Waiver Consulting Group — Start any program. In any state.

Utah - Personal Assistance Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

In Utah, Personal Assistance Services (PAS) are funded through the Medicaid Home and Community-Based Services (HCBS) Waiver for Individuals Age 65 or Older (Aging Waiver) and the Employment-related Personal Assistant Services (EPAS) program. The Utah Department of Health and Human Services (DHHS) oversees these programs, and providers must enroll through the PRISM provider portal.

To become an approved provider, agencies must obtain an applicable business license, pass Utah criminal history and background checks, and secure authorization from the Division of Aging and Adult Services (DAAS) or its designee (such as an Area Agency on Aging). There is no distinct state licensure category exclusively for PAS; instead, providers operate under general business licensure and Medicaid enrollment requirements, with service delivery governed by the waiver's quality management systems.

1. Service Definition and Scope

Personal Assistance Services (PAS) in Utah provide hands-on assistance with activities of daily living (ADLs) such as bathing, dressing, transferring, and toileting in the participant's own home. These services are designed to serve as an alternative to institutional care for eligible Medicaid recipients.

Under the Aging Waiver and EPAS program, PAS must be delivered as ordered by a physician and stated in the established care plan. Services can be provided by agency staff or participant-employed providers, depending on the specific waiver program.

2. Regulatory and Oversight Agencies

The Utah Department of Health and Human Services (DHHS) is the primary regulatory body for Medicaid HCBS waivers. Within DHHS, the Division of Integrated Healthcare (DIH) manages Medicaid operations, while the Division of Aging and Adult Services (DAAS) oversees the Aging Waiver.

Provider enrollment is processed through the PRISM (Provider Reimbursement Information System for Medicaid) portal. DAAS or its designees, typically Area Agencies on Aging (AAAs), are responsible for authorizing services and managing care plans.

3. Gatekeeping Prerequisites: Who Can Even Apply

Utah does not impose a Certificate of Need (CON) or a closed network moratorium for PAS providers under the Aging Waiver. Any willing provider that meets the qualifications defined in the Aging Waiver State Implementation Plan (SIP) may enroll at any time.

However, providers must be enrolled with both the State Medicaid Agency (SMA) and the DAAS designee (AAA) to provide services. Services must be ordered by DAAS or their designee, meaning providers cannot bill for services without an approved care plan and authorization from the local AAA.

4. Licensure and Certification Requirements

Utah does not have a specific state license exclusively for non-medical Personal Assistance Services. Instead, providers must hold a valid business license in the jurisdiction where they operate and meet the qualifications outlined in the Medicaid provider manual and waiver SIP.

Agencies providing personal care may operate as licensed personal care agencies if they provide services under Utah Admin. Code Subsection R156-31b-701a, but for basic PAS under the waiver, a standard business license and Medicaid enrollment are the primary requirements.

5. Medicaid Provider Enrollment

Providers must enroll through the Utah Medicaid PRISM provider portal. The application requires submitting a provider enrollment application, completing Attachment A, and agreeing to provider responsibilities in Attachment B within the PRISM system.

Providers must bill with the appropriate National Provider Identifier (NPI) or Medicaid provider number associated with the waiver and area. Enrollment is open year-round for qualified providers.

6. Staffing, Training and Background Checks

All PAS providers and agency staff must pass a Utah criminal history and background check before providing services. Agencies are responsible for ensuring their staff meet these requirements.

For specific programs like EPAS, providers must attend mandatory service coordinator training provided by State Medicaid Agency staff and demonstrate required competencies for service coordination, protocols, and procedures.

7. Documentation, Policies and Records

Providers must maintain documentation consistent with the amount, frequency, and duration of services ordered by DAAS or their designee. Claims must match the approved care plan exactly.

Electronic Visit Verification (EVV) is mandatory for all personal care services provided under a 1915(c) HCBS Waiver in Utah. Providers may choose their own EVV reporting system, provided it meets all federal requirements, including HIPAA standards.

8. Billing, Rates and Claims

Reimbursement rates are established by DHHS using methods such as market surveys, component cost analysis, or comparative analysis to determine a Maximum Allowable Rate (MAR). Providers bill using the PRISM system and must submit claims within 90 days of service delivery, though Medicaid allows a 12-month submission and correction period.

A rural rate enhancement (TN modifier) is available for services provided in rural counties (all Utah counties except Weber, Davis, Salt Lake, and Utah Counties) to account for additional travel expenses. This must be authorized by DAAS or its designee.

9. Approval Sequence and Timeline

The approval process begins with obtaining a local business license and securing general and professional liability insurance. The provider then completes the Utah criminal history and background checks.

Once prerequisites are met, the provider submits the Medicaid application via the PRISM portal. After PRISM enrollment is approved, the provider must coordinate with the local AAA (DAAS designee) to receive service authorizations and care plans before billing can commence.

10. Common Denials and Survey Findings

Providers often face claim denials if the billed services do not exactly match the care plan or service authorization form issued by the AAA. Discrepancies in service start/end dates, service names, units, frequency, or HCPCS codes will result in rejected claims.

Failure to implement a compliant Electronic Visit Verification (EVV) system or failing to maintain current background checks for all staff are significant compliance issues that can lead to enrollment termination or recoupment of funds.

11. Key Contacts and Resources

The primary contact for enrollment is the Utah Medicaid Provider Enrollment team. Providers should also familiarize themselves with the PRISM portal and the specific waiver manuals available on the DHHS website.

For service authorizations and local coordination, providers must work directly with the Area Agency on Aging (AAA) in their region, which acts as the DAAS designee.

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