Delaware - Integrated Employment — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-08-16

In Delaware, Integrated Employment services—often billed as Supported Employment or Pre-Vocational services—provide individualized job development, placement, and on-site coaching to help Medicaid waiver participants secure and maintain competitive employment in community settings at prevailing wages. These services are primarily funded through the Division of Developmental Disabilities Services (DDDS) Lifespan Waiver and the Pathways to Employment 1915(i) State Plan Amendment.

The single biggest structural barrier to entry for this service in Delaware is obtaining certification through the DDDS Provider Authorization Committee (PAC). Delaware does not issue a traditional facility or agency license for HCBS employment providers; instead, applicants must pass a rigorous, document-heavy PAC review of their policies, procedures, and qualifications to achieve "Qualified Provider" status before the state's Medicaid portal will even accept their enrollment application.

1. Service Definition and Scope

Integrated Employment in Delaware encompasses services designed to assist individuals with intellectual and developmental disabilities in obtaining and sustaining paid work in competitive, integrated community environments. The service model focuses on matching the participant's skills and preferences with local business needs.

The scope of work includes job development, job coaching, and long-term retention support. Services must be delivered in settings that facilitate interaction with non-disabled coworkers and the general public, strictly adhering to the CMS HCBS Settings Rule.

• Target Population: Individuals enrolled in the DDDS Lifespan Waiver or the Pathways to Employment program.
• Job Development: Activities including resume building, interview preparation, and employer outreach to secure competitive employment.
• Job Coaching: On-site training, behavioral support, and task adaptation to ensure the participant meets employer expectations.
• Settings Requirement: Services must occur in competitive, integrated community settings, explicitly excluding sheltered workshops or segregated facilities.
• Wage Standard: Participants must be compensated at or above the state minimum wage and receive the prevailing wage for the specific job category.
• Excluded Activities: Medicaid funds cannot be used to pay the participant's wages or to duplicate services available through the Delaware Division of Vocational Rehabilitation (DVR).

2. Regulatory and Oversight Agencies

The Delaware Department of Health and Social Services (DHSS) is the umbrella agency overseeing all Medicaid and waiver programs in the state. Within DHSS, two primary divisions manage the approval and funding of Integrated Employment providers.

The Division of Developmental Disabilities Services (DDDS) handles provider certification and quality oversight, while the Division of Medicaid and Medical Assistance (DMMA) manages the financial enrollment and claims processing through its designated portal.

• Umbrella Agency: Delaware Department of Health and Social Services (DHSS) (https://dhss.delaware.gov/)
• Operating Agency: Delaware Division of Developmental Disabilities Services (DDDS) (https://dhss.delaware.gov/ddds/)
• Medicaid Authority: Delaware Division of Medicaid and Medical Assistance (DMMA) (https://dhss.delaware.gov/dmma/)
• Certification Body: DDDS Provider Authorization Committee (PAC) (https://dhss.delaware.gov/dhss/ddds/cps.html)
• Medicaid Enrollment Portal: Delaware Medical Assistance Portal (DMAP) (https://medicaid.dhss.delaware.gov)
• Quality Oversight: DDDS Service Integrity and Enhancement Unit (https://dhss.delaware.gov/ddds/)

3. Gatekeeping Prerequisites: Who Can Even Apply

Delaware operates an open and continuous enrollment model for DDDS HCBS providers. There is no Certificate of Need (CON) required for employment services, nor is there a closed network, moratorium, or competitive Request for Proposals (RFP) procurement process blocking new entrants.

However, the absolute structural precondition is that an applicant must be approved by the DDDS Provider Authorization Committee (PAC) before applying for Medicaid enrollment. The Delaware Medical Assistance Portal (DMAP) will automatically reject any enrollment application for these waiver services that does not include a formal PAC approval letter.

• Procurement Model: Open and continuous enrollment; no RFP or closed network restrictions apply.
• Certificate of Need: Not required for HCBS employment services in Delaware.
• Primary Precondition: DDDS Provider Authorization Committee (PAC) approval is a mandatory prerequisite to DMAP Medicaid enrollment.
• Business Registration: Applicants must possess a Delaware State Business License from the Division of Revenue or provide proof of 501(c)(3) non-profit status.
• Federal Registration: Applicants must obtain an Employer Identification Number (EIN) and a Type 2 National Provider Identifier (NPI) prior to submitting the PAC application.

4. Licensure and Certification Requirements

Delaware does not issue a specific "Employment Agency" or "Facility" license for HCBS Supported Employment providers. Because there is no distinct licensure category under the Office of Health Facilities Licensing and Certification for this service, providers are instead certified directly by DDDS.

To achieve "Qualified Provider" status, agencies must submit a comprehensive application to the DDDS PAC. This review evaluates the agency's organizational structure, financial stability, and a highly detailed policy and procedure manual to ensure alignment with state standards and the HCBS Settings Rule.

• Licensure Exemption: No formal state facility license exists for HCBS Integrated Employment; certification replaces licensure.
• Certification Authority: DDDS Provider Authorization Committee (PAC).
• Application Submission: Providers must submit the DDDS Provider Application, including organizational charts, service descriptions, and staff qualifications.
• Policy Manual: Applicants must submit a comprehensive policy manual covering intake, incident reporting, participant rights, and emergency response.
• HCBS Settings Compliance: Providers must attest to and demonstrate that their service delivery model fully complies with federal community integration mandates.

5. Medicaid Provider Enrollment

Once a provider receives their official approval letter from the DDDS PAC, they must enroll as a billing provider through the Delaware Medical Assistance Portal (DMAP). This system is managed by the state's MMIS vendor.

During the DMAP enrollment process, providers must link their Type 2 NPI to the specific HCBS taxonomy codes authorized by DDDS and upload their PAC approval documentation to validate their eligibility to bill the Lifespan Waiver or Pathways to Employment program.

• Enrollment System: Delaware Medical Assistance Portal (DMAP) (https://medicaid.dhss.delaware.gov).
• Required Credential: The DDDS PAC Approval Letter must be uploaded as an attachment during the DMAP application.
• Application Fee: Subject to the ACA institutional provider application fee (approximately $731) unless previously paid to Medicare or another state's Medicaid program.
• Tax Documentation: Must submit a signed W-9 form matching the exact business name and address on the application.
• Revalidation: Providers must revalidate their DMAP enrollment every 5 years in accordance with federal regulations.

6. Staffing, Training and Background Checks

Direct Support Professionals (DSPs) and Job Coaches must meet strict background and training requirements before providing any billable services. Delaware law mandates comprehensive registry checks to protect vulnerable adults.

Agencies are responsible for maintaining personnel files that prove all staff have cleared these specific state registry checks and have completed all DDDS-mandated training modules, including participant-specific behavioral and communication protocols.

• Minimum Qualifications: Staff must be at least 18 years old, possess a high school diploma or GED, and be legally able to work in Delaware.
• Criminal Background: Mandatory state and federal criminal background checks are required for all direct care staff.
• Registry Checks: Mandatory screening against the Delaware Child Abuse Registry and Adult Abuse Registry (11 Del. C. Sections 8563 and 8564) with no adverse findings.
• Service Letters: Providers must obtain service letters from previous employers in accordance with 19 Del. C. Section 708.
• Required Training: Staff must hold current CPR/First Aid certification and complete DDDS-required training on the participant's specific Person-Centered Service Plan (PCSP).

7. Documentation, Policies and Records

Providers must maintain robust, contemporaneous documentation to survive DDDS Quality Service Reviews (QSR) and DMMA financial audits. Records must clearly link the job coaching activities provided to the specific employment goals outlined in the participant's Person-Centered Service Plan (PCSP).

Policies must also dictate strict adherence to incident reporting timelines, ensuring that any critical incidents occurring at the job site are reported to DDDS immediately.

• Service Notes: Daily documentation must include exact start and stop times, specific coaching activities performed, and progress toward PCSP employment goals.
• Person-Centered Plans: Providers must maintain a copy of the participant's current PCSP and document how daily services align with its objectives.
• Incident Reporting: Policies must mandate the reporting of critical incidents to the DDDS Service Integrity and Enhancement unit within state-defined timeframes.
• Record Retention: All Medicaid billing and clinical records must be retained for a minimum of 5 years.
• Financial Records: Agencies must maintain clear billing ledgers, payroll records, and proof of staff time worked for audit purposes.

8. Billing, Rates and Claims

Integrated Employment services are reimbursed on a fee-for-service basis according to the rate schedule published by DHSS/DMMA. Claims are submitted electronically through the DMAP system using standard HIPAA-compliant 837P formats.

Providers must ensure that services are prior-authorized in the participant's PCSP before billing. Additionally, providers must verify that funding through the Division of Vocational Rehabilitation (DVR) is either exhausted or inapplicable before billing Medicaid, as Medicaid is the payer of last resort.

• Billing System: Claims are processed through the Delaware Medical Assistance Portal (DMAP) MMIS.
• Authorization: Services must be explicitly prior-authorized in the participant's PCSP before any billing can occur.
• Unit of Service: Job coaching and job development are typically billed in 15-minute increments.
• Rate Schedule: Rates are established by DHSS/DMMA and published in the DDDS HCBS rate methodology documents.
• Third-Party Liability: Providers must document that DVR funding was unavailable or exhausted before billing Medicaid for employment services.

9. Approval Sequence and Timeline

The end-to-end process from business formation to billing Delaware Medicaid typically takes 4 to 6 months. This timeline is heavily dependent on the completeness of the initial DDDS PAC application and the committee's meeting schedule.

Providers should not hire billable staff or begin providing services until the DMAP enrollment is fully approved and an effective date is issued, as services provided prior to this date are not reimbursable.

• Step 1: Business Formation & NPI: Register the business in Delaware and obtain a Type 2 NPI (1-2 weeks).
• Step 2: DDDS PAC Application: Submit the comprehensive application and policy manual to the DDDS PAC (Review takes 60-90 days).
• Step 3: PAC Approval: Receive the official Qualified Provider status letter from DDDS.
• Step 4: DMAP Enrollment: Submit the Medicaid enrollment application via the DMAP portal (30-45 days for processing).
• Step 5: Service Authorization: Receive participant referrals and PCSP service authorizations to begin billable work.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied by the DDDS PAC when providers submit generic, out-of-state policy manuals that do not reference Delaware-specific statutes, such as the Adult Abuse Registry requirements.

During annual Quality Service Reviews (QSR), active providers often face citations for failing to document specific employment outcomes, providing services in non-integrated settings, or allowing staff training certifications to lapse.

• Application Denial: Submitting generic policy manuals that fail to reference Delaware DDDS standards or state laws.
• Background Check Failures: Allowing staff to provide services before the Delaware Adult and Child Abuse Registry checks are fully cleared.
• Settings Rule Violations: QSR citations for providing services in segregated environments rather than competitive, integrated community settings.
• Documentation Deficiencies: Service notes that lack specific start/stop times or fail to describe the actual job coaching interventions provided.
• Training Lapses: Expired CPR/First Aid certifications or failure to document completion of participant-specific behavioral training.

11. Key Contacts and Resources

Prospective providers should utilize the official state portals and contact the DDDS Provider Relations team for application assistance and manual templates.

Familiarity with the DMAP portal and the DDDS policy manuals is essential for maintaining compliance and ensuring timely claims payment.

• DDDS Provider Authorization Committee: https://dhss.delaware.gov/dhss/ddds/cps.html
• Delaware Medical Assistance Portal (DMAP): 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 (Business Licenses): https://revenue.delaware.gov/

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