Delaware - Environmental Accessibility Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

The Delaware Division of Developmental Disabilities Services (DDDS) Lifespan Waiver and the Diamond State Health Plan (DSHP) Plus 1115 demonstration fund Environmental Accessibility Adaptations (EAA) up to a combined $10,000 budget for home and vehicle modifications. Providers deliver physical adaptations to the home, such as ramps, widened doorways, and roll-in showers, tied to an assessed need to prevent institutionalization.

Approval requires holding a standard Delaware Division of Revenue contractor license and securing network contracts with Delaware's Medicaid Managed Care Organizations (MCOs) or the DDDS provider network, as the state does not issue a distinct healthcare facility license for home modification providers. Applicants must pass the Delaware Medical Assistance Program (DMAP) enrollment process and adhere to local building codes and permit requirements for all structural modifications.

1. Service Definition and Scope

In Delaware, Environmental Accessibility Adaptations (EAA) are defined as physical adaptations to the private residence of the waiver participant or their family that are necessary to ensure the health, welfare, and safety of the individual. These services enable the individual to function with greater independence in the home.

The scope excludes adaptations or improvements to the home that are of general utility and are not of direct medical or remedial benefit to the individual, such as carpeting, roof repair, or central air conditioning. All services must be documented in the individual's Person-Centered Plan.

• Covered Modifications: Ramps, grab bars, widened doorways, and roll-in showers.
• Excluded Items: General home maintenance, roof repair, and standard carpeting.
• Benefit Limit: Up to $10,000 combined budget for Home and Vehicle Modifications under the DDDS Lifespan Waiver.
• Requirement: Must be tied to an assessed need in the Person-Centered Plan.
• Location: Must be provided in the participant's primary private residence.

2. Regulatory and Oversight Agencies

The Delaware Department of Health and Social Services (DHSS) oversees the Medicaid program through its Division of Medicaid and Medical Assistance (DMMA). The Division of Developmental Disabilities Services (DDDS) directly manages the Lifespan Waiver.

Because EAA is a construction-based service, providers are also subject to oversight by local county or municipal building code enforcement agencies, and must maintain standard business licensure through the Delaware Division of Revenue.

• State Medicaid Agency: Delaware Division of Medicaid and Medical Assistance (DMMA) (https://dhss.delaware.gov/dmma/).
• Operating Agency: Delaware Division of Developmental Disabilities Services (DDDS) (https://dhss.delaware.gov/ddds/).
• Business Licensure: Delaware Division of Revenue (https://revenue.delaware.gov/).
• Medicaid Portal: Delaware Medical Assistance Program (DMAP) (https://medicaid.dhss.delaware.gov/).

3. Gatekeeping Prerequisites: Who Can Even Apply

Delaware does not issue a specific healthcare facility license for EAA providers. Instead, the primary structural precondition is holding a valid Delaware business license as a general contractor or specialized tradesperson (e.g., plumber, carpenter).

For the DSHP Plus program, providers must successfully contract with one or more of Delaware's Medicaid Managed Care Organizations (MCOs). For the DDDS waiver, providers must be approved through the DDDS Authorized Provider network process.

• Business License: Must hold a valid Delaware Division of Revenue contractor or business license.
• MCO Contracting: Required affiliation with Highmark Health Options, AmeriHealth Caritas DE, or Delaware First Health for DSHP Plus.
• DDDS Authorization: Must apply and be accepted as an authorized provider for the DDDS Lifespan Waiver.
• Local Permits: Must be eligible to pull local building permits in the county of service delivery.

4. Licensure and Certification Requirements

The Delaware Division of Health Care Quality (DHCQ) does not license home modification contractors. Providers must instead meet the professional standards of their specific construction trade.

Providers must ensure that all work complies with the Americans with Disabilities Act (ADA) guidelines where applicable, and all local building codes. Electrical and plumbing work must be performed by tradespeople holding specific state licenses for those fields.

• General Contractor License: Required through the Division of Revenue for general structural modifications.
• Specialty Trades: Plumbers and electricians must hold specific Delaware professional licenses.
• Code Compliance: All modifications must pass local municipal or county building inspections.
• ADA Standards: Work must align with ADA accessibility guidelines for residential modifications.

5. Medicaid Provider Enrollment

Providers must enroll in the Delaware Medical Assistance Program (DMAP) using the state's online provider portal. Enrollment requires submitting proof of business licensure, a W-9, and passing standard Medicaid screening.

EAA providers typically enroll under an atypical provider type or a specific waiver service provider code, depending on whether they are billing DDDS directly or contracting through an MCO.

• Enrollment Portal: DMAP Provider Portal (https://medicaid.dhss.delaware.gov/).
• Provider Type: Enrolled as an HCBS Waiver Provider or Atypical Provider.
• Required Documents: W-9, Delaware Business License, and voided check for EFT.
• Screening Level: Subject to limited or moderate risk screening depending on exact provider classification.

6. Staffing, Training and Background Checks

Unlike direct care staff, construction contractors providing EAA are not typically subject to the same intensive clinical training requirements (like CPR or medication administration). However, they must pass standard background checks.

Any staff entering a waiver participant's home must clear the Delaware Adult Abuse Registry and standard criminal background checks to ensure participant safety.

• Background Checks: Required state and federal criminal background checks for staff entering homes.
• Abuse Registry: Must check the Delaware Adult Abuse Registry prior to dispatching workers.
• Trade Competency: Staff must be competent and, if applicable, licensed in their specific construction trade.
• Waiver Orientation: Agency owners may be required to complete basic DDDS or MCO provider orientation.

7. Documentation, Policies and Records

EAA providers must maintain detailed records of all modifications, including initial bids, signed contracts, before-and-after photographs, and final sign-offs from the participant or their representative.

Providers must also keep copies of all local building permits and inspection approvals on file for a minimum of five years, as these are subject to audit by DMMA or the MCOs.

• Bidding Documentation: Must retain original written estimates and scope of work.
• Permit Records: Copies of all pulled permits and final municipal inspection reports.
• Photographic Evidence: Before and after photos of the modification are typically required for claim justification.
• Participant Sign-off: Written acknowledgment from the participant that the work was completed satisfactorily.
• Record Retention: All records must be kept for at least 5 years per Delaware Medicaid rules.

8. Billing, Rates and Claims

EAA services are generally reimbursed based on the approved bid amount rather than a fixed fee schedule. The state or MCO must prior-authorize the specific modification and the agreed-upon cost before work begins.

Claims are submitted through the DMAP portal or the respective MCO's clearinghouse using specific HCPCS codes (often S5165) along with the prior authorization number.

• Reimbursement Method: Paid based on the authorized bid amount, not a standard fee schedule.
• Prior Authorization: 100% of EAA services require prior authorization before construction starts.
• Procedure Code: Typically billed using HCPCS code S5165 (Home modifications; per service).
• Budget Cap: Subject to the $10,000 combined limit under the DDDS Lifespan Waiver.
• Claim Submission: Submitted via DMAP or MCO portals depending on the participant's enrollment.

9. Approval Sequence and Timeline

The approval process begins with obtaining a Delaware business license, followed by applying to the DMAP portal and the specific MCO or DDDS network. This initial credentialing can take 60 to 90 days.

Once enrolled, the sequence for a specific job involves receiving a referral, submitting a bid, waiting for state/MCO prior authorization (which can take 14-30 days), completing the work, passing local inspection, and then billing.

• Business Licensure: 1-3 weeks through the Delaware Division of Revenue.
• Medicaid Enrollment: 30-60 days through the DMAP portal.
• MCO Contracting: 60-90 days for credentialing and contract execution.
• Job Authorization: 14-30 days for bid review and prior authorization approval.
• Payment Timeline: Clean claims are typically paid within 14-21 days of submission.

10. Common Denials and Survey Findings

EAA providers most commonly face claim denials due to starting work before the official prior authorization is issued, or failing to submit required completion documentation (like permits or photos).

Audits frequently cite providers for exceeding the participant's lifetime or annual budget cap, or for performing general home repairs that do not meet the strict definition of a medical/accessibility necessity.

• Premature Work: Denials for construction started before prior authorization date.
• Missing Documentation: Failure to provide final permit sign-offs or participant satisfaction signatures.
• Scope Creep: Billing for general utility repairs (e.g., fixing a roof) instead of accessibility adaptations.
• Budget Exhaustion: Claims denied because the participant has already met their $10,000 waiver limit.

11. Key Contacts and Resources

Providers should utilize the Delaware Health and Social Services (DHSS) websites and the DMAP portal for official manuals, billing guidelines, and enrollment applications.

For DSHP Plus, providers must contact the provider relations departments of the specific Managed Care Organizations operating in Delaware.

• DMAP Provider Portal: https://medicaid.dhss.delaware.gov/
• Division of Developmental Disabilities Services (DDDS): https://dhss.delaware.gov/ddds/
• Division of Medicaid and Medical Assistance (DMMA): https://dhss.delaware.gov/dmma/
• Delaware Division of Revenue: https://revenue.delaware.gov/

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