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

Last reviewed: 2026-08-16

Assistive Technology (AT) Services in Virginia's Developmental Disabilities (DD) Waivers (Building Independence, Family and Individual Supports, and Community Living) provide specialized medical equipment, supplies, devices, and training to increase an individual's functional capability and reduce reliance on paid staff. This service covers the evaluation for the need of the device, the purchase or lease of the equipment, and the training required for the individual or their caregivers to use it effectively.

The single biggest structural barrier to entry is that Virginia does not enroll standalone "Assistive Technology" agencies. Under Virginia Administrative Code 12VAC30-122-270, an applicant must already be a fully enrolled Virginia Medicaid Durable Medical Equipment (DME) provider, or a statutorily designated Community Services Board (CSB) or Behavioral Health Authority (BHA), before they can be approved to bill for AT services. If you do not meet one of these structural prerequisites, your application to provide AT services will not be accepted.

1. Service Definition and Scope

In Virginia, Assistive Technology services are defined under 12VAC30-122-270 as specialized medical equipment, supplies, devices, controls, and appliances that enable individuals to increase their abilities to perform activities of daily living or perceive, control, or communicate with the environment in which they live.

The scope of the service includes the cost of the independent professional evaluation, the actual device or modification, and the training for the individual and their support network. It strictly excludes standard consumer electronics or items that are not specialized for the individual's diagnosed disability.

• Target Population: Individuals enrolled in the Building Independence (BI), Family and Individual Supports (FIS), or Community Living (CL) waivers.
• Covered Components: Professional evaluations, equipment purchase/lease, adaptive software, and user training.
• Excluded Items: General utility items (e.g., standard computers, standard tablets, swimming pools, standard furniture) unless heavily modified for the disability.
• Financial Cap: Services are strictly capped at $5,000 per individual per calendar year across all AT services.
• Evaluation Requirement: Must be recommended by an independent professional evaluation conducted by a qualified, licensed practitioner.

2. Regulatory and Oversight Agencies

The Virginia Department of Medical Assistance Services (DMAS) serves as the single state Medicaid agency, overseeing provider enrollment, claims processing, and federal compliance through its Medicaid Enterprise System (MES).

The Virginia Department of Behavioral Health and Developmental Services (DBHDS) manages the day-to-day operations of the DD Waivers, including service authorizations, provider quality monitoring, and the administration of the Waiver Management System (WaMS).

• Virginia Department of Medical Assistance Services (DMAS): [https://www.dmas.virginia.gov](https://www.dmas.virginia.gov)
• Virginia Department of Behavioral Health and Developmental Services (DBHDS): [https://dbhds.virginia.gov](https://dbhds.virginia.gov)
• Medicaid Enterprise System (MES) PRSS Portal: [https://vamedicaid.dmas.virginia.gov](https://vamedicaid.dmas.virginia.gov)
• Virginia Assistive Technology System (VATS): [https://www.vats.virginia.gov](https://www.vats.virginia.gov)
• Cardinal Care MCO Network Resources: [https://vamedicaid.dmas.virginia.gov/provider/mco](https://vamedicaid.dmas.virginia.gov/provider/mco)

3. Gatekeeping Prerequisites: Who Can Even Apply

Virginia utilizes a strict closed-category gatekeeping model for Assistive Technology. You cannot apply to DMAS to become a standalone AT provider. You must first meet the structural precondition of belonging to one of two specific provider categories.

If an applicant does not hold active status as a DME provider or a CSB/BHA, the MES Provider Services Solution (PRSS) portal will automatically reject the enrollment attempt for DD Waiver AT services.

• DME Enrollment Prerequisite: The applicant must be an active, fully enrolled DMAS Durable Medical Equipment (DME) provider.
• CSB/BHA Alternative: Alternatively, the applicant must be a statutorily established Virginia Community Services Board (CSB) or Behavioral Health Authority (BHA).
• Waiver Provider Agreement: The entity must hold a signed, current DD Waiver provider agreement with DMAS.
• NPI Requirement: The applicant must hold an active Type 2 National Provider Identifier (NPI) mapped to the DME or CSB taxonomy.
• Independent Evaluator Restriction: The professional conducting the AT evaluation cannot be the same entity that sells or supplies the AT device, preventing conflicts of interest.

4. Licensure and Certification Requirements

Because Virginia does not issue a distinct "Assistive Technology Agency" license, regulatory compliance defaults to the licensure requirements of the prerequisite provider type (DME or CSB) and the professional licenses of the evaluating staff.

Evaluations must be conducted by professionals licensed by the Virginia Department of Health Professions (DHP) or certified by recognized national rehabilitation engineering bodies.

• DME Standards: Must meet all DMAS DME provider participation requirements, including physical location and inventory standards.
• DBHDS Licensure: Required only if the provider is operating as a CSB/BHA under DBHDS authority.
• Professional Evaluator Licenses: Evaluators must hold an active Virginia DHP license as an Occupational Therapist (OT), Physical Therapist (PT), or Speech-Language Pathologist (SLP).
• Rehabilitation Engineer Certification: If an engineer conducts the evaluation, they must hold active certification from the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA).
• Business Registration: Must maintain active corporate registration with the Virginia State Corporation Commission (SCC).

5. Medicaid Provider Enrollment

All provider enrollment in Virginia is processed electronically through the DMAS Provider Services Solution (PRSS) portal within the Medicaid Enterprise System (MES).

Providers must complete the categorical risk screening associated with their base provider type (DME) and execute the specific DD Waiver addendums to bill for AT services.

• Enrollment Portal: Applications must be submitted via the MES PRSS Portal at [https://vamedicaid.dmas.virginia.gov](https://vamedicaid.dmas.virginia.gov).
• Application Fee: DME providers are subject to the ACA institutional provider application fee (approximately $709 for 2024/2025) upon initial enrollment and revalidation.
• Risk Screening: DME enrollment triggers "High" or "Moderate" risk screening, which includes mandatory fingerprint-based background checks and unannounced site visits.
• Taxonomy Codes: Must enroll with the specific taxonomy code matching the DME specialty and the DD Waiver AT service lines.
• MCO Credentialing: While DD Waiver services are carved out of managed care for some functions, providers must often credential with the Cardinal Care MCOs for comprehensive member coverage.

6. Staffing, Training and Background Checks

Staff involved in the provision, evaluation, or training of Assistive Technology must meet strict background and competency standards mandated by DMAS and DBHDS.

Agencies must maintain a roster of qualified professionals and ensure all direct-contact staff clear state and federal registry checks before interacting with waiver participants.

• Criminal Background Checks: Required via the Virginia State Police for all staff with direct participant contact.
• Child Protective Services (CPS): Registry checks required through the Virginia Department of Social Services for staff serving individuals under 18.
• OIG Exclusion Screening: Mandatory monthly screening of all staff and owners against the federal LEIE and SAM.gov databases.
• DBHDS Orientation: Agency directors and key personnel must complete the DBHDS DD Waiver Provider Orientation training modules.
• Evaluator Competency: The agency must verify and maintain copies of the DHP licenses or RESNA certifications for all evaluating professionals.

7. Documentation, Policies and Records

Virginia requires a direct, documented link between the AT device and the participant's DBHDS Individual Support Plan (ISP). The device must demonstrably reduce the need for human assistance.

Providers must maintain comprehensive files that include the independent evaluation, the service authorization, and proof of delivery and training.

• Independent Evaluation Report: A written assessment detailing the individual's functional limitations, the specific AT recommended, and how it reduces reliance on paid staff.
• ISP Integration: The AT service and specific device must be explicitly documented as a goal/support in the participant's DBHDS ISP.
• Service Authorization: Providers must secure an approved authorization via the DBHDS Waiver Management System (WaMS) prior to purchasing or delivering the device.
• Delivery Receipt: A signed and dated receipt from the participant or caregiver confirming delivery of the device and completion of user training.
• Policy Manual: Must maintain agency policies covering intake, procurement tracking, technological safety risk management, and mandatory abuse reporting.

8. Billing, Rates and Claims

Claims for Assistive Technology are submitted through the MES PRSS portal or an approved clearinghouse, utilizing specific HCPCS codes and waiver modifiers.

Reimbursement is strictly governed by the DMAS fee schedule or, for unlisted items, based on the manufacturer's invoice cost plus a state-defined markup, not to exceed the annual waiver cap.

• Billing System: Claims are processed through the MES PRSS portal or via EDI 837P transactions.
• Procedure Codes: Billed using specific HCPCS codes (e.g., T1999 for miscellaneous AT) accompanied by DD Waiver-specific modifiers.
• Reimbursement Methodology: Paid at the lesser of the provider's usual and customary charge, the DMAS fee schedule, or invoice cost plus the allowable markup.
• Annual Cap: Total AT billing cannot exceed $5,000 per participant per calendar year.
• Prior Authorization Requirement: Claims submitted without a matching, approved WaMS service authorization will be automatically denied by the MMIS.

9. Approval Sequence and Timeline

The timeline to become an AT provider is dictated entirely by the prerequisite DME enrollment process, which is rigorous and subject to federal high-risk screening standards.

Once the base DME enrollment is secured, adding the DD Waiver AT specialty is a faster administrative process within the PRSS portal.

• DME Enrollment: Takes 60 to 120 days, accounting for ACA high-risk fingerprinting and mandatory site visits.
• PRSS Application Processing: Once submitted, the electronic PRSS enrollment request for the waiver specialty takes up to 10 business days.
• WaMS Registration: Gaining access to the DBHDS Waiver Management System takes 1 to 2 weeks after DMAS enrollment is active.
• MCO Contracting: Credentialing with the five Cardinal Care MCOs typically adds 60 to 90 days to the operational timeline.

10. Common Denials and Survey Findings

DMAS Program Integrity and DBHDS Quality Management frequently audit AT claims. Recoupments are common when providers fail to prove the device's medical necessity or its role in reducing paid support.

Applications for enrollment are most frequently denied because the applicant attempts to enroll as an AT provider without first securing DME status.

• Gatekeeping Denial: Immediate rejection in PRSS because the applicant is not an enrolled DME provider or CSB.
• Lack of Independence Justification: Claim denials because the evaluation failed to explicitly state how the device reduces reliance on paid staff.
• Missing Authorization: Billing for a device before the WaMS service authorization was fully approved by DBHDS.
• General Use Items: Denials for requesting standard consumer electronics (like unmodified iPads) that do not meet the specialized medical/adaptive definition.
• Conflict of Interest: Recoupment of funds if the entity that performed the evaluation also sold the device to the participant.

11. Key Contacts and Resources

Prospective providers must navigate resources across DMAS, DBHDS, and the MES portal to successfully enroll and maintain compliance.

Utilize the official state portals for all applications, manual updates, and service authorization submissions.

• DMAS Provider Portal (MES): [https://vamedicaid.dmas.virginia.gov](https://vamedicaid.dmas.virginia.gov)
• DBHDS Provider Network Resources: [https://dbhds.virginia.gov/developmental-services/provider-network](https://dbhds.virginia.gov/developmental-services/provider-network)
• DBHDS Waiver Management System (WaMS): [https://dbhds.virginia.gov/developmental-services/wams/](https://dbhds.virginia.gov/developmental-services/wams/)
• Virginia Town Hall (Regulations & Manuals): [https://townhall.virginia.gov](https://townhall.virginia.gov)
• Virginia Assistive Technology System (VATS): [https://www.vats.virginia.gov](https://www.vats.virginia.gov)
• Cardinal Care MCO Network: [https://vamedicaid.dmas.virginia.gov/provider/mco](https://vamedicaid.dmas.virginia.gov/provider/mco)

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