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

Last reviewed: 2026-08-16

In Delaware, Assistive Technology Services are primarily administered through the Division of Developmental Disabilities Services (DDDS) under the 1915(c) HCBS Lifespan Waiver. This service covers the evaluation, customization, purchasing, and training associated with devices or specialized medical equipment that increase a participant's functional capabilities and reduce their reliance on paid support staff.

The single biggest structural barrier to entry for this service in Delaware is the mandatory Request for Proposal (RFP) procurement process and DDDS Authorized Provider Committee approval. Providers cannot simply submit a Medicaid enrollment application; they must first apply to DDDS for Initial Authorization, enroll in the Medicaid portal, and then successfully respond to a formal state RFP under Delaware Code Title 29 to be permitted to accept waiver participants.

1. Service Definition and Scope

Under the Delaware DDDS Lifespan Waiver, Assistive Technology (AT) encompasses items, equipment, or product systems used to increase, maintain, or improve the functional capabilities of waiver participants. It also includes specialized medical equipment and supplies that are not covered under the standard Medicaid State Plan.

The service is comprehensive, covering not just the physical device, but the clinical evaluation required to select it, the customization to fit the participant, and the training necessary for the participant and their caregivers to use it effectively.

• Evaluation: Functional assessment of the participant's need for assistive technology in their customary environment.
• Purchasing and Leasing: Acquisition of the approved assistive device, specialized medical equipment, or product system.
• Customization: Designing, fitting, customizing, adapting, applying, maintaining, or repairing AT devices.
• Participant Training: Training or technical assistance for the participant or their family members to ensure effective use of the device.
• Professional Training: Training for paid support staff or other professionals who assist the participant with the device.
• Exclusions: Items that are not of direct medical or remedial benefit, or items that are already covered under the standard Medicaid State Plan Durable Medical Equipment (DME) benefit.

2. Regulatory and Oversight Agencies

The Delaware Department of Health and Social Services (DHSS) is the umbrella agency overseeing Medicaid and HCBS waivers. Within DHSS, the Division of Developmental Disabilities Services (DDDS) directly manages the Lifespan Waiver, the Authorized Provider Network, and the RFP procurement process.

The Division of Medicaid and Medical Assistance (DMMA) oversees the broader Medicaid State Plan and the Medicaid Management Information System (MMIS), which is operated by Gainwell Technologies via the Delaware Medical Assistance Portal (DMAP).

• Delaware Department of Health and Social Services (DHSS): https://dhss.delaware.gov/dhss/
• Division of Developmental Disabilities Services (DDDS): https://dhss.delaware.gov/ddds/
• Division of Medicaid and Medical Assistance (DMMA): https://dhss.delaware.gov/dmma/
• Delaware Medical Assistance Portal (DMAP / Gainwell): https://medicaid.dhss.delaware.gov/provider
• Division of Health Care Quality (HCQ): https://dhss.delaware.gov/dhcq/

3. Gatekeeping Prerequisites: Who Can Even Apply

Delaware strictly controls entry into the DDDS HCBS provider network. A provider cannot simply enroll in Medicaid to offer AT services; they must pass a multi-phase authorization and procurement process dictated by state law.

The absolute barrier to entry is the DHSS Request for Proposal (RFP) requirement under DEL C 69 Title 29. Providers must first submit an application to the DDDS Authorized Provider Committee. If approved, they receive an Initial Authorization letter, which is a mandatory prerequisite to enroll in the Delaware Medical Assistance Portal (DMAP). Finally, they must respond to the open RFP for 'Home and Community Based Services for Individuals with Intellectual and Developmental Disabilities.'

• DDDS Initial Authorization: Applicants must submit a provider application to the DDDS Authorized Provider Committee and receive a Qualified Provider Authorization Letter before Medicaid enrollment is permitted.
• RFP Procurement: Providers must successfully respond to the DHSS RFP for HCBS under Delaware Code Title 29, Chapter 69 to contract with the state.
• Wait Period for Denials: If the DDDS Authorized Provider Committee denies the initial application, the entity is barred from reapplying for six (6) months from the date of the denial letter.
• Provisional Authorization: DDDS reserves the right to issue Provisional Authorization based on network need, but full RFP completion is still required for full authorization.
• Business Licensure: Applicants must hold a valid State of Delaware Division of Revenue business license prior to submitting the DDDS application.

4. Licensure and Certification Requirements

Delaware does not issue a distinct 'Assistive Technology Agency' facility license. Instead, providers are approved based on their professional credentials, business licensure, and adherence to DDDS Provider Standards.

If the provider is supplying standard medical equipment alongside AT, they must meet Delaware's Durable Medical Equipment (DME) provider standards. Clinicians performing the AT evaluations must hold active Delaware professional licenses in their respective fields.

• Facility Licensure: No specific facility license exists for AT agencies; approval is designation-based via the DDDS Authorized Provider Network.
• Professional Licensing: Evaluators must hold active Delaware licenses (e.g., Occupational Therapist, Physical Therapist, or Speech-Language Pathologist) issued by the Division of Professional Regulation.
• DME Certification: If acting as a DME supplier, the agency must meet Medicare/Medicaid DMEPOS quality standards and hold a National Supplier Clearinghouse (NSC) number.
• DDDS Provider Standards: Agencies must attest to and comply with the comprehensive DDDS Provider Standards published by DHSS.
• Medicaid Compliance Plan: Applicants must submit an 'Essential Elements to a Medicaid Compliance Plan' document during the DDDS application phase.

5. Medicaid Provider Enrollment

After receiving the Qualified Provider Authorization Letter from DDDS, the agency must enroll in the Delaware Medical Assistance Program (DMAP). This is completed through the web-based portal operated by Gainwell Technologies.

Providers must enroll using the specific taxonomy codes for Assistive Technology or DME and link their enrollment to the DDDS Lifespan Waiver. Attempting to enroll without the DDDS authorization letter will result in immediate rejection.

• Enrollment Portal: Applications are submitted via the Delaware Medical Assistance Portal (https://medicaid.dhss.delaware.gov/provider).
• Required Document: Providers must upload the DDDS Qualified Provider Authorization Letter during the Gainwell enrollment process.
• Application Tracking Number (ATN): An ATN is issued upon submission to track the status of the enrollment application in the portal.
• Processing Time: DMAP processing typically takes approximately two weeks from the date of receipt of a complete application.
• Revalidation: Providers are required to revalidate their DMAP enrollment at least every five (5) years.
• Application Fee: Providers are subject to the CMS-mandated institutional provider application fee unless waived by prior Medicare enrollment.

6. Staffing, Training and Background Checks

Staff providing AT evaluations, fittings, or training must meet specific credentialing and background check requirements mandated by DHSS and DDDS.

Any direct support professionals or technicians delivering equipment and interacting with waiver participants must clear Delaware's centralized background check system and registry screenings.

• Evaluator Qualifications: Evaluations must be performed by a licensed OT, PT, SLP, or a certified Assistive Technology Professional (ATP) credentialed through RESNA.
• Background Checks: All staff with direct participant contact must pass a Delaware State Police and FBI fingerprint-based criminal background check.
• Registry Checks: Mandatory screening against the Delaware Adult Abuse Registry and Child Protection Registry is required prior to hire.
• OIG Exclusion: Agencies must conduct monthly screenings of all staff and owners against the federal OIG List of Excluded Individuals/Entities (LEIE).
• Orientation: Agency leadership must complete the mandatory DDDS Provider Orientation as part of Phase 3 of the authorization process before accepting participants.

7. Documentation, Policies and Records

Assistive Technology providers must maintain rigorous documentation to justify the medical or functional necessity of the devices and to prove delivery. DDDS requires specific policy manuals to be submitted during the application phase.

Records must be retained in accordance with DMMA and DDDS policies, typically for a minimum of five years, and must be readily available for state or federal audit.

• Independent Evaluation: Providers must maintain a copy of the independent clinical evaluation recommending the specific AT device or modification.
• Prior Authorization Records: Agencies must keep records of DDDS or MCO prior authorization approvals for all purchased items.
• Proof of Delivery: Providers must maintain signed delivery slips or invoices proving the participant received the customized device or equipment.
• Policy Submission: Agencies must submit operational policies, including a Medicaid Compliance Plan, during the DDDS Self-Assessment/Application phase.
• Record Retention: All Medicaid and waiver service records must be retained for a minimum of five (5) years from the date of service.

8. Billing, Rates and Claims

Assistive Technology is reimbursed based on the Delaware Medicaid fee schedule or through manual pricing for customized items. Claims are submitted via the DMAP portal (Gainwell) or to the respective Managed Care Organization (MCO) if the member is enrolled in a managed care program.

For items without an established fee schedule rate, reimbursement is typically based on the lower of billed charges or a manually reviewed invoice cost plus a standard state-approved markup.

• Prior Authorization: All AT devices and specialized medical equipment require prior authorization from DDDS before purchase and delivery.
• Payer of Last Resort: Providers must bill Medicare or the standard Medicaid State Plan (DME benefit) before billing the DDDS Lifespan Waiver for AT.
• Manual Pricing: Unlisted or highly customized AT items are manually priced based on the manufacturer invoice plus a state-approved percentage.
• Claim Submission: Claims are submitted electronically via the Gainwell DMAP portal using standard 837P or CMS-1500 formats.
• MCO Contracting: If serving members under Diamond State Health Plan Plus, providers must contract and credential with MCOs like Delaware First Health or Highmark Health Options.

9. Approval Sequence and Timeline

Becoming an AT provider for the DDDS waiver is a strict three-phase process. It begins with the DDDS application, moves to Medicaid enrollment, and concludes with the RFP response.

The entire process can take 3 to 6 months, heavily dependent on the timing of the RFP submission windows and the DDDS Authorized Provider Committee's meeting schedule.

• Phase 1 (Application): Submit the provider application and required policies to the DDDS Authorized Provider Committee.
• Phase 2 (Initial Authorization): The Committee reviews the application and, if approved, issues a Qualified Provider Authorization Letter.
• Phase 3a (Medicaid Enrollment): Submit enrollment via the DMAP portal (Gainwell), which takes approximately 2 weeks to process.
• Phase 3b (RFP Submission): Respond to the DHSS RFP for HCBS under Title 29 to secure a state contract.
• Phase 3c (Orientation & Final Approval): Complete DDDS orientation and receive final approval to begin accepting service recipients.

10. Common Denials and Survey Findings

Applications and claims are frequently delayed or denied due to missing documentation or failure to follow the strict sequence of the DDDS authorization process.

During audits, the most common findings relate to billing the waiver for items that should have been covered by the Medicaid State Plan, or failing to secure prior authorization before purchasing equipment.

• Premature Enrollment: Attempting to enroll in the DMAP portal before receiving the DDDS Qualified Provider Authorization Letter results in immediate denial.
• Missing RFP: Failing to complete the formal RFP process after Medicaid enrollment leaves the provider unauthorized to accept participants.
• State Plan Exhaustion: Audit findings frequently occur when providers bill the waiver for equipment that is covered under the standard Medicaid DME benefit.
• Inadequate Proof of Delivery: Recoupment of funds due to missing participant or caregiver signatures on equipment delivery receipts.
• Unlicensed Evaluators: Claim denials for AT evaluations performed by staff lacking active Delaware professional licenses (e.g., OT/PT).

11. Key Contacts and Resources

Providers should utilize the official State of Delaware portals and DDDS contact points for application materials, RFP instructions, and Medicaid enrollment support.

The Gainwell call center is the primary resource for technical issues with the DMAP portal and claim submission questions.

• DDDS Provider Network: https://dhss.delaware.gov/ddds/homepage/services/authorized-providers/
• Delaware Medical Assistance Portal (DMAP): https://medicaid.dhss.delaware.gov/provider
• DMAP Provider Call Center: 1-800-999-3371 (Assistance with Gainwell enrollment and billing).
• DHSS Division of Medicaid and Medical Assistance (DMMA): https://dhss.delaware.gov/dmma/
• Delaware First Health (MCO): https://www.delawarefirsthealth.com/providers/become-a-provider.html
• Highmark Health Options (MCO): https://providers.highmark.com/content/highmark/en/providerresourcecenter/hho-de/provider-manual-and-resources.html

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