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

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

Last reviewed: 2026-09-10

The Virginia Department of Medical Assistance Services (DMAS) funds Assistive Technology Services through the Building Independence (BI), Community Living (CL), Family and Individual Supports (FIS), and Commonwealth Coordinated Care Plus (CCC+) waivers. Providers must enroll through the Medicaid Enterprise System (MES) Provider Services Solution (PRSS) portal and secure network contracts with Cardinal Care Managed Care organizations to serve the majority of waiver participants.

Approval requires applicants to hold appropriate retail, pharmacy, or Durable Medical Equipment (DME) credentials rather than a distinct DBHDS behavioral health license, as Virginia does not issue a standalone Assistive Technology facility license. Effective September 1, 2025, providers must manage authorizations against a combined $10,000 annual calendar year limit shared between Assistive Technology and Electronic Home-Based Services for the developmental disability waivers.

1. Service Definition and Scope

In Virginia, Assistive Technology Services encompass the evaluation, provision of devices, and training necessary to increase a waiver participant's functional capability and reduce their reliance on paid staff. This includes specialized medical equipment, supplies, and devices not otherwise covered under the Medicaid State Plan.

The service covers the cost of the equipment, maintenance, and independent evaluations required to determine the appropriate technology. It does not cover standard consumer electronics unless specifically modified and authorized to address a documented disability need.

2. Regulatory and Oversight Agencies

The Department of Medical Assistance Services (DMAS) serves as the primary regulatory authority for Medicaid enrollment, billing, and policy formulation for Assistive Technology Services. DMAS manages the Medicaid Enterprise System (MES) and issues provider bulletins detailing service limits and enrollment rules.

For individuals on the BI, CL, and FIS waivers, the Department of Behavioral Health and Developmental Services (DBHDS) oversees the broader waiver operations and person-centered planning processes, though they do not directly license AT vendors.

3. Gatekeeping Prerequisites: Who Can Even Apply

Virginia does not utilize a Certificate of Need, competitive RFP procurement, or closed enrollment window for Assistive Technology providers. There is no requirement to affiliate with a designated lead agency prior to applying.

The primary structural precondition is that the applicant must already be an established business capable of providing specialized equipment, typically holding a National Provider Identifier (NPI) and operating as a DME provider, pharmacy, or specialized technology vendor. Providers must also secure contracts with Cardinal Care Managed Care plans to serve members enrolled in managed care.

4. Licensure and Certification Requirements

Virginia does not issue a distinct HCBS Assistive Technology license through DBHDS or the Virginia Department of Health (VDH). Instead, providers are approved based on their professional credentials, business licenses, and adherence to DMAS provider enrollment standards.

Providers conducting the independent evaluations must hold the appropriate professional Virginia license for their discipline, such as Occupational Therapy, Physical Therapy, or Speech-Language Pathology, issued by the Virginia Department of Health Professions.

5. Medicaid Provider Enrollment

All prospective providers must enroll through the Medicaid Enterprise System (MES) using the Provider Services Solution (PRSS) portal. Applicants must select the appropriate provider type and specialty corresponding to Assistive Technology or DME.

Providers must revalidate their enrollment at least every five years. Effective July 1, 2025, new or returning providers are enrolled based on the month they apply, and any lapse in enrollment or licensure will result in immediate claim denials without a grace period.

6. Staffing, Training and Background Checks

While AT vendors do not provide direct daily care, staff who interact with waiver participants or enter their homes to install equipment must pass standard Virginia background checks. Evaluators must maintain their continuing education requirements as dictated by their specific professional licensing boards.

Vendors must ensure that staff delivering and installing equipment are trained in the specific technology being provided and are capable of instructing the waiver participant and their caregivers on its safe use.

7. Documentation, Policies and Records

Providers must maintain comprehensive records for every device authorized and delivered. This includes the independent evaluation justifying the need, the service authorization approval, and the delivery ticket signed by the participant or their Legally Responsible Individual (LRI).

Documentation must clearly link the provided technology to the goals outlined in the participant's Person-Centered Plan of Care (DMAS-97AB) and demonstrate how the device reduces reliance on paid staff or increases functional independence.

8. Billing, Rates and Claims

Assistive Technology Services are billed using specific HCPCS codes authorized by DMAS and the managed care organizations. Claims must be submitted electronically through the MES portal or the respective MCO's clearinghouse.

Reimbursement is typically based on the authorized cost of the equipment plus a defined margin, or a set fee schedule for evaluations. Providers must secure prior authorization before delivering the equipment, and claims will be denied if the provider's PRSS enrollment is not active for the exact date of service.

9. Approval Sequence and Timeline

The approval process begins with obtaining an NPI and registering in the PRSS portal. Because there is no separate state facility license required, the timeline is dictated by the PRSS credentialing process and subsequent MCO contracting.

Once the PRSS application is submitted with all required business and professional credentials, DMAS typically processes the enrollment within 30 to 60 days. MCO credentialing can add an additional 60 to 90 days before a provider can bill for managed care members.

10. Common Denials and Survey Findings

Enrollment applications are frequently denied or delayed due to missing data points in the PRSS portal, such as incorrect Dates of Birth or Social Security Numbers for managing employees. Providers must ensure all affiliated individual profiles are accurate.

Claim denials commonly occur when providers fail to revalidate their enrollment on time or when professional licenses expire. Effective July 1, 2025, the removal of the 90-day grace period means any lapse in licensure will result in immediate claim denials for dates of service during the lapsed period.

11. Key Contacts and Resources

Providers should utilize the MES portal for all enrollment, revalidation, and fee-for-service billing inquiries. The PRSS helpdesk is the primary contact for resolving enrollment data issues.

For managed care contracting and claims, providers must contact the individual Cardinal Care MCOs directly. DMAS publishes all official policy updates, including waiver amendments and enrollment rules, in the Medicaid Memos and Bulletins library.

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