Delaware - Assistive Technology Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

The Delaware Department of Health and Social Services (DHSS), through the Division of Developmental Disabilities Services (DDDS) and the Division of Medicaid and Medical Assistance (DMMA), authorizes Assistive Technology Services under the 1915(c) Lifespan Waiver and the 1915(i) State Plan HCBS benefit. This service encompasses the evaluation, procurement, and training for devices that increase a participant's functional capability and reduce their reliance on paid staff.

Prospective providers must secure an award through the Division of Management Services (DMS) continuous Request for Proposals (RFP) process on the Bonfire Hub and pass the DDDS Authorized Provider Committee interview before executing a contract with the DDDS Office of Business Supports and Services (OBSS). Applicants cannot enroll directly in the Medicaid portal for this waiver service without first obtaining a Qualified Provider Authorization Letter from DDDS.

1. Service Definition and Scope

In Delaware, Assistive Technology under HCBS waivers includes items, equipment, or product systems used to increase, maintain, or improve functional capabilities of participants. It also covers the evaluation of the participant's needs and training for the participant or their caregivers on how to use the equipment.

This service is strictly the payer of last resort. Any device or equipment that is covered under the standard Delaware Medicaid State Plan as Durable Medical Equipment (DME) must be billed to the DME program first.

• Evaluation: Functional assessment of the participant's need for assistive technology in their customary environment.
• Acquisition: Purchasing, leasing, or otherwise providing for the acquisition of assistive technology devices.
• Maintenance: Repairing or replacing defective parts of authorized assistive technology devices.
• Training: Instruction for the participant, family members, or paid support staff on the operation and maintenance of the device.
• Exclusions: Items that are not of direct medical or remedial benefit to the participant, or items available via standard Medicaid DME.

2. Regulatory and Oversight Agencies

The Delaware Department of Health and Social Services (DHSS) serves as the umbrella agency. Within DHSS, the Division of Developmental Disabilities Services (DDDS) operates the HCBS waivers and manages provider authorization.

The Division of Medicaid and Medical Assistance (DMMA) oversees the Medicaid State Plan and MMIS system, while the Division of Management Services (DMS) handles the mandatory procurement and RFP processes.

• Department of Health and Social Services (DHSS): Umbrella agency overseeing all health divisions (https://dhss.delaware.gov/dhss/).
• Division of Developmental Disabilities Services (DDDS): Operating agency for the Lifespan Waiver and provider authorization (https://dhss.delaware.gov/dhss/ddds/).
• Division of Medicaid and Medical Assistance (DMMA): Single State Medicaid Agency managing enrollment and MMIS (https://dhss.delaware.gov/dhss/dmma/).
• Division of Management Services (DMS): Manages the mandatory RFP procurement process via Bonfire Hub (https://dhss.delaware.gov/dhss/dms/).
• Gainwell Technologies: The fiscal agent operating the Delaware Medical Assistance Portal (https://medicaid.dhss.delaware.gov/).

3. Gatekeeping Prerequisites: Who Can Even Apply

Delaware utilizes a strict procurement and committee review gate for HCBS waiver providers. An applicant cannot simply submit a Medicaid enrollment application; they must first respond to the open and continuous Request for Proposals (RFP) titled 'Home and Community Based Services for Individuals with Intellectual and Developmental Disabilities' through the DMS Bonfire Hub.

Concurrently, the agency must submit a comprehensive application to the DDDS Authorized Provider Committee and pass a mandatory 60-minute interview and presentation. Only after scoring passing marks on the interview and receiving a Qualified Provider Authorization Letter can the entity proceed to Medicaid enrollment.

• RFP Submission: Mandatory response to the continuous HCBS RFP via the Delaware DHSS Bonfire Hub.
• Authorized Provider Committee Interview: A 15-minute presentation and 45-minute Q&A session with DDDS leadership.
• Qualified Provider Authorization Letter: The physical document issued by DDDS required to unlock the Gainwell Medicaid enrollment portal.
• Business Licensure: Must hold an active Delaware State Business License or proof of 501(c)(3) status prior to application.

4. Licensure and Certification Requirements

Delaware does not issue a distinct 'Assistive Technology Agency' license through the Office of Health Facilities Licensing and Certification (OHFLC). Instead, providers are approved based on their adherence to DDDS Provider Standards and their business credentials.

Providers must maintain a standard Delaware State Business License and comply with all DDDS policies, including the Essential Elements to a Medicaid Compliance Plan.

• State Business License: Required from the Delaware Division of Revenue.
• DDDS Provider Standards: Must attest to and comply with the comprehensive standards published by DDDS.
• Medicaid Compliance Plan: Must adopt the 'Essential Elements to a Medicaid Compliance Plan' as required by DHSS.
• Vendor Status: Assistive Technology can be offered by a vendor enrolled as a Medicaid provider but not necessarily certified as a traditional direct-care DD provider.

5. Medicaid Provider Enrollment

Once the Qualified Provider Authorization Letter is obtained from DDDS, the provider must enroll through the Delaware Medical Assistance Portal operated by Gainwell Technologies.

Applicants select 'Enrollment Application' on the portal, input their NPI, and upload the DDDS authorization letter, business license, and W-9. The system generates an Application Tracking Number (ATN) to monitor status.

• Enrollment Portal: Delaware Medical Assistance Portal via Gainwell (https://medicaid.dhss.delaware.gov/).
• Required Uploads: Qualified Provider Authorization Letter, Delaware Business License, and IRS Form W-9.
• Application Tracking Number (ATN): Issued upon initiating the application to resume or check status.
• Provider Services Call Center: Available for enrollment assistance at 1-800-999-3371.

6. Staffing, Training and Background Checks

Any personnel interacting directly with waiver participants to evaluate or train them on assistive technology must pass comprehensive background checks as mandated by Delaware law.

This includes screening against state abuse registries and completing DDDS-mandated training regarding the participant's specific service plan and disability needs.

• Age Requirement: All personnel must be at least 18 years of age.
• Criminal Background Check: Required in accordance with state requirements.
• Adult Abuse Registry: Screening required per 11 Del. C. Sections 8563 and 8564.
• Child Abuse Registry: Screening required per 11 Del. C. Sections 8563 and 8564.
• Service Letters: Must obtain service letters from previous employers in accordance with 19 Del. C. Section 708.

7. Documentation, Policies and Records

Providers must maintain detailed records justifying the need for the assistive technology and proving that the item is not covered by the Medicaid State Plan.

Documentation must link the device directly to an outcome in the participant's person-centered service plan.

• Service Plan Alignment: The AT device must be explicitly associated with at least one outcome in the participant's service plan.
• DME Denial Proof: If the item is potentially covered by Medicaid DME, a copy of the Medicaid denial letter must be kept on file.
• Invoices and Receipts: Detailed purchase records must be maintained for manual pricing and auditing.
• Training Logs: Documentation of the date, time, and content of training provided to the participant on device usage.

8. Billing, Rates and Claims

Claims for Assistive Technology are submitted through the Gainwell MMIS portal. Because AT encompasses a wide variety of custom devices, reimbursement is often manually priced.

Providers are typically paid the lower of their billed charges or the Medicaid rate published in the fee schedule. For items without an established rate, DDDS and OBSS establish billing rates based on invoice costs during the final contracting phase.

• Prior Authorization: All AT purchases must be prior-authorized by DDDS before the item is acquired.
• Manual Pricing: Items without a set fee schedule rate are manually reviewed and reimbursed based on invoice cost.
• Payer of Last Resort: Providers must bill Medicare or standard Medicaid DME before billing the waiver AT service code.
• OBSS Contracting: Final billing rates and contract terms are established during a mandatory meeting with the DDDS Office of Business Supports and Services.

9. Approval Sequence and Timeline

The DDDS provider approval process is divided into four distinct phases: Information Gathering, Application/Interview, Medicaid Enrollment/RFP, and Final Approval.

The entire process, from submitting the RFP on Bonfire to executing the final contract with OBSS, typically takes 3 to 6 months depending on the completeness of the application and the quarterly review schedule of the DMS Procurement Office.

• Phase 1 (Information Gathering): Reviewing DDDS standards, HCBS Service Options, and completing mandatory overview sessions.
• Phase 2 (Application & Interview): Submitting the zipped PDF application to the Auth Committee and passing the 60-minute interview.
• Phase 3 (Medicaid & RFP): Enrolling in Gainwell and submitting the formal RFP bid via Bonfire Hub.
• Phase 4 (Final Approval): Attending New Provider Orientation and executing the contract with OBSS.

10. Common Denials and Survey Findings

Applications are frequently rejected at the Phase 2 stage if the submission is incomplete or if the applicant scores a zero on any sub-question during the Authorized Provider Committee interview.

During post-payment reviews, common findings include billing the waiver for items that should have been covered by standard Medicaid DME, or failing to maintain proof of the required abuse registry checks for staff.

• Incomplete Application: DDDS will immediately return applications that do not follow the exact ZIP/PDF formatting rules.
• Interview Failure: Scoring zero on any interview component results in denial and a 6-month waiting period to reapply.
• DME Overlap: Disallowances occur when providers fail to obtain a DME denial before billing the waiver.
• Registry Check Gaps: Missing Adult or Child Abuse Registry checks in personnel files during audits.

11. Key Contacts and Resources

Prospective providers should utilize the official DHSS portals and direct inquiries to the DDDS Provider Authorization Committee.

Technical assistance for the Medicaid enrollment portal is handled exclusively by Gainwell Technologies.

• DDDS Provider Auth Committee: [email protected] (for application submissions and questions).
• Bonfire Hub (RFP Submission): https://dhss.bonfirehub.com/portal/?tab=openOpportunities
• Delaware Medical Assistance Portal: https://medicaid.dhss.delaware.gov/
• Gainwell Provider Services: 1-800-999-3371 (for MMIS enrollment assistance).

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