Utah - Housing Stabilization — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-08-16

In Utah, housing stabilization services are delivered under the Housing Related Services and Supports (HRSS) program, authorized by the state's 1115 Demonstration Waiver. This program provides tenancy support, housing search assistance, landlord mediation, and retention planning specifically to Medicaid members in the Targeted Adult Medicaid (TAM) and Adult Expansion Medicaid (AEM) populations who are experiencing or at risk of homelessness.

The single biggest structural barrier to entry for new HRSS providers in Utah is the dual-layer enrollment and managed care contracting requirement. Because the TAM and AEM populations are heavily managed by regional Accountable Care Organizations (ACOs), simply securing an active Medicaid Provider ID through the state's centralized PRISM portal is insufficient to sustain a business. Providers must successfully execute independent credentialing applications and secure network contracts with Utah's ACOs (such as SelectHealth, Molina, or University of Utah Health Plans) to receive referrals and bill for services.

1. Service Definition and Scope

Utah defines housing stabilization under the Housing Related Services and Supports (HRSS) program. This initiative is designed to address social determinants of health by providing non-medical interventions to vulnerable Medicaid populations.

The service scope focuses on securing and maintaining housing, rather than providing physical shelter. It includes pre-tenancy supports to find housing and post-move-in supports to ensure the member does not face eviction.

• Target Population: Individuals participating in the Targeted Adult Medicaid (TAM) and Adult Expansion Medicaid (AEM) programs who face homelessness, food insecurity, or interpersonal violence.
• Tenancy Support: Direct assistance with housing searches, completing rental applications, and navigating the housing market.
• Landlord Mediation: Intervening in tenant-landlord disputes, negotiating lease terms, and preventing evictions.
• Retention Planning: Developing individualized housing support plans that connect members to ongoing community resources and benefits.
• Move-In Costs: Facilitating waiver-covered financial assistance for security deposits, utility setup fees, and essential furnishings.
• Community Transition: Assisting members transitioning from institutional settings back into independent community living.

2. Regulatory and Oversight Agencies

The HRSS program is administered at the state level by the Utah Department of Health and Human Services (DHHS), specifically through its Division of Integrated Healthcare, which manages Medicaid policy and provider enrollment.

Because Utah relies on professional licensure rather than facility licensure for this service, the Division of Occupational and Professional Licensing (DOPL) plays a critical oversight role for the staff delivering these services.

• Utah Department of Health and Human Services (DHHS): The umbrella agency administering the 1115 Waiver and the HRSS program (https://dhhs.utah.gov/).
• DHHS Division of Integrated Healthcare: The specific division responsible for Medicaid policy, waiver administration, and provider enrollment (https://medicaid.utah.gov/).
• Utah Division of Occupational and Professional Licensing (DOPL): The state regulatory body that issues and oversees the required social work and behavioral health licenses for rendering staff (https://dopl.utah.gov/).
• PRISM Portal: The Provider Resources Information System Medicaid, Utah's centralized MMIS and provider enrollment system (https://medicaid.utah.gov/become-medicaid-provider).
• Accountable Care Organizations (ACOs): Regional managed care entities, such as University of Utah Health Plans (https://uhealthplan.utah.edu/), that oversee network adequacy and claims for TAM/AEM members.

3. Gatekeeping Prerequisites: Who Can Even Apply

Utah does not require a Certificate of Need (CON) or limit HRSS enrollment through a closed Request for Proposals (RFP) process. However, there are strict structural preconditions that block an applicant before an application is accepted.

The most significant gatekeeping prerequisites are professional licensure mandates for staff and the necessity of ACO network affiliation. A provider cannot operate as a standalone fee-for-service entity for the majority of HRSS clients.

• ACO Network Affiliation: Providers must secure active contracts with regional Accountable Care Organizations (e.g., Health Choice Utah, SelectHealth) to receive referrals and bill for the TAM/AEM populations.
• Professional Licensure Gate: Agencies must employ rendering staff who already hold active DOPL licenses (SSW, CSW, LCSW) or DHHS Case Manager certification before the agency can bill for their services.
• NPI Requirement: The agency must hold a valid Type 2 National Provider Identifier (NPI), and all rendering staff must hold Type 1 NPIs registered in NPPES.
• Business Registration: The entity must have an active Utah business license and be registered in good standing with the Utah Department of Commerce.
• No Moratoria: There are currently no state-imposed moratoria on enrolling new HRSS providers, provided all credentialing criteria are met.

4. Licensure and Certification Requirements

Utah does not issue a distinct "Housing Stabilization Facility" or "HRSS Agency" license. Instead, the state regulates this service by requiring the rendering staff to hold specific professional credentials.

Agencies must enroll as Medicaid providers and ensure that every employee billing for HRSS case management meets the state's strict educational and licensing standards.

• Agency Licensure: No specific facility license is required by DHHS; providers operate under standard corporate/business licensure while meeting Medicaid provider standards.
• DOPL Licensure: Rendering case managers must hold an active license from DOPL, such as a Social Service Worker (SSW), Certified Social Worker (CSW), or Licensed Clinical Social Worker (LCSW).
• DHHS Certification: Non-licensed staff must complete and maintain a specific DHHS Case Manager Certification to provide HRSS services.
• HCBS Settings Rule: Providers must comply with the CMS HCBS Settings Rule, ensuring that all services are integrated into the community and do not isolate individuals.
• Insurance Requirements: Agencies must maintain professional liability insurance and general business liability insurance meeting state and ACO thresholds.

5. Medicaid Provider Enrollment

Provider enrollment in Utah is a two-layered process. Layer 1 requires building an organizational profile and gaining centralized state approval through the PRISM portal.

Once the PRISM enrollment is approved and a Medicaid Provider ID is issued, providers must proceed to Layer 2, which involves independent credentialing applications with the regional ACOs.

• System: All state-level enrollments must be submitted electronically through the PRISM (Provider Resources Information System Medicaid) portal (https://medicaid.utah.gov/become-medicaid-provider).
• Taxonomy: Providers must select the exact taxonomy code that aligns with case management or housing support services as directed by the HRSS billing manual.
• IRS Form W-9: Must be signed within the current calendar year, and the legal name must match the IRS EIN letter exactly to avoid PRISM rejection.
• Application Fee: Subject to federal guidelines; HCBS providers may have the fee waived, but this depends on the exact enrollment type and risk category.
• ACO Credentialing: Following PRISM approval, providers must submit separate credentialing packets to entities like Health Choice Utah (https://healthchoiceutah.com/) and University of Utah Health Plans (https://uhealthplan.utah.edu/).

6. Staffing, Training and Background Checks

Because HRSS providers work with highly vulnerable populations, Utah mandates rigorous background screening and specialized training for all direct-care staff.

Agencies are responsible for maintaining continuous compliance, tracking certification renewals, and ensuring no staff member provides services prior to clearing the background check.

• Background Check: Mandatory fingerprint-based criminal history check processed through the Utah Bureau of Criminal Identification (BCI) for all direct care staff.
• Federal Screening: Agencies must screen all employees and owners monthly against the OIG LEIE and SAM.gov exclusion databases.
• Staff Qualifications: Case managers must hold a DOPL license (SSW, CSW, LCSW) or the DHHS Case Manager Certification.
• Required Training: Staff must complete DHHS-mandated HRSS provider education, which includes trauma-informed care and navigating the TAM/AEM waiver requirements.
• CPR/First Aid: Direct support staff are typically required to maintain active CPR and First Aid certifications.

7. Documentation, Policies and Records

Utah DHHS and the regional ACOs require HRSS providers to maintain comprehensive, audit-ready documentation. Records must clearly link the member's eligibility status to the specific housing interventions provided.

Failure to maintain individualized housing support plans or detailed encounter notes is a primary driver of clawbacks during state or managed care audits.

• Housing Support Plan: A required, individualized document detailing the member's housing barriers, specific retention goals, and planned interventions.
• Eligibility Verification: Documentation confirming the member is actively enrolled in the TAM or AEM Medicaid programs and meets the HRSS risk criteria (e.g., homelessness).
• Encounter Notes: Detailed, date-stamped logs of all tenancy support activities, landlord mediations, and housing searches, including time spent and outcomes.
• Ownership Disclosure: Complete disclosure of any individual or entity with a 5 percent or greater ownership interest, as required by 42 CFR Part 455.
• Emergency Management: A Business Continuity Plan that is reviewed and updated annually to ensure uninterrupted service delivery.
• Record Retention: All Medicaid and HRSS service records must be retained for a minimum of five to seven years, depending on specific ACO contract terms.

8. Billing, Rates and Claims

Billing for HRSS in Utah is predominantly managed through the regional ACOs rather than straight fee-for-service Medicaid. Providers must adhere to the billing rules of the specific managed care plan assigned to the member.

Services are billed using specific HCPCS codes for case management and tenancy support, while move-in costs are handled as distinct waiver pass-throughs.

• Billing Manual: Providers must follow the Utah Medicaid General Information Manual and the specific HRSS program guidelines for allowable billing.
• Payer Routing: Claims for TAM and AEM members must be submitted directly to the member's assigned ACO (e.g., Molina, SelectHealth) rather than the state MMIS.
• Coding: Services are billed using state-designated HCPCS codes for housing case management and tenancy supports.
• Move-In Costs: Security deposits and utility setups are covered under the 1115 waiver but require specific prior authorization and documentation of actual costs.
• Electronic Billing: Claims must be submitted electronically using the EDI 837P format or through the respective ACO's proprietary provider portal.
• NPI Requirement: Every claim must include the agency's Type 2 NPI as the billing provider and the credentialed staff member's Type 1 NPI as the rendering provider.

9. Approval Sequence and Timeline

Becoming a fully operational HRSS provider in Utah is a multi-step process that requires sequential approvals. Providers cannot bill until both state and managed care credentialing are complete.

The entire process from staff credentialing to active ACO network status typically takes between 3 to 6 months, depending on application accuracy and ACO paneling schedules.

• Step 1: Staff Credentialing: Ensure all rendering staff obtain their DOPL licenses or DHHS Case Manager certifications (4-8 weeks).
• Step 2: BCI Background Checks: Submit fingerprints to the Utah Bureau of Criminal Identification for all direct care staff (2-4 weeks).
• Step 3: PRISM Enrollment: Submit the Layer 1 Medicaid enrollment application through the PRISM portal (30-60 days for state review).
• Step 4: ACO Contracting: Submit Layer 2 credentialing applications to the regional ACOs to join their provider networks (60-90 days).
• Step 5: Provider Education: Connect with the DHHS HRSS team for mandatory provider education and onboarding prior to accepting clients.

10. Common Denials and Survey Findings

Applications and claims in the HRSS program are frequently denied due to administrative mismatches across databases or a misunderstanding of Utah's managed care landscape.

During audits, DHHS and ACOs frequently cite providers for inadequate documentation that fails to justify the time billed for tenancy supports.

• PRISM Rejections: Applications are often rejected because the legal business name or address does not match exactly across the IRS W-9, NPPES, and PRISM.
• ACO Claim Denials: Attempting to bill fee-for-service Medicaid for TAM/AEM members instead of routing claims to the assigned ACO.
• Staff Credentialing Lapses: Billing for services rendered by staff whose DOPL license or DHHS certification has expired.
• Documentation Audits: Surveyors frequently issue corrective action plans when encounter notes do not clearly link back to the goals established in the Housing Support Plan.
• Background Check Violations: Allowing staff to provide direct services before the BCI background check has officially cleared.

11. Key Contacts and Resources

Providers should rely on official state portals and the provider relations departments of the regional ACOs for the most accurate and up-to-date information.

The DHHS HRSS team is specifically designated to assist new providers with education and understanding participant requirements under the 1115 waiver.

• Utah Medicaid PRISM Portal: For centralized provider enrollment and MMIS access (https://medicaid.utah.gov/become-medicaid-provider).
• Utah HRSS Program Information: Official program overview, eligibility, and provider manuals (https://medicaid.utah.gov/hrss/).
• Utah Division of Occupational and Professional Licensing (DOPL): For staff licensure verification and applications (https://dopl.utah.gov/).
• Medicaid Provider Enrollment Phone: (801) 538-6155 or toll-free 1-800-662-9651 (option 3, then 4).
• University of Utah Health Plans (ACO): For Layer 2 credentialing and network contracting (https://uhealthplan.utah.edu/).
• Health Choice Utah (ACO): For Layer 2 credentialing and network contracting (https://healthchoiceutah.com/).

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