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

Last reviewed: 2026-09-10

The Pennsylvania Department of Human Services (DHS) funds Assistive Technology through the Office of Developmental Programs (ODP) waivers, including the Consolidated, Community Living, and Adult Autism waivers, and the Office of Long-Term Living (OLTL) Community HealthChoices (CHC) program. Providers enroll as un-licensed waiver agencies or Durable Medical Equipment (DME) suppliers rather than holding a distinct state assistive technology license.

Approval requires completing the ODP provider qualification process via the Home and Community Services Information System (HCSIS) or contracting directly with CHC Managed Care Organizations (MCOs), followed by enrollment in the PROMISe Medicaid portal. Applicants must secure an organizational Type 2 NPI and, for clinical assessments, employ staff with RESNA Assistive Technology Professional (ATP) certification before applications are accepted.

1. Service Definition and Scope

In Pennsylvania, Assistive Technology encompasses the evaluation, procurement, and training for devices that increase a waiver participant's functional capability and reduce reliance on paid staff. The service covers commercial or custom-modified equipment, communication devices, and environmental control systems not covered by State Plan Medicaid or Medicare.

The service is designed to promote independence and must be directly tied to a need identified in the participant's person-centered plan.

• Scope: Includes clinical needs assessments, equipment purchase, delivery, setup, and user training.
• Exclusions: Cannot duplicate items covered under the Medicaid State Plan, Medicare, or private insurance.
• Limits: Items over $500 typically require insurance or an extended warranty.
• Replacement: Uninsured items that are damaged, stolen, or lost may be replaced once every two years.

2. Regulatory and Oversight Agencies

Oversight is split between two primary DHS program offices depending on the target population. ODP manages intellectual disability and autism waivers, while OLTL manages physical disability and aging waivers through the CHC managed care model.

Both offices utilize the centralized state Medicaid enrollment system to finalize provider agreements and process fee-for-service claims.

• Department of Human Services (DHS): https://www.pa.gov/agencies/dhs
• Office of Developmental Programs (ODP): https://www.pa.gov/agencies/dhs/about/offices/office-of-developmental-programs
• Office of Long-Term Living (OLTL): https://www.pa.gov/agencies/dhs/about/offices/office-of-long-term-living
• PROMISe Provider Portal: https://provider.enrollment.dhs.pa.gov/

3. Gatekeeping Prerequisites: Who Can Even Apply

Pennsylvania does not restrict Assistive Technology enrollment through a Certificate of Need or closed RFP process, but structural prerequisites block incomplete applicants. Providers targeting the aging and physical disability populations must secure network contracts with regional CHC MCOs, which may close their networks based on adequacy.

ODP providers face mandatory pre-application training gates that must be cleared before the state will review qualification documents.

• Business Registration: Must establish a business entity with the Pennsylvania Department of State and obtain an IRS EIN.
• NPI Requirement: Must obtain an organizational Type 2 National Provider Identifier (NPI) prior to PROMISe enrollment.
• MCO Contracting: For OLTL CHC waivers, providers must secure contracts with MCOs (e.g., UPMC, AmeriHealth Caritas, PA Health & Wellness) which act as the gatekeepers for that population.
• ODP Orientation: Prospective ODP providers must complete mandatory administrative and compliance training via the MyODP portal before submitting qualification documents.

4. Licensure and Certification Requirements

Pennsylvania does not issue a specific facility or agency license for Assistive Technology providers. Instead, entities enroll as qualified service agencies, independent vendors, or DME suppliers under 55 PA Code Chapter 52 and Chapter 6100 regulations.

While the agency itself is unlicensed, individual staff members performing clinical evaluations must hold specific national certifications.

• Agency Licensure: No distinct state license exists; providers operate under general HCBS provider qualification standards.
• Clinical Certification: Professionals conducting clinical AT needs assessments must hold Assistive Technology Professional (ATP) certification from RESNA.
• DME Standards: Suppliers of medical equipment must meet PA Department of Health requirements for medical supplies providers if billing State Plan services.
• Insurance: Proof of Commercial General Liability and Professional/Product Liability insurance is required.

5. Medicaid Provider Enrollment

Enrollment is a dual-step process requiring program-office qualification followed by Medicaid portal registration. ODP providers use HCSIS for qualification, while all providers use the PROMISe portal for final fee-for-service Medicaid enrollment.

Providers must ensure their ownership and control interest disclosures match IRS records exactly to avoid application rejection.

• System: PROMISe (Provider Reimbursement and Operations Management Information System) is the mandatory enrollment portal.
• ODP Qualification: Providers must submit qualification applications through the electronic HCSIS Portal.
• Provider Type: Typically enrolls under Provider Type 52 (Waiver/Service) or 55 (Vendor), depending on the specific waiver and billing structure.
• Fee: Enrollment requires payment of the federal Medicaid application fee unless waived via Medicare or other state enrollment.

6. Staffing, Training and Background Checks

Agencies must ensure that all personnel interacting with waiver participants meet strict background and training standards. While vendors shipping products may have reduced requirements, staff conducting in-home evaluations or training must clear state background checks.

Specialized waivers, such as the Adult Autism Waiver, require specific population-focused training before service delivery begins.

• Clearances: Mandatory Pennsylvania State Police criminal history record check for all staff handling client evaluations or deliveries.
• Child Abuse: PA Child Abuse History Clearance required if serving participants under age 18.
• Autism Training: Staff serving the Adult Autism Waiver must complete BAS-approved training regarding autism spectrum disorders prior to service provision.
• Competency: Agencies must maintain documentation of staff technical competencies for the specific devices they install and support.

7. Documentation, Policies and Records

Providers must maintain comprehensive records that satisfy both ODP/OLTL waiver requirements and federal Medicaid standards. Documentation must prove that devices were authorized, delivered, and that the participant was trained on their use.

Auditors frequently review these records to ensure compliance with 55 PA Code Chapter 6100 and Chapter 52.

• Service Plans: Procurements must be explicitly authorized within the participant's Individual Service Plan (ISP) by a Supports Coordinator before billing.
• Delivery Logs: Must maintain detailed records of technology deliveries, including equipment serial numbers and participant signatures.
• Training Records: User training logs must be kept to validate that the participant or caregiver was instructed on device usage.
• Policy Manual: Must maintain agency-specific policies aligned with 55 PA Code Chapter 6100 (ODP) or Chapter 52 (OLTL) guidelines.

8. Billing, Rates and Claims

Assistive Technology is generally reimbursed on a per-item basis rather than a time-based unit, subject to annual budget caps. Claims are submitted through PROMISe for fee-for-service waivers or directly to MCOs for CHC participants.

Providers must not charge Medicaid more than the customary rate offered to the general public.

• Budget Caps: ODP waivers typically impose an annual or multi-year budget cap for AT, which varies by specific waiver appendix.
• Pricing: Vendors cannot charge Medicaid more than the rate offered to the general public for the same item.
• Procedure Codes: Billed using specific HCPCS codes as defined in the current ODP/OLTL fee schedule.
• Transportation: The cost of transportation or shipping is generally not billed separately; it must be factored into the approved item rate.

9. Approval Sequence and Timeline

The end-to-end process from business formation to active billing status requires coordinating with multiple state systems. Delays often occur during the HCSIS qualification review or MCO credentialing phases.

Applicants should expect the entire process to take several months from initial registration to final PROMISe approval.

• Step 1: Establish business entity, obtain EIN, and secure a Type 2 NPI (1-2 weeks).
• Step 2: Complete mandatory MyODP pre-application training and orientation (1-2 weeks).
• Step 3: Submit provider qualification documentation via HCSIS or to CHC MCOs (30-60 days for review).
• Step 4: Submit the formal Medicaid enrollment application via the PROMISe portal (30-45 days).

10. Common Denials and Survey Findings

Applications and claims are frequently rejected due to administrative errors or failure to exhaust primary insurance. State monitors closely audit AT providers to ensure Medicaid is the payer of last resort.

Maintaining active credentials and exact matches on tax documents is critical for continuous enrollment.

• State Plan Duplication: Denials occur if the provider fails to prove the item was rejected by or unavailable through the Medicaid State Plan or Medicare.
• Missing ISP Authorization: Claims reject in PROMISe if the exact item cost and code are not pre-authorized in the participant's approved ISP.
• Incomplete Ownership Forms: PROMISe applications are frequently returned if the Ownership and Control Interest Form does not match IRS records exactly.
• Lapsed Certifications: Qualification renewals are denied if the agency fails to maintain active RESNA ATP certifications for clinical staff.

11. Key Contacts and Resources

Providers must utilize state-managed portals and help desks to navigate the enrollment and billing processes. The DHS provider enrollment hotline and MyODP portal are the primary technical assistance resources.

For CHC, providers must contact the individual MCOs directly for contracting and credentialing support.

• PROMISe Enrollment Portal: https://provider.enrollment.dhs.pa.gov/
• MyODP Training Portal: https://www.myodp.org/
• DHS Provider Enrollment Help Desk: 1-800-537-8862
• PA Department of State (Business Registration): https://www.dos.pa.gov/

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