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Delaware - Physical Therapy Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

The Delaware Division of Developmental Disabilities Services (DDDS) authorizes Physical Therapy services under the 1915(c) Lifespan Waiver and the 1915(i) Pathways to Employment program to address mobility, strength, balance, and fall risk. Individual physical therapists are licensed by the Examining Board of Physical Therapists under 24 Del.C. Chapter 26, while agencies providing these services in the home may require Home Health Agency licensure from the Division of Health Care Quality.

Prospective providers must first complete the DDDS Phase 1 and Phase 2 authorization process, which includes mandatory information gathering sessions and submission to the Provider Authorization Committee, before enrolling through the Delaware Medical Assistance Program (DMAP) portal. Managed Care Organization-Only Providers (MCOPs) must also be screened and enrolled with DMAP prior to credentialing with any MCO.

1. Service Definition and Scope

In Delaware's HCBS waivers, Physical Therapy services include the evaluation and treatment of individuals to address mobility, strength, balance, and fall risk. These services are designed to maintain or improve the participant's physical functioning and independence in their community setting.

Under 24 Del.C. Chapter 26, the practice of physical therapy also includes the supervision of physical therapy activities, consultation, and the establishment and modification of physical therapy programs. It strictly excludes radiology, surgery, the prescription of drugs, and the medical diagnosis of disease.

2. Regulatory and Oversight Agencies

The Delaware Department of Health and Social Services (DHSS) serves as the umbrella agency for Medicaid and HCBS programs. Within DHSS, the Division of Developmental Disabilities Services (DDDS) operates the waivers, while the Division of Medicaid and Medical Assistance (DMMA) serves as the single state Medicaid agency.

Individual professional licensure is overseen by the Examining Board of Physical Therapists under the Division of Professional Regulation. Agency-level licensure for home-based services is regulated by the DHSS Division of Health Care Quality.

3. Gatekeeping Prerequisites: Who Can Even Apply

Delaware DDDS accepts applications for HCBS providers on an open and continuous basis; there is no closed network or moratorium for physical therapy services. However, applicants must clear specific structural preconditions before their application is accepted by the Provider Authorization Committee.

Providers must complete a mandatory multi-step information gathering process and, if serving managed care populations, must enroll with the state Medicaid portal before approaching MCOs.

4. Licensure and Certification Requirements

Physical therapists must hold an active, unrestricted license issued by the Delaware Examining Board of Physical Therapists. The board requires applicants to meet specific educational standards and pass the national examination.

If the physical therapy services are provided through a home health agency structure, the agency itself must obtain a Home Health Agency license from the DHSS Division of Health Care Quality before operating or billing.

5. Medicaid Provider Enrollment

Medicaid enrollment is processed through the Delaware Medical Assistance Portal for Providers (DMAP). Providers must first obtain a National Provider Identifier (NPI) and complete the DDDS authorization process if serving waiver participants.

The DMAP portal utilizes an Application Tracking Number (ATN) system, allowing providers to save, resume, and check the status of their enrollment applications.

6. Staffing, Training and Background Checks

All staff providing direct HCBS services must meet DDDS Provider Standards and hold the appropriate professional licenses. Agencies must ensure that their physical therapists are actively licensed in Delaware.

Background checks are mandatory for all direct care staff. Additionally, providers must utilize the DDDS Electronic Training System to ensure staff are trained on waiver requirements and state policies.

7. Documentation, Policies and Records

Providers must adhere to DDDS Policies and the federal Community Settings Rule. Clinical documentation must support medical necessity and align strictly with the participant's person-centered service plan.

For services delivered in the home, providers must comply with Electronic Visit Verification (EVV) requirements. Lifespan Waiver providers are also required to use the Delaware Therap system for documentation.

8. Billing, Rates and Claims

Claims for Medicaid reimbursement are submitted through the DMAP secure internet portal or directly to the respective Managed Care Organization. The portal allows providers to upload 837 transactions and inquire on claim status.

For in-home services, claims will be denied if they do not have a valid authorization, visit, or paid claims match in the EVV system. Rates are established by DMMA and published in the provider manuals.

9. Approval Sequence and Timeline

The approval sequence begins with the DDDS Phase 1 information gathering process, which includes reviewing manuals and completing 10 mandatory sessions. Once Phase 1 is complete, providers submit their Phase 2 application to the Provider Authorization Committee.

After receiving DDDS authorization, the provider initiates the Medicaid enrollment application through the DMAP portal. The entire process requires careful tracking using the ATN provided by DMAP.

10. Common Denials and Survey Findings

Applications to DDDS are frequently rejected if they are incomplete or if the provider failed to complete the mandatory Phase 1B Information Gathering Sessions. DDDS explicitly states that incomplete applications will not be accepted.

On the billing side, claims are commonly denied due to EVV mismatches for in-home services, or because the provider attempted to credential with an MCO before completing their DMAP enrollment.

11. Key Contacts and Resources

Prospective physical therapy providers should utilize the official Delaware state portals for the most current manuals, forms, and enrollment applications. The DDDS and DMAP websites are the primary hubs for HCBS providers.

For individual licensure questions, providers should contact the Examining Board of Physical Therapists. The DMAP Call Center is available for technical assistance with Medicaid enrollment and claims.

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