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

Last reviewed: 2026-08-16

Assistive Technology Services in Maryland, administered under the Developmental Disabilities Administration (DDA) Home and Community-Based Services (HCBS) waivers (such as the Community Pathways, Community Supports, and Family Supports waivers), provide evaluations, devices, and training designed to increase a participant's functional capability and reduce their reliance on paid staff. These services empower individuals with developmental disabilities to interact more independently with their environment through customized equipment and specialized instruction.

The single biggest structural barrier to entry for this service is the DDA Qualified Provider application process. Prospective agencies cannot simply apply for a license or enroll directly in Medicaid; they must first be approved by the DDA as an Organized Health Care Delivery System (OHCDS) or a direct DDA provider. This gatekeeping step requires the submission and regional office approval of a comprehensive Program Service Plan (PSP) before the applicant is permitted to access Maryland's ePREP Medicaid enrollment portal.

1. Service Definition and Scope

In Maryland, Assistive Technology Services encompass a broad range of supports designed to assess the need for, acquire, and maintain assistive devices. The service is strictly focused on items and training that directly improve the participant's independence and decrease the need for human assistance.

The scope of the service extends beyond the physical device to include the clinical evaluation required to justify the equipment, the customization of the item, and the training necessary for the participant and their support network to utilize it effectively.

• Assessment: Comprehensive evaluation of the participant's assistive technology needs in their customary environment by a licensed professional.
• Acquisition: Purchasing, leasing, or otherwise providing the authorized assistive technology device.
• Customization: Adapting, modifying, fitting, or repairing the assistive technology device to meet the specific needs of the participant.
• Participant Training: Direct instruction provided to the waiver participant on how to safely and effectively use the device.
• Caregiver Training: Educating family members, unpaid caregivers, or paid staff on how to support the participant in using the device.
• Coordination: Integrating the assistive technology with other therapies, interventions, or services outlined in the Person-Centered Plan (PCP).

2. Regulatory and Oversight Agencies

Assistive Technology Services under Maryland's HCBS waivers are jointly overseen by the state's Medicaid authority and its developmental disabilities operating agency. These entities manage provider approval, policy enforcement, and claims processing.

Professional licensing boards also play a critical oversight role, as the individuals performing the clinical assessments must maintain active state licenses or national certifications.

• Maryland Department of Health (MDH): The single State Medicaid Agency responsible for overall waiver administration (https://health.maryland.gov).
• Developmental Disabilities Administration (DDA): The MDH division that operates the HCBS waivers and approves Qualified Providers (https://health.maryland.gov/dda).
• ePREP: Maryland Medicaid's Electronic Provider Revalidation and Enrollment Portal used for all MMIS enrollment (https://eprep.health.maryland.gov).
• LTSSMaryland: The state's Long Term Services and Supports tracking, case management, and billing system (https://ltssmaryland.org).
• Maryland Board of Occupational Therapy Practice: Licenses Occupational Therapists who frequently perform AT assessments (https://health.maryland.gov/botp).
• Maryland Board of Audiologists, Hearing Aid Dispensers & Speech-Language Pathologists: Licenses SLPs providing communication-based AT services (https://health.maryland.gov/boardsahs).

3. Gatekeeping Prerequisites: Who Can Even Apply

Maryland does not utilize a Certificate of Need (CON) program, closed network, or competitive RFP procurement for Assistive Technology Services. However, there is a strict structural precondition: DDA Qualified Provider Approval.

An applicant cannot submit a Medicaid enrollment application until they have successfully navigated the DDA's internal vetting process. This requires submitting a detailed operational plan and proving that the agency already employs or contracts with appropriately credentialed professionals.

• DDA Qualified Provider Status: The mandatory prerequisite approval from the DDA that must be obtained before any Medicaid ePREP application is accepted.
• Program Service Plan (PSP): Applicants must submit a PSP to the DDA detailing their rationale, scope, staffing, training, and service delivery model for approval.
• Professional Affiliation: The applying agency must demonstrate it employs or subcontracts with licensed clinicians (OT, PT, SLP) or RESNA-certified Assistive Technology Professionals (ATP) prior to approval.
• No Certificate of Need (CON): Maryland does not require a CON for HCBS Assistive Technology providers.
• No Closed Network: The provider network is open to any entity that meets DDA qualifications and completes the PSP approval process.

4. Licensure and Certification Requirements

Maryland does not issue a distinct "Assistive Technology Agency" facility license. Because this service does not have a standalone facility licensure category, providers are approved through the DDA's Qualified Provider process and operate under the authority of COMAR regulations.

Instead of an agency license, the state relies on the individual professional licenses and certifications of the staff performing the services. The agency itself may be approved as an Organized Health Care Delivery System (OHCDS) to procure and bill for devices.

• OHCDS Approval: Agencies often enroll as an Organized Health Care Delivery System under the DDA to facilitate the purchase and billing of AT devices.
• COMAR 10.09.26 Compliance: Providers must adhere to the regulatory standards set forth in the Community Pathways Waiver regulations.
• RESNA Certification: Staff functioning specifically as Assistive Technology Professionals must hold an active ATP certification from the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA).
• State Clinical Licensure: Staff performing clinical evaluations (OT, PT, SLP) must hold active, unencumbered licenses from their respective Maryland health occupation boards.
• Business Registration: The entity must be registered, active, and in good standing with the Maryland State Department of Assessments and Taxation (SDAT).

5. Medicaid Provider Enrollment

Once DDA approval is secured, the provider must formally enroll in the Maryland Medical Assistance Program. This is done entirely online through the ePREP system.

Providers must ensure that all corporate information matches exactly across their IRS documentation, SDAT registration, and ePREP application to avoid processing delays.

• System: Enrollment is processed exclusively through ePREP (Electronic Provider Revalidation and Enrollment Portal).
• NPI Requirement: The agency must obtain an organizational Type 2 National Provider Identifier (NPI) via the NPPES registry.
• DDA Transmittal Letter: The official approval letter from the DDA must be uploaded into ePREP as proof that the gatekeeping prerequisite has been met.
• Application Fee: Providers may be subject to the ACA institutional provider application fee (approximately $732) unless they are already enrolled in Medicare or qualify for a waiver.
• Provider Agreement: Applicants must sign the Maryland Medicaid Provider Agreement, binding them to state and federal Medicaid regulations.

6. Staffing, Training and Background Checks

Agencies providing Assistive Technology Services must ensure that all personnel interacting with waiver participants meet strict background and training standards. This applies to both direct employees and independent contractors.

While the clinical staff hold advanced degrees and licenses, all personnel must complete DDA-mandated foundational training regarding the rights and safety of individuals with developmental disabilities.

• Criminal Background Checks: All staff with direct participant contact must pass a fingerprint-based background check via the Maryland Criminal Justice Information System (CJIS).
• Exclusion Screening: Agencies must screen all employees and contractors monthly against the OIG List of Excluded Individuals/Entities (LEIE) and the Maryland Medicaid exclusion list.
• Primary Source Verification: The agency must maintain proof of primary source verification for all required clinical licenses (OT, PT, SLP) and RESNA certifications.
• DDA Basic Training: Staff must complete required DDA trainings, including Incident Management, Person-Centered Thinking, and Community Integration.
• CPR and First Aid: Personnel interacting directly with participants must maintain current certification in CPR and First Aid.

7. Documentation, Policies and Records

Thorough documentation is critical for Assistive Technology Services, as the state requires proof that the devices and training provided are medically or functionally necessary and cost-effective.

Providers must utilize LTSSMaryland to review approved services and must maintain internal records that align with the participant's Person-Centered Plan (PCP).

• AT Assessments: Must maintain comprehensive written evaluations that clearly justify how the requested device will reduce reliance on paid staff or increase independence.
• Cost Estimates: Providers must keep documented bids, invoices, or cost estimates for all devices and modifications to justify the billed amounts.
• Person-Centered Plan (PCP): Services cannot be rendered or billed unless they are explicitly documented and authorized in the participant's DDA-approved PCP.
• Service Delivery Logs: Must maintain detailed logs of all training hours provided to the participant or caregivers, including dates, times, and outcomes.
• Incident Reporting: Agencies must implement policies that comply with the DDA's Policy on Reportable Incidents and Investigations (PORII).
• Record Retention: All clinical and financial records must be retained for a minimum of six years from the date of service, or longer if an audit is pending.

8. Billing, Rates and Claims

Reimbursement for Assistive Technology Services is managed through Maryland's MMIS and the LTSSMaryland system. Services are typically reimbursed based on a fee schedule for assessments and training, and invoice cost for devices.

Because AT devices can be expensive, providers must ensure they have explicit prior authorization before purchasing equipment, and they must exhaust other funding sources first.

• Billing System: Claims are submitted electronically via LTSSMaryland or directly to the MMIS, depending on the specific procedure code and provider setup.
• Prior Authorization: All AT services, evaluations, and device purchases require prior authorization generated through the approved PCP in LTSSMaryland.
• Reimbursement Methodology: Evaluations and training are paid according to the DDA fee schedule; devices are typically reimbursed at the authorized invoice cost.
• Waiver Limits: Services are subject to strict financial caps (e.g., specific dollar limits per participant per waiver year for AT devices and modifications).
• Payer of Last Resort: Medicaid is the payer of last resort; providers must document denials from Medicare, private insurance, or the Division of Rehabilitation Services (DORS) when applicable.

9. Approval Sequence and Timeline

Becoming an Assistive Technology provider in Maryland is a multi-step, sequential process. Providers cannot initiate Medicaid enrollment until the DDA has fully approved their programmatic structure.

The entire process from initial DDA application to active Medicaid billing status typically takes between 3 to 6 months, depending on the completeness of the application and regional office workloads.

• Step 1: Submit the DDA Qualified Provider Application and Program Service Plan (PSP) to the applicable DDA Regional Office.
• Step 2: Undergo DDA Regional Office review, which may include requests for additional information or policy revisions (typically 60-90 days).
• Step 3: Receive the official DDA approval letter and transmittal document.
• Step 4: Submit the Medicaid provider enrollment application via the ePREP portal, uploading the DDA approval (typically 30-60 days).
• Step 5: Receive the Medicaid Provider Number (MA Number) and gain access to LTSSMaryland to begin receiving authorizations and billing.

10. Common Denials and Survey Findings

Applications and claims are frequently delayed or denied due to administrative errors, mismatched information, or failure to properly justify the need for the service.

During audits or quality reviews, the DDA often cites providers for failing to link the assistive technology directly to the goals outlined in the participant's Person-Centered Plan.

• Incomplete PSP: DDA applications are often returned if the Program Service Plan fails to adequately describe the specific service delivery model for Assistive Technology.
• ePREP Mismatches: Medicaid enrollment delays frequently occur when the business name on the IRS W-9 does not perfectly match the SDAT registration and ePREP application.
• Missing Credentials: Applications are denied if the provider fails to include primary source verification of RESNA certifications or state clinical licenses.
• Lack of Prior Authorization: Claims are denied if a provider purchases a device or conducts an evaluation before the PCP is officially approved in LTSSMaryland.
• Insufficient Justification: Audits frequently flag AT assessments that fail to explicitly prove how the device reduces the participant's reliance on paid staff.

11. Key Contacts and Resources

Prospective providers should utilize the official state portals and help desks to navigate the DDA approval and Medicaid enrollment processes.

Maintaining contact with the DDA Regional Offices and the ePREP support team is essential for resolving application bottlenecks.

• Maryland DDA Provider Enrollment: Official guidance and application materials (https://health.maryland.gov/dda/Pages/providers.aspx).
• ePREP Portal: Maryland Medicaid's enrollment system (https://eprep.health.maryland.gov).
• LTSSMaryland: The state's case management and billing system (https://ltssmaryland.org).
• Maryland Department of Disabilities (MDOD) Technology Assistance Program: Resource for AT guidance in the state (https://mdod.maryland.gov/mdtap).
• Maryland Medicaid Provider Enrollment Help Desk: Support for ePREP issues at 1-844-463-7768 or MDH.bhenrollment@maryland.gov.

See all Maryland services · Maryland Medicaid consulting · book a consultation.