaquely from a scatter of statutes and from positions taken by the Board of Physicians and the Attorney General, the essential point being that an ordinary corporation should not operate a medical practice through employed physicians in a way that interferes with physician judgment. The Maryland Limited Liability Company Act, which permits LLCs to render professional services, further muddied the picture, even as the Board and the Attorney General have suggested a non-licensee-owned LLC may not practice medicine.
Two things follow for ABA. First, the doctrine is centered on the practice of medicine, and its application to behavior analysis, a separately licensed profession, is uncertain. Second, the softness and ambiguity mean Maryland does not aggressively force a licensee-only structure on a non-medical practice the way a strict state does. The practical answer turns less on a doctrine and more on which entity you choose.
ABA is a licensed profession in Maryland
Maryland began licensing behavior analysts in 2015, after a 2014 law placed the profession under the Board of Professional Counselors and Therapists (Health Occupations Article, Title 17, Annotated Code of Maryland; the behavior-analyst provisions are in Subtitle 6A). Practicing behavior analysis requires the Licensed Behavior Analyst credential, with BCBA certification as the base requirement. So the people delivering ABA must be licensed, while the entity that employs them is governed by the murky corporate-practice picture and by your entity choice.
No PLLC: the LLC-versus-PC decision
Maryland does not recognize the Professional Limited Liability Company. Licensed professionals use one of two main forms: a Professional Corporation (Corporations and Associations Article, Title 5, Subtitle 1), whose shareholders must be licensed in the professional service and which requires the relevant licensing board's involvement, or a standard LLC, which the Maryland LLC Act permits to render professional services. Limited liability partnerships are also available (Corporations and Associations Article, Title 9A). The choice decides ownership: a PC is licensee-owned, while a standard LLC is open to non-licensee owners.
Maryland has no PLLC, so the structural decision is binary: a licensee-only Professional Corporation, or a standard LLC that a non-licensee can own. That choice, not a doctrine, is what drives whether you need an MSO.
Who is allowed to own the practice
If you use a standard LLC, a non-licensee can generally own it and employ licensed behavior analysts, given the soft and medicine-focused doctrine, provided the licensees control clinical decisions and the licensing board's authority is respected. If you use a Professional Corporation, shareholders must be individuals licensed to render the professional service named in the articles (Corporations and Associations Article, Title 5). So a non-licensee owner uses the LLC path; a PC is the licensee-only path, and an MSO is how outside capital reaches a PC structure.
What a management services organization actually is
An MSO is a separate company that provides the non-clinical side of a practice to a clinical entity. The clinical entity employs the licensed clinicians; the MSO employs everyone else and runs the business. A management services agreement ties them together, and the clinical entity pays the MSO a fee. In a strict state the split is mandatory. In Maryland you can often avoid it by using a standard LLC, but the model still has uses.
Business and administrative functions
- Billing and collections
- Scheduling and intake logistics
- Real estate, equipment, and facilities
- Technology and data systems
- Non-clinical HR, marketing, finance
Clinical judgment, in every model
- Clinical and treatment decisions
- Behavior intervention plans
- Clinical supervision
- Professional judgment
- The licensee delivering the professional service
When you would still want an MSO in Maryland
The MSO model still earns its place in three situations. First, the Professional Corporation route: if you use a PC, it must be licensee-owned, and an MSO is how outside capital participates. Second, multistate scale: a single management company across separate, locally compliant clinical entities is cleaner than a different structure in each state. Third, private equity, which prefers a clean, sellable management company. See the practice expansion and sale page for the transaction view.
How Maryland would evaluate your arrangement
Maryland looks at the entity form and at whether clinical judgment stays with the licensee, more than at a clear doctrine. These are the factors that keep a structure clean.
Licensed practitioners
Is everyone delivering ABA a Licensed Behavior Analyst (Health Occupations Article, Title 17)?
Entity form matches ownership
Is a non-licensee owner using a standard LLC, not a PC that requires licensee shareholders (C&A Title 5)?
Clinical decision authority
Do the licensed clinicians, not the management company, control treatment, assessment, and clinical staffing?
Licensing-board authority respected
Does the structure leave the Board of Professional Counselors and Therapists' authority intact?
Fair-market-value fee
If you use an MSO, does the fee track real services rather than disguise a profit transfer?
Federal overlay for Medicaid
For Medicaid clients, does the structure satisfy the federal anti-kickback statute?
Fee design and fee-splitting
Maryland does not impose a percentage-fee ban, so an MSO fee can be fixed, cost-plus, or a percentage, with fixed and cost-plus the safest because they trace to documented services. Standard professional-conduct rules against improper fee-sharing and kickbacks still apply, and for Medicaid clients the federal anti-kickback statute applies on top (42 U.S.C. § 1320a-7b(b)). Set any fee to the fair market value of real services rather than using it to move the practice's profit to the management side.
Keeping clinical judgment with the clinician
The one durable principle behind Maryland's murky doctrine is that the licensee must control the professional service. A non-licensee owner can run the business, but the Licensed Behavior Analyst must keep authority over assessment, treatment, and clinical supervision. Write the operating documents so the business side cannot override clinical decisions, and you stay clear of the place the doctrine still has bite.
How this connects to the rest of your compliance stack
Ownership is one layer. Three others interact with it directly:
- Payor and Medicaid disclosure. Your real ownership stack, including any MSO, is disclosed at enrollment and revalidation (42 C.F.R. Part 455). See Medicaid and insurance mandates.
- Facility licensure. A change in the service model can affect facility and records obligations. See facility licensure and HIPAA.
- Entity structure. The no-PLLC reality and the LLC-versus-PC choice are their own analysis. See entity structures for ABA practices.
Setting it up in Maryland: the sequence
- License the practitioners. Everyone delivering ABA must hold the Maryland Licensed Behavior Analyst credential (Health Occupations Article, Title 17).
- Choose the entity form. A standard LLC (non-licensee ownership generally workable) or a Professional Corporation (licensee-owned; C&A Title 5). Maryland has no PLLC.
- Decide whether you even need an MSO. For a single-state LLC with non-licensee owners, often not. For a PC, multistate, or PE, build one.
- If using an MSO, paper it to fair market value. Define the services and keep the fee tied to them, not to referrals.
- Preserve clinical control. Keep clinical judgment and supervision with the Licensed Behavior Analyst.
- Confirm with Maryland healthcare counsel. The murky doctrine and the no-PLLC entity choice are exactly where advice pays off.
Maryland MSO variables at a glance
| Variable | Maryland value |
|---|---|
| Is ABA a licensed profession? | Yes, since 2015; Licensed Behavior Analyst (Health Occupations Article, Title 17) |
| Corporate-practice doctrine | Never explicitly adopted by the courts; murky; centers on medicine |
| PLLC available? | No; use a standard LLC or a Professional Corporation |
| Non-licensee ownership of the practice | Generally workable through a standard LLC |
| Professional Corporation ownership | Licensees in the professional service only (C&A Article, Title 5) |
| Is an MSO required? | No. Usually optional; used for a PC structure, multistate scale, or PE |
| Percentage management fee | Not banned; fair-market-value fixed or cost-plus is safest |
| Transaction-notice or PE-review law | None as of June 2026 |
| Key authorities | Md. Health Occupations Article, Title 17; Corporations and Associations Article, Title 5 and Title 9A |
Frequently asked questions
Do I need an MSO to run an ABA practice in Maryland?
Does Maryland have a PLLC?
Can a non-licensed investor own my Maryland ABA practice?
Are behavior analysts licensed in Maryland?
Does Maryland require notice before a practice sale or investment?
Where professional advice is essential, not optional
Maryland's answer turns on a murky doctrine and a binary entity choice, which is exactly the kind of ambiguity where counsel earns its fee. Confirm the structure with Maryland healthcare counsel before bringing in an outside owner or building an MSO.
The governing authorities to know are the behavior-analyst licensure provisions (Health Occupations Article, Title 17, Annotated Code of Maryland), the Professional Corporation provisions (Corporations and Associations Article, Title 5, Subtitle 1), the LLP provisions (Corporations and Associations Article, Title 9A), and the Maryland Limited Liability Company Act for the standard-LLC path, with the federal anti-kickback statute (42 U.S.C. § 1320a-7b(b)) layered on for Medicaid.
This page describes general patterns in a regulatory environment that changes. The Maryland Board of Professional Counselors and Therapists, the Maryland Board of Physicians, the State Department of Assessments and Taxation, and qualified counsel provide current requirements. Neither this page nor any secondary source should be relied on in place of direct verification with the relevant authorities and counsel.