Utah - Adult Companion Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

Utah's Department of Health and Human Services (DHHS) funds Adult Companion Services primarily through the Community Supports Waiver (CSW) and the Aging Waiver, requiring prospective agencies to first secure certification from the Division of Services for People with Disabilities (DSPD) or the Division of Aging and Adult Services (DAAS). Providers deliver non-medical supervision and socialization to help adults with intellectual disabilities or age-related frailties remain safely in their communities.

Securing approval requires navigating a strict sequence: obtaining a Department of Commerce business registration, passing the DSPD or DAAS certification review, and finally enrolling as an atypical provider in the PRISM Medicaid portal. The mandatory DSPD or DAAS certification process functions as the primary structural precondition, mandating that applicants submit a comprehensive policy manual and pass a readiness review before PRISM enrollment is even permitted.

1. Service Definition and Scope

Adult Companion Services in Utah consist of non-medical care, supervision, and socialization provided to a waiver participant. Providers assist with light tasks incidental to the supervision and socialization, but the core service is ensuring the individual's safety and community integration.

This service is distinct from personal care or home health, as it does not include hands-on medical care or routine assistance with activities of daily living (ADLs) like bathing or dressing.

• Target Population: Adults on the Community Supports Waiver or Aging Waiver who require supervision to ensure safety.
• Core Activities: Socialization, supervision, and assistance with light incidental tasks like meal preparation.
• Exclusions: Cannot be billed concurrently with personal care, supported living, or residential habilitation.
• Setting: Delivered in the participant's home or in community settings.
• Transportation: May include incidental transportation if specified in the person-centered support plan.

2. Regulatory and Oversight Agencies

Multiple divisions within the Utah Department of Health and Human Services (DHHS) oversee the certification, enrollment, and auditing of Adult Companion Services. Providers must interact with both the programmatic divisions and the central Medicaid enrollment system.

Because Adult Companion Services do not require a facility license, oversight is primarily contract- and certification-based rather than facility-licensure-based.

• Utah Department of Health and Human Services (DHHS): The umbrella agency managing Medicaid and HCBS waivers (https://dhhs.utah.gov/).
• Division of Services for People with Disabilities (DSPD): Certifies providers for the Community Supports Waiver (https://dspd.utah.gov/).
• Division of Aging and Adult Services (DAAS): Oversees providers operating under the Aging Waiver (https://daas.utah.gov/).
• Utah Medicaid PRISM Portal: The Provider Reimbursement Information System for Medicaid used for enrollment and claims (https://medicaid.utah.gov/prism/).
• Office of Background Check (OBC): Processes mandatory background screenings for all direct care staff (https://dhhs.utah.gov/office-of-background-checks/).

3. Gatekeeping Prerequisites: Who Can Even Apply

Utah does not currently impose a Certificate of Need (CON) or a closed-network moratorium for Adult Companion Services. There are no county sponsorship letters required to initiate an application.

However, prospective providers cannot simply enroll in Medicaid. They must first pass a rigorous certification process with the operating division (DSPD or DAAS), which acts as the structural gatekeeper. Without this certification, the PRISM Medicaid application will be rejected.

• DSPD/DAAS Certification: Required prior-approval step; providers must submit an application and policy manual to the respective division before Medicaid enrollment.
• Business Registration: Must be registered and in good standing with the Utah Department of Commerce.
• NPI Requirement: Must obtain a National Provider Identifier (NPI) prior to initiating the PRISM application.
• No Certificate of Need: Utah does not require a CON for HCBS waiver services.
• Open Enrollment: DSPD generally accepts new provider applications on a rolling basis, though processing times vary based on state capacity.

4. Licensure and Certification Requirements

Utah does not issue a standalone "Adult Companion License." Instead, agencies must obtain HCBS Certification through DSPD or DAAS. If the agency also provides hands-on personal care, they may require a Personal Care Agency license from the DHHS Office of Licensing.

The certification process requires demonstrating compliance with the HCBS Settings Rule and submitting comprehensive operational policies.

• Certification Type: DSPD or DAAS HCBS Provider Certification.
• Policy Manual: Must submit customized policies covering incident reporting, rights, and emergency procedures.
• HCBS Settings Rule: Must attest and demonstrate that services integrate participants into the broader community.
• Financial Solvency: May be required to demonstrate financial stability or provide a business plan during the DSPD review.
• On-Site Review: DSPD may conduct a readiness review or initial site visit prior to issuing final certification.

5. Medicaid Provider Enrollment

Once certified by DSPD or DAAS, the agency must enroll as a Medicaid provider using the PRISM (Provider Reimbursement Information System for Medicaid) portal. Every provider rendering services must be enrolled in PRISM prior to the date of service.

The enrollment process requires uploading the DSPD/DAAS certification, ownership disclosures, and paying the federal application fee if applicable.

• System: PRISM (Provider Reimbursement Information System for Medicaid).
• Provider Type: Typically enrolled as an Atypical Provider or under the specific HCBS Waiver provider taxonomy.
• Application Fee: Subject to the CMS-mandated application fee (approx. $709 for 2024) unless waived or paid to another state/Medicare.
• Ownership Disclosure: Must complete detailed disclosures of all individuals with 5% or more ownership.
• Revalidation: Providers must revalidate their Medicaid enrollment through PRISM every 3 to 5 years.

6. Staffing, Training and Background Checks

Direct support professionals (DSPs) providing Adult Companion Services must meet strict background and training requirements before working with participants. Agencies are responsible for maintaining these records.

Training must align with DSPD standards, including specific modules on abuse prevention and incident reporting.

• Age Requirement: Staff must be at least 18 years of age.
• Background Check: Mandatory fingerprint-based criminal background check through the Utah DHHS Office of Background Check.
• First Aid/CPR: All direct care staff must hold current First Aid and CPR certification.
• Initial Training: Must complete DSPD-mandated training on participant rights, abuse/neglect reporting, and the HCBS Settings Rule.
• Ongoing Training: Annual continuing education hours are required as specified in the DSPD provider contract.

7. Documentation, Policies and Records

Utah requires Adult Companion providers to maintain detailed, audit-ready records. Documentation must prove that services were delivered according to the person-centered support plan.

Agencies must also maintain administrative policies that dictate how incidents are reported to the state and how participant grievances are handled.

• Service Logs: Must document the date, start/stop times, location, and specific activities provided during each shift.
• Incident Reporting: Critical incidents must be reported to DSPD and DHHS within 24 hours of discovery.
• Person-Centered Plan: Services must strictly align with the goals and authorized hours in the participant's support plan.
• Record Retention: Medicaid records must typically be retained for a minimum of 5 to 7 years.
• Quality Assurance: Agencies must implement an internal QA plan to monitor service delivery and staff compliance.

8. Billing, Rates and Claims

Billing for Adult Companion Services is processed through the PRISM system or via an approved clearinghouse like the Utah Health Information Network (UHIN). Services are reimbursed on a fee-for-service basis according to the published Medicaid fee schedule.

Providers must ensure they only bill for authorized units and that no claims overlap with other billed waiver services.

• Clearinghouse: Utah Health Information Network (UHIN) is the standard for EDI transactions in Utah.
• Procedure Code: Typically billed using HCPCS code S5135 (Companion care, adult), though providers must verify the current code on the DSPD rate sheet.
• Unit of Service: Usually billed in 15-minute increments.
• Prior Authorization: All services must be prior-authorized by the participant's support coordinator before billing.
• Timely Filing: Claims must generally be submitted within 365 days of the date of service.

9. Approval Sequence and Timeline

Becoming a fully billable Adult Companion provider in Utah is a multi-step process that typically takes 4 to 8 months. The timeline is heavily dependent on the provider's readiness and the state's processing queues.

Providers cannot skip steps; DSPD certification must precede PRISM enrollment, and PRISM enrollment must precede any service delivery.

• Step 1: Establish a legal business entity and obtain an NPI (1-2 weeks).
• Step 2: Develop policy manuals and submit the DSPD/DAAS certification application (2-3 months for state review).
• Step 3: Complete staff background checks and initial training (concurrent with Step 2).
• Step 4: Submit the Medicaid enrollment application via PRISM (30-90 days for processing).
• Step 5: Receive the Welcome Letter and execute the provider agreement before accepting referrals.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied due to incomplete policy manuals or failure to properly disclose ownership in PRISM. State reviewers will reject applications that use generic, non-Utah-specific templates.

During post-enrollment audits, the most common citations involve missing documentation of service delivery times or lapsed staff background checks.

• PRISM Errors: Denials often occur because the ownership information in PRISM does not match the IRS or state business registry.
• Policy Gaps: DSPD will reject applications if policies do not explicitly address Utah's incident reporting timelines.
• Documentation Failures: Auditors frequently recoup funds if service logs lack specific start and stop times.
• Training Lapses: Citations are common when staff files are missing proof of current CPR/First Aid certification.
• Settings Rule Violations: Failure to demonstrate that the service promotes community integration can lead to contract termination.

11. Key Contacts and Resources

Providers should rely on official Utah DHHS and DSPD resources for the most current manuals, fee schedules, and enrollment instructions.

The PRISM helpdesk and the UHIN support team are critical contacts for resolving billing and enrollment technical issues.

• Utah Medicaid Provider Portal (PRISM): https://medicaid.utah.gov/prism/
• Division of Services for People with Disabilities (DSPD): https://dspd.utah.gov/
• Utah Medicaid Provider Manuals: https://medicaid.utah.gov/manuals/
• Utah Health Information Network (UHIN): https://uhin.org/
• DHHS Office of Background Check: https://dhhs.utah.gov/office-of-background-checks/

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