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

Last reviewed: 2026-09-10

The Maryland Department of Health (MDH) Developmental Disabilities Administration (DDA) and Office of Long Term Services and Supports (OLTSS) fund Assistive Technology Services through the Community Pathways, Community Supports, and Community Options waivers. Prospective providers must secure DDA certification or OLTSS vendor approval before submitting a Medicaid enrollment application through the electronic Provider Revalidation and Enrollment Portal (ePREP).

Approval requires demonstrating compliance with COMAR 10.09.54 or COMAR 10.22.17, depending on the target waiver, which mandates specific vendor qualifications, itemized cost estimates, and coordination with the participant's Coordinator of Community Services (CCS) or case manager.

1. Service Definition and Scope

In Maryland, Assistive Technology Services encompass the evaluation, purchasing, leasing, customizing, and training associated with devices that increase a waiver participant's functional capability and reduce reliance on paid staff. This service is distinct from standard Durable Medical Equipment (DME) covered under the Medicaid State Plan.

The scope includes communication devices, environmental controls, and specialized software, provided they are documented in the participant's Person-Centered Plan (PCP) and are not available through the Division of Rehabilitation Services (DORS) or local school systems.

• Service Components: Evaluation, design, customization, installation, maintenance, and repair of assistive technology items.
• Training Scope: Instruction for the participant, family members, and paid support staff on how to use the device.
• Exclusions: Items that are strictly recreational, standard household appliances, or covered under the Medicaid State Plan DME benefit.
• Waiver Authority: Authorized under 1915(c) waivers including the Community Options Waiver and DDA Waivers.
• Cost Limits: Subject to individual waiver caps and requires prior authorization based on the lowest cost alternative.

2. Regulatory and Oversight Agencies

The Maryland Department of Health (MDH) serves as the single State Medicaid Agency, with specific waiver operations delegated to its internal divisions. The Developmental Disabilities Administration (DDA) oversees providers serving individuals with intellectual and developmental disabilities.

The Office of Long Term Services and Supports (OLTSS) manages the Community Options Waiver. Provider enrollment is centralized through the ePREP system.

• Maryland Department of Health (MDH): The overarching Medicaid authority (https://health.maryland.gov).
• Developmental Disabilities Administration (DDA): Certifies providers for the Community Pathways and Community Supports waivers (https://health.maryland.gov/dda).
• Office of Long Term Services and Supports (OLTSS): Administers the Community Options Waiver (https://health.maryland.gov/mmcp/ltss).
• ePREP Portal: The mandatory electronic system for all Medicaid provider enrollment and revalidation (https://eprep.health.maryland.gov).
• LTSSMaryland: The state's case management and billing system for waiver services (https://ltssmaryland.health.maryland.gov).

3. Gatekeeping Prerequisites: Who Can Even Apply

Maryland does not issue a standalone Assistive Technology license. Instead, applicants must pass through specific programmatic gates depending on the waiver they intend to serve. For DDA waivers, an applicant must first submit and receive approval of a DDA Provider Application.

For the Community Options Waiver, providers must often be enrolled as a Medicaid DMEPOS provider or a specialized vendor, requiring prior Medicare enrollment or specific accreditation before ePREP will accept the application.

• DDA Provider Application: Mandatory pre-approval step for DDA waivers before ePREP enrollment is permitted.
• Medicare Enrollment: Required for vendors supplying items that cross over with standard DMEPOS categories.
• State Plan Exhaustion: Providers must verify that the requested item is not covered by the Medicaid State Plan before billing the waiver.
• Business Registration: Must be registered and in good standing with the Maryland State Department of Assessments and Taxation (SDAT).
• NPI Requirement: Must possess a valid National Provider Identifier (NPI) appropriate for a DME or specialized vendor.

4. Licensure and Certification Requirements

Because Assistive Technology spans a wide range of devices and services, Maryland relies on vendor qualifications rather than a single facility license. Providers must meet the standards outlined in COMAR 10.09.54 for the Community Options Waiver or COMAR 10.22 for DDA waivers.

Evaluators and trainers must hold the appropriate professional licenses (e.g., Occupational Therapists, Speech-Language Pathologists) issued by the respective Maryland health occupation boards.

• Vendor Certification: Must be an authorized dealer or manufacturer of the specific assistive technology device.
• Professional Licensure: Evaluators must hold active Maryland licenses in their respective clinical fields (e.g., OT, PT, SLP).
• COMAR Compliance: Must adhere to the general provider conditions in COMAR 10.09.36.
• DMEPOS Accreditation: Required if the provider also bills standard medical equipment to Medicaid.
• Out-of-State Providers: Must be licensed in their home state and registered to do business in Maryland if shipping devices.

5. Medicaid Provider Enrollment

All Assistive Technology providers must enroll through the Maryland Department of Health's electronic Provider Revalidation and Enrollment Portal (ePREP). The system requires uploading proof of DDA certification or OLTSS vendor approval.

Providers must select the appropriate provider type and specialty codes corresponding to waiver services or DME, and must complete the Medicaid Provider Agreement within the portal.

• ePREP System: The exclusive portal for submitting enrollment applications and updates.
• Provider Type: Typically enrolled as Provider Type 87 (Waiver Services) or Provider Type 25 (DME), depending on the specific service.
• Application Fee: Subject to the federal Medicaid application fee unless enrolled in Medicare or waived by MDH.
• Site Visit: High-risk DMEPOS providers may be subject to a pre-enrollment site visit by MDH or its contractors.
• Revalidation: Required every five years through the ePREP system.

6. Staffing, Training and Background Checks

Agencies providing direct evaluation or training services must ensure their staff meet Maryland's background check and training mandates. Vendors who only ship devices without direct participant contact have reduced training requirements.

For DDA waiver providers, staff interacting with participants must complete DDA-mandated basic trainings and undergo criminal history record checks.

• CJIS Background Checks: Required through the Maryland Criminal Justice Information System for staff with direct participant contact.
• Medicaid Exclusion Checks: Monthly screening of all employees against the OIG LEIE and Maryland Medicaid exclusion lists.
• DDA Basic Training: Required for direct support professionals under DDA waivers, covering incident reporting and participant rights.
• Professional Competency: Staff providing training on devices must have documented expertise or manufacturer certification.
• CPR and First Aid: Required for staff providing in-person services in the participant's home.

7. Documentation, Policies and Records

Providers must maintain comprehensive records demonstrating that the assistive technology was authorized, delivered, and functioning as intended. Documentation must align with the participant's Person-Centered Plan (PCP).

Records must be retained for a minimum of six years and be available for inspection by MDH, DDA, or federal auditors upon request.

• Person-Centered Plan (PCP): The device and training must be explicitly authorized in the participant's approved PCP.
• Itemized Invoices: Must retain original manufacturer invoices and detailed cost breakdowns for all devices.
• Delivery Receipts: Signed documentation from the participant or representative confirming receipt of the device.
• Evaluation Reports: Clinical justification documents from licensed professionals recommending the specific technology.
• Record Retention: Six years from the date of service or final payment, per COMAR regulations.

8. Billing, Rates and Claims

Assistive Technology is typically billed as a discrete item or service rather than a continuous hourly rate. Claims are processed through the LTSSMaryland system or the MMIS, depending on the waiver.

Rates are established based on the actual cost of the item plus a state-defined administrative markup, or according to a specific fee schedule for evaluations and training.

• Prior Authorization: All Assistive Technology purchases require prior authorization from the waiver operating agency.
• Billing System: Claims for waiver services are submitted through LTSSMaryland or the state's MMIS.
• Procedure Codes: Typically utilizes HCPCS codes such as T2028 (Specialized supply) or specific DME codes.
• Cost Estimates: Providers must submit three bids or a detailed cost estimate for items exceeding a certain dollar threshold.
• Payer of Last Resort: Medicaid only pays after Medicare, private insurance, and DORS have denied coverage.

9. Approval Sequence and Timeline

The approval process begins with the programmatic gatekeeper (DDA or OLTSS) and concludes with ePREP enrollment. The entire sequence can take several months depending on application completeness.

Once ePREP approves the enrollment, the provider is activated in LTSSMaryland and can begin receiving authorizations from Coordinators of Community Services (CCS).

• Step 1: Programmatic Approval: Submit application to DDA or OLTSS (30 to 90 days).
• Step 2: ePREP Submission: Upload programmatic approval and complete Medicaid enrollment (30 to 60 days).
• Step 3: Site Visit: If applicable, MDH conducts a site visit (adds 30 days).
• Step 4: ePREP Approval: MDH issues the Medicaid provider number and effective date.
• Step 5: LTSSMaryland Activation: Provider is linked to the billing system and can accept PCP authorizations.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied due to missing documentation in ePREP or failure to secure the necessary programmatic pre-approvals. MDH strictly enforces the requirement that the business name in ePREP matches the SDAT registration exactly.

Post-enrollment audits often cite providers for billing items not explicitly authorized in the PCP or failing to maintain signed delivery receipts.

• ePREP Mismatches: Denials due to discrepancies between the W-9, SDAT registration, and ePREP application.
• Missing Pre-Approval: Submitting an ePREP application without the required DDA certification letter.
• Unapproved Substitutions: Delivering and billing for a different device model than what was authorized in the PCP.
• Lack of Delivery Proof: Recoupment of funds during audits due to missing participant signatures on delivery receipts.
• State Plan Overlap: Denials for billing the waiver for items that should have been billed to the Medicaid State Plan DME benefit.

11. Key Contacts and Resources

Prospective providers should utilize the official Maryland Department of Health portals and division websites for the most current manuals, fee schedules, and application forms.

The ePREP call center and DDA regional offices are the primary points of contact for enrollment and certification questions.

• Maryland Department of Health (MDH): https://health.maryland.gov
• ePREP Portal: https://eprep.health.maryland.gov
• Developmental Disabilities Administration (DDA): https://health.maryland.gov/dda
• Office of Long Term Services and Supports (OLTSS): https://health.maryland.gov/mmcp/ltss
• LTSSMaryland Portal: https://ltssmaryland.health.maryland.gov

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