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

Last reviewed: 2026-08-16

In Utah, Transitional Assistance Services are officially categorized as Community Transition Services under the state's 1915(c) Medicaid waivers, such as the New Choices Waiver and the Community Supports Waiver. This service provides critical, non-recurring financial support to cover one-time set-up expenses—such as security deposits, utility activation fees, and essential furnishings—for Medicaid members moving out of an Intermediate Care Facility (ICF) or nursing facility into an independent community setting.

The single biggest structural barrier to entry for this service in Utah is the state's procurement and contracting gatekeeper. Providers cannot simply submit a Medicaid enrollment application; they must first be awarded a contract through the Division of Services for People with Disabilities (DSPD) via a formal Request for Statement of Qualifications (RFS) during an open procurement window, or they must secure a specific waiver provider agreement from the Bureau of Authorization and Community Based Services (BACBS) for the New Choices Waiver.

1. Service Definition and Scope

Community Transition Services (CTS) in Utah are defined as non-recurring set-up expenses for individuals who are transitioning from an institutional or another provider-operated living arrangement to a living arrangement in a private residence where the person is directly responsible for their own living expenses.

The service acts as a pass-through funding mechanism rather than a direct care service. It is designed to remove the financial barriers of establishing a new household, ensuring the waiver participant has a safe, furnished, and functional home environment upon discharge from an institution.

• Covered Expense: Security deposits and first month's rent required to obtain a lease in the member's name.
• Covered Expense: Essential household furnishings, including a bed, basic dining furniture, and window coverings.
• Covered Expense: Set-up fees or deposits for utility or service access, including telephone, electricity, heating, and water.
• Covered Expense: Services necessary for the individual's health and safety, such as one-time pest eradication or deep cleaning prior to move-in.
• Exclusion: Monthly rental or mortgage expenses, food, regular utility charges, and household appliances or items intended for recreational purposes (e.g., televisions).
• Funding Cap: Expenses are strictly capped per transition, historically around $2,000 to $3,000 depending on the specific waiver limits outlined in the member's Person-Centered Support Plan.

2. Regulatory and Oversight Agencies

Utah's Medicaid program is consolidated under the Department of Health and Human Services (DHHS). Different divisions within DHHS handle the operational aspects of Community Transition Services depending on the target population's specific waiver.

Providers must interact with both the overarching Medicaid enrollment division and the specific operating agency that manages the waiver contract under which they are providing transition services.

• Umbrella Agency: [Utah Department of Health and Human Services (DHHS)](https://dhhs.utah.gov) oversees all Medicaid and human services in the state.
• Medicaid Authority: [Division of Integrated Healthcare (DIH)](https://medicaid.utah.gov) is the single state Medicaid agency responsible for overall administration and the PRISM enrollment system.
• Operating Agency (Disabilities): [Division of Services for People with Disabilities (DSPD)](https://dspd.utah.gov) operates the Community Supports, Acquired Brain Injury, and Physical Disabilities waivers.
• Operating Agency (Aging/Transitions): [Bureau of Authorization and Community Based Services (BACBS)](https://medicaid.utah.gov/ltc-2/nc/) manages the New Choices Waiver.
• Background Screening: [DHHS Office of Background Processing](https://dhhs.utah.gov) manages the Direct Access Clearance System (DACS) for all HCBS provider staff.

3. Gatekeeping Prerequisites: Who Can Even Apply

Utah does not allow open-ended, standalone enrollment for Community Transition Services. The structural precondition depends entirely on the waiver program you intend to serve, and bypassing this step will result in immediate denial of any Medicaid application.

There is no Certificate of Need (CON) required for this service, but the procurement and contracting gates act as strict network controls. Providers are typically already enrolled as Support Coordination or Financial Management Services agencies before adding CTS to their contract.

• DSPD Procurement Gate: To serve DSPD waivers, applicants must respond to a Request for Statement of Qualifications (RFS) issued via the [Utah Division of Purchasing](https://purchasing.utah.gov); applications are only accepted during open procurement windows.
• New Choices Waiver Gate: Providers must obtain a formal New Choices Waiver Provider Agreement directly from [BACBS](https://medicaid.utah.gov/ltc-2/nc/) before a PRISM enrollment application will be accepted.
• Service Bundling Prerequisite: CTS is rarely approved as a standalone business model; the state prefers to contract with established Support Coordination or Case Management agencies to administer these funds.
• Medicaid Enrollment Prerequisite: You cannot bill for CTS without an active Utah Medicaid Provider ID obtained through the [PRISM Portal](https://medicaid.utah.gov/prism/).
• Moratoria: While there is no permanent moratorium, DSPD operates a closed network that only opens when the state identifies a geographic or capacity need via an RFS.

4. Licensure and Certification Requirements

Utah does not issue a specific facility or agency license for Transitional Assistance Services, as this is an administrative and purchasing service rather than direct physical care.

Instead of a license, providers must meet the certification standards of the specific waiver operating agency (DSPD or BACBS) and hold any underlying professional certifications required to manage waiver funds and coordinate care.

• Facility Licensure: None required by the DHHS Office of Licensing for the provision of CTS alone.
• Business License: Providers must hold a standard local city or county commercial business license in their Utah jurisdiction of operation.
• DSPD Certification: Providers must pass the DSPD provider certification review, which verifies administrative policies, accounting practices, and background screening compliance.
• Support Coordination Certification: If the provider is also acting as the transition coordinator, staff must hold a valid Utah Support Coordinator certification.
• Liability Insurance: Providers must maintain commercial general liability insurance (typically $1 million per occurrence and $3 million aggregate) as mandated by their state contract.

5. Medicaid Provider Enrollment

All Medicaid enrollment in Utah is processed through the Provider Reimbursement Information System for Medicaid (PRISM). Providers must enroll under the specific HCBS waiver atypical provider type.

Enrollment cannot begin until the provider has secured their contract or provider agreement from the respective waiver operating agency.

• Enrollment Portal: Applications must be submitted through the [PRISM Portal](https://medicaid.utah.gov/prism/).
• Provider Type: Providers enroll as an Atypical Provider (Waiver Service Provider) since CTS does not require a standard medical National Provider Identifier (NPI).
• Application Fee: Applicants are subject to the ACA institutional provider application fee (approximately $709 for 2024) unless waived or already paid to Medicare or another state Medicaid program.
• Required Form: Providers must sign and upload the Utah Medicaid Provider Agreement (Form FC-21) during the PRISM process.
• Revalidation: Utah requires all Medicaid providers to revalidate their enrollment every five years through the PRISM system.

6. Staffing, Training and Background Checks

Because Community Transition Services involve managing state funds and interacting with vulnerable adults transitioning from institutions, strict background checks and basic HCBS training are required for all involved personnel.

Agencies must ensure that any staff member coordinating purchases or interacting with the waiver participant is fully cleared before providing services.

• Background Check System: All owners and staff must clear the Direct Access Clearance System (DACS) managed by the DHHS Office of Background Processing.
• Disqualifying Offenses: Utah law strictly prohibits hiring individuals with convictions for abuse, neglect, exploitation, or financial fraud.
• Staff Qualifications: Personnel coordinating the transition must be at least 18 years old, pass the DACS background check, and possess a high school diploma or GED.
• Training Requirement: Staff must complete DSPD or BACBS mandated training modules on incident reporting, abuse/neglect prevention, and the HCBS Settings Rule.
• Financial Integrity: Agency directors and owners must be screened against the federal OIG List of Excluded Individuals/Entities (LEIE).

7. Documentation, Policies and Records

Providers must maintain rigorous financial documentation, as CTS is essentially a pass-through reimbursement for purchased goods and deposits. Audits are strict regarding the proof of actual costs.

All purchases must be directly tied to the member's approved care plan, and providers must have policies in place to prevent fraud, waste, and abuse of transition funds.

• Receipt Retention: Providers must keep original, itemized receipts and invoices for all purchased furnishings, deposits, and services for a minimum of five years.
• Transition Plan Alignment: Every purchase must be explicitly documented and authorized in the member's Person-Centered Support Plan (PCSP) prior to expenditure.
• Inventory Log: Agencies must maintain a detailed log of all physical items purchased and delivered to the member's new home.
• Policy Requirement: Providers must maintain written policies on financial management, fraud/waste/abuse prevention, and member grievance procedures.
• Settings Rule Compliance: Documentation must be kept proving the new residence meets the HCBS Final Settings Rule (e.g., a copy of the lease in the member's name, proof of lockable doors).

8. Billing, Rates and Claims

Community Transition Services are billed as a waiver service through the PRISM system. It is strictly a reimbursement for actual costs incurred, up to the waiver's lifetime or per-transition cap.

Providers are prohibited from marking up the cost of goods, services, or deposits. The billed amount must match the exact total on the retained receipts.

• Billing System: Claims are submitted electronically via the [PRISM Portal](https://medicaid.utah.gov/prism/) or through an approved EDI clearinghouse.
• HCPCS Code: CTS is typically billed using code T2038 (Community Transition, waiver; per service).
• Reimbursement Model: Billed at actual cost; providers cannot add administrative fees or markups to the cost of goods or deposits.
• Prior Authorization: 100% of CTS expenditures require Prior Authorization (PA) from the state waiver agency or the member's Support Coordinator before any purchase is made.
• Funding Cap: The New Choices Waiver and Community Supports Waiver strictly cap these expenses, meaning claims exceeding the authorized transition budget will be denied.

9. Approval Sequence and Timeline

The timeline to become a fully billable CTS provider in Utah is lengthy, primarily due to the procurement and contracting phases required before Medicaid enrollment.

Prospective providers should expect the entire process to take anywhere from 3 to 6 months, heavily dependent on when the state opens procurement windows.

• Step 1: Establish the business entity and obtain local city/county commercial business licenses (1 to 4 weeks).
• Step 2: Respond to a DSPD RFS via the Division of Purchasing or apply for a BACBS New Choices Waiver Provider Agreement (2 to 4 months, dependent on open windows).
• Step 3: Obtain DACS background clearances for all owners and coordinating staff (1 to 3 weeks).
• Step 4: Submit the PRISM Medicaid Enrollment Application with the approved contract attached (30 to 60 days for state review).
• Step 5: Receive PRISM approval and an active Utah Medicaid Provider ID.
• Step 6: Receive authorized Person-Centered Support Plans with Prior Authorizations and begin service delivery.

10. Common Denials and Survey Findings

Audits of CTS providers usually focus on financial discrepancies and unauthorized purchases. Because this service involves state funds being used for retail purchases and deposits, financial exactness is heavily scrutinized.

Denials at the application stage are almost always due to bypassing the gatekeeping entities and attempting to enroll directly in PRISM.

• Application Denial: Attempting to enroll in PRISM without an approved DSPD contract or BACBS provider agreement attached.
• Claim Denial: Billing for items or deposits that were not explicitly listed and approved in the member's Prior Authorization and PCSP.
• Audit Finding: Missing original receipts or invoices to back up the exact amounts billed to Medicaid.
• Audit Finding: Purchasing prohibited items (e.g., televisions, entertainment systems, food) instead of essential furnishings.
• Audit Finding: Failure to ensure the member's new setting complies with the HCBS Settings Rule before funding the transition (e.g., paying a deposit for a non-compliant group home).

11. Key Contacts and Resources

Prospective providers should bookmark the primary Utah DHHS divisions and the PRISM portal for the most up-to-date manuals, billing guidelines, and procurement announcements.

Monitoring the Utah Division of Purchasing is essential for catching open RFS windows for DSPD waivers.

• Utah Medicaid PRISM Portal: [https://medicaid.utah.gov/prism/](https://medicaid.utah.gov/prism/)
• Division of Integrated Healthcare (DIH): [https://medicaid.utah.gov](https://medicaid.utah.gov)
• Division of Services for People with Disabilities (DSPD): [https://dspd.utah.gov](https://dspd.utah.gov)
• New Choices Waiver (BACBS): [https://medicaid.utah.gov/ltc-2/nc/](https://medicaid.utah.gov/ltc-2/nc/)
• Utah Division of Purchasing (for DSPD RFS announcements): [https://purchasing.utah.gov](https://purchasing.utah.gov)

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