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

Last reviewed: 2026-09-10

Utah’s New Choices Waiver (NCW) and Division of Services for People with Disabilities (DSPD) waivers fund Assistive Technology Devices under HCPCS code T2028 with modifier U8, requiring providers to secure a local business license and National Supplier Clearinghouse (NSC) approval before applying. The state does not issue a distinct state-level facility license for this service; instead, applicants enroll as Medical Suppliers or individual professionals based on their underlying business credentials.

Approval requires executing a Medicaid Provider Agreement through the PRISM portal and receiving individual service authorizations from designated waiver case management agencies. Providers must maintain active Medicare certification or NSC enrollment to supply medical equipment and devices to waiver participants, and cannot bill for any device or evaluation without a prior authorization executed by the client's case manager.

1. Service Definition and Scope

In Utah, Assistive Technology Devices are defined as items, equipment, or product systems used to increase, maintain, or improve functional capabilities of waiver clients. The service covers the full lifecycle of the device, from the initial functional assessment to the final training of the client and their caregivers.

The service is utilized in conjunction with other paid and unpaid support systems to contribute to the health, safety, and welfare of the targeted population, specifically aiming to reduce reliance on paid staff.

• HCPCS Code: T2028 is the primary billing code for Assistive Technology Devices.
• Modifier: U8 is required when billing under the New Choices Waiver.
• Evaluation: Includes the functional assessment of the assistive technology needs of a waiver client.
• Acquisition: Covers purchasing, leasing, or otherwise providing for the acquisition of devices.
• Customization: Includes designing, fitting, customizing, adapting, applying, maintaining, repairing, or replacing devices.
• Training: Mandates training or technical assistance for the waiver client, family members, or paid staff.

2. Regulatory and Oversight Agencies

The Utah Department of Health and Human Services (DHHS) oversees the Medicaid program and its associated waivers. Within DHHS, the Division of Integrated Healthcare (DIH) manages provider enrollment and claims.

Waiver-specific policies and service authorizations are managed by the Bureau of Authorization and Community-Based Services (for the New Choices Waiver) and the Division of Services for People with Disabilities (for the Community Supports and ABI waivers).

• Utah Department of Health and Human Services (DHHS): https://dhhs.utah.gov
• Division of Integrated Healthcare (DIH): https://medicaid.utah.gov
• Division of Services for People with Disabilities (DSPD): https://dspd.utah.gov
• Bureau of Authorization and Community-Based Services: https://medicaid.utah.gov/ltc/
• PRISM Provider Portal: https://medicaid.utah.gov/provider/

3. Gatekeeping Prerequisites: Who Can Even Apply

Utah does not require a Certificate of Need or a closed RFP process for Assistive Technology Devices. There are no current state-imposed moratoria on enrolling new providers in this category.

However, structural preconditions exist regarding business licensure and Medicare enrollment. Providers must secure these federal and local approvals before the state will accept a Medicaid enrollment application.

• Local Business License: Required by the municipality or county where the business is physically located, specifically designated as a Medical Supplier.
• Medicare Certification/NSC: Medical Suppliers must provide a National Supplier Clearinghouse (NSC) letter with the current service address.
• Waiver Case Management Affiliation: Providers cannot bill without a prior service authorization executed by a designated waiver case management agency.
• Network Status: Utah operates this service under an open enrollment model for qualified providers; it is not restricted to a closed managed care network.

4. Licensure and Certification Requirements

Utah does not issue a specific state-level "Assistive Technology Provider" license. Instead, providers enroll based on their underlying professional or business credentials.

Agencies typically enroll as Medical Suppliers, while individual therapists conducting evaluations enroll under their respective professional licenses.

• Medical Supplier License: Requires a Local Business License as a Medical Supplier.
• Professional License: If an individual professional (e.g., physical therapist) provides the evaluation, a State Professional License for the physical location of service is required.
• Accreditation: Requires a current letter of accreditation (JCAHO or AOA), or a letter from HHS, CMS, or a Medicare intermediary showing current enrollment.
• Out-of-State Providers: Must meet Utah's requirements and hold equivalent licensure if shipping devices or providing services to Utah Medicaid clients.

5. Medicaid Provider Enrollment

Enrollment is processed entirely through the PRISM (Provider Reimbursement Information System for Medicaid) online system. Providers must submit the Utah Medicaid Provider Application and sign the Provider Agreement.

Corporate providers must ensure their tax information perfectly matches IRS records to avoid enrollment rejection.

• Application Portal: PRISM online enrollment system.
• Required Forms: IRS Form W-9, Ownership Disclosure information, and Direct Deposit Authorization Form for EFT.
• Provider Agreement: Must be signed by a corporate manager, officer, administrator, or business owner.
• NPI Requirement: Must provide a National Provider Identifier (NPI) and Employer Identification Number (EIN) matching the W-9 exactly.

6. Staffing, Training and Background Checks

Staff providing evaluations or training must hold the appropriate professional credentials for their discipline. The state requires providers to adhere to general Medicaid standards and strict conflict of interest rules.

Agencies must ensure that any staff member delivering or setting up equipment in a client's home has passed required background screenings.

• Evaluator Qualifications: Functional assessments must be conducted by appropriately licensed professionals (e.g., PT, OT, Speech-Language Pathologist).
• Conflict of Interest: Providers cannot conduct the evaluation and supply the device unless an exception is explicitly approved by the State Medicaid Agency.
• Background Checks: Required for all staff with direct patient contact under DHHS Office of Licensing rules.
• Training Competency: Staff must be trained on the specific devices supplied to effectively train the client and family members.

7. Documentation, Policies and Records

Providers must maintain comprehensive records of evaluations, device warranties, and service authorizations. The New Choices Waiver requires strict adherence to the authorized units and frequency.

Documentation must clearly show that the device was delivered, installed, and that the client received adequate training on its use.

• Service Authorizations: Must be received and executed by both the case management agency and the provider before rendering any services.
• Eligibility Verification: Providers must verify client Medicaid eligibility each month to avoid non-reimbursable claims.
• Utilization Tracking: Providers must contact the case management agency if actual service utilization trends appear to exceed authorized units.
• Record Retention: Must maintain documentation of device delivery, setup, client training, and all manufacturer warranties.

8. Billing, Rates and Claims

Claims are submitted through the PRISM system or via EDI. Services must strictly align with the prior authorization issued by the case management agency.

The state actively recovers funds for claims that exceed authorized limits or fall outside the authorized date spans.

• Billing Code: T2028 (Assistive Technology Devices).
• Modifier: U8 (Specific to New Choices Waiver).
• Claim Submission: Electronic (EDI) with a Trading Partner number, or directly via the PRISM portal.
• Unit Limits: Claims paid for services exceeding the authorized units or frequency will be recovered by the state.
• Date Spans: Claims paid for waiver services for dates of service outside of the date span listed in the service authorization will be recovered.

9. Approval Sequence and Timeline

The approval sequence requires securing federal and local credentials before approaching the state Medicaid agency. The PRISM enrollment process cannot begin without an active NPI and NSC letter.

Once enrolled, providers still cannot bill until they receive individual service authorizations from waiver case managers.

• Step 1: Obtain Local Business License and National Supplier Clearinghouse (NSC) approval or Medicare certification.
• Step 2: Submit Utah Medicaid Provider Application via PRISM with W-9 and Ownership Disclosure.
• Step 3: Sign and submit the Utah Medicaid Provider Agreement.
• Step 4: Receive Medicaid Provider ID and establish connections with waiver case management agencies to receive service authorizations.

10. Common Denials and Survey Findings

The State Medicaid Agency actively monitors compliance and will terminate contracts for patterns of non-compliance with waiver rules. Denials almost always stem from authorization or eligibility failures.

Auditors frequently target claims where the provider delivered a device before the authorization was fully executed.

• Missing Authorization: Rendering services before a service authorization is properly executed by the case management agency.
• Expired Authorizations: Billing for dates of service outside the date span listed in the service authorization.
• Eligibility Loss: Providing services without verifying monthly Medicaid eligibility, resulting in non-reimbursable claims.
• Conflict of Interest: Supplying devices based on self-referrals without State Medicaid Agency exception approval.

11. Key Contacts and Resources

Primary contacts include the Bureau of Medicaid Operations for PRISM enrollment issues and the Bureau of Authorization and Community-Based Services for New Choices Waiver policy.

Providers should regularly check the PRISM portal and DHHS waiver pages for updates to service definitions and billing modifiers.

• Bureau of Medicaid Operations (Provider Enrollment): https://medicaid.utah.gov/provider/
• New Choices Waiver Program: https://medicaid.utah.gov/ltc/nc/
• Division of Services for People with Disabilities (DSPD): https://dspd.utah.gov
• PRISM Portal: https://medicaid.utah.gov/provider/

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