Virginia - Speech & Language Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Virginia Board of Audiology and Speech-Language Pathology issues the mandatory professional license required before any practitioner can bill the Department of Medical Assistance Services (DMAS) for speech, language, cognition, and swallowing therapies. Providers deliver these services under the standard Medicaid State Plan, the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit, and the Developmental Disabilities (DD) Waivers.

Approval to deliver these services to Medicaid members requires enrollment through the Provider Services Solution (PRSS) portal and subsequent credentialing with Cardinal Care Managed Care organizations. Independent practitioners must secure their National Provider Identifier (NPI) and complete the Affordable Care Act (ACA) provider screening process before initiating MCO network contracts.

1. Service Definition and Scope

In Virginia Medicaid, Speech-Language Pathology (SLP) services encompass the evaluation and treatment of speech, language, voice, communication, and swallowing disorders. These services aim to restore, improve, or maintain a member's ability to communicate and swallow safely.

Services are covered across multiple delivery models, including outpatient clinics, home health agencies, and home-based settings under the DD Waivers (Community Living, Family and Individual Supports, and Building Independence).

• Target Populations: Medicaid members with communication, cognitive, or swallowing deficits, including children under EPSDT and adults on DD waivers.
• Covered Modalities: Diagnostic evaluations, therapeutic interventions, and augmentative/alternative communication (AAC) assessments.
• Service Settings: Outpatient hospitals, independent clinics, home-based environments, and approved telehealth platforms.
• Exclusions: Educational services strictly tied to an Individualized Education Program (IEP) without demonstrated medical necessity.

2. Regulatory and Oversight Agencies

The Virginia Department of Health Professions (DHP) governs the professional practice and licensure of speech-language pathologists in the Commonwealth. The Department of Medical Assistance Services (DMAS) administers the Medicaid program, sets reimbursement policies, and oversees provider enrollment.

Day-to-day service authorization and claims processing for the majority of Medicaid members are managed by the Cardinal Care Managed Care organizations (MCOs).

• Virginia Board of Audiology and Speech-Language Pathology (DHP): https://www.dhp.virginia.gov/Boards/ASLP/
• Virginia Department of Medical Assistance Services (DMAS): https://www.dmas.virginia.gov
• Medicaid Enterprise System (MES) PRSS Portal: https://vamedicaid.dmas.virginia.gov/provider
• Cardinal Care Managed Care: https://www.dmas.virginia.gov/for-providers/managed-care/cardinal-care-managed-care/

3. Gatekeeping Prerequisites: Who Can Even Apply

Virginia does not impose a Certificate of Need (CON), Request for Proposals (RFP) procurement, or closed network moratorium on independent speech-language pathology practices. The primary structural precondition is holding an active, unrestricted state license from DHP.

Providers must also obtain a National Provider Identifier (NPI) and, if operating as a business entity, register with the Virginia State Corporation Commission (SCC) before DMAS will accept a PRSS enrollment application.

• Professional Licensure: Active Virginia SLP license issued by the Board of Audiology and Speech-Language Pathology.
• Federal Enumeration: Type 1 NPI for individual practitioners and Type 2 NPI for group practices or facilities.
• Business Registration: Active corporate registration with the Virginia State Corporation Commission (SCC) for group practices.
• Network Status: Open enrollment; no moratoria or county sponsorship letters are required to apply.

4. Licensure and Certification Requirements

To obtain a license from the Virginia Board of Audiology and Speech-Language Pathology, applicants must demonstrate advanced education and clinical competency. The state aligns its requirements closely with national certification standards.

Most practitioners demonstrate this competency by holding the Certificate of Clinical Competence (CCC-SLP) from the American Speech-Language-Hearing Association (ASHA).

• Degree Requirement: Master's degree or equivalent in speech-language pathology from an accredited institution.
• Examination: Passing score on the Praxis Examination in Speech-Language Pathology.
• Clinical Fellowship: Successful completion of a supervised clinical practicum or fellowship year.
• National Certification: ASHA Certificate of Clinical Competence (CCC-SLP) is standard for demonstrating qualifications.

5. Medicaid Provider Enrollment

All providers must enroll in Virginia Medicaid through the Provider Services Solution (PRSS) module within the Medicaid Enterprise System (MES). SLPs typically enroll as Provider Type 063 (Speech/Hearing Therapist).

During enrollment, providers undergo ACA screening. Individual practitioners are generally categorized as limited risk, while certain rehabilitation agencies may face moderate or high-risk screening requirements.

• System: Provider Services Solution (PRSS) via the MES portal.
• Provider Type: Type 063 (Speech/Hearing Therapist).
• Application Fee: Waived for individual practitioners; institutional providers must pay the ACA fee unless already enrolled in Medicare.
• Screening Risk Level: Limited risk for individual SLPs; moderate/high risk for certain facility-based entities.

6. Staffing, Training and Background Checks

Licensed SLPs must maintain their clinical competency through ongoing education as mandated by DHP. When providing services under HCBS waivers, additional background screening is required to protect vulnerable populations.

Agencies employing SLPs must routinely verify that their staff are not excluded from participating in federal healthcare programs.

• Continuing Education: 30 hours of continuing competency activities per biennium required for DHP licensure renewal.
• Background Checks: State Police criminal history and Virginia DSS Child Protective Services registry checks required for waiver service providers.
• Exclusion Screening: Monthly checks against the OIG LEIE and Virginia Medicaid exclusion lists.
• CPR/First Aid: Current certification required for providers delivering in-home waiver services.

7. Documentation, Policies and Records

DMAS requires strict adherence to medical necessity documentation. All SLP services must be supported by a physician's order and a detailed Plan of Care (POC).

Clinical records must clearly demonstrate the member's progress toward measurable goals and must be retained for a minimum of six years.

• Physician Order: Written referral or order from a licensed physician, physician assistant, or nurse practitioner.
• Plan of Care: Detailed treatment plan with measurable goals, updated at least every 6 months or as the patient's condition changes.
• Session Notes: Documentation of date, time, duration, specific interventions used, and patient response for every encounter.
• Record Retention: Minimum of six years from the last date of service, or longer for pediatric patients.

8. Billing, Rates and Claims

Speech-language services are billed using standard CPT codes. Claims for Fee-For-Service members are submitted directly through the MES portal, while Cardinal Care claims go to the respective MCO.

Reimbursement rates are established by DMAS and published annually on the agency's fee schedule.

• Evaluation Codes: CPT 92521, 92522, 92523, 92524 for speech, language, voice, and swallowing evaluations.
• Treatment Code: CPT 92507 for treatment of speech, language, voice, communication, and/or auditory processing disorders.
• Prior Authorization: Generally required by MCOs for treatment sessions beyond the initial diagnostic evaluation.
• Fee Schedule: Published annually on the DMAS website under the Rehabilitation Services fee schedule.

9. Approval Sequence and Timeline

The approval sequence begins with securing the DHP professional license, followed by PRSS Medicaid enrollment, and concludes with MCO credentialing. Providers cannot bill MCOs until fully credentialed and contracted.

The entire process from licensure to active MCO contracts typically spans 3 to 6 months.

• DHP Licensure: Approximately 4-6 weeks after submission of all transcripts and Praxis scores.
• PRSS Enrollment: DMAS has 10 business days to process a complete and accurate enrollment application.
• MCO Credentialing: 60-90 days per Cardinal Care health plan.
• Contract Activation: Effective date is established once the MCO countersigns the network agreement.

10. Common Denials and Survey Findings

Enrollment applications in PRSS are frequently returned if the license dates entered do not exactly match the primary source verification from DHP. Claim denials often stem from administrative oversights.

During audits, DMAS frequently recoups funds if the medical record lacks a valid physician signature on the Plan of Care.

• Enrollment Denial: License effective or end date in PRSS does not match DHP records.
• Claim Denial: Failure to secure prior authorization from the member's specific Cardinal Care MCO before initiating treatment.
• Audit Finding: Missing or expired physician signature on the Plan of Care.
• Audit Finding: Session notes lack specific start/stop times or fail to document the exact therapeutic interventions used.

11. Key Contacts and Resources

Providers should rely on the official state portals for licensure and enrollment. The DMAS website hosts provider manuals, Medicaid Memos, and fee schedules.

For managed care issues, providers must contact the provider relations department of the specific Cardinal Care MCO.

• Virginia Board of Audiology and Speech-Language Pathology: https://www.dhp.virginia.gov/Boards/ASLP/
• DMAS Provider Portal (MES): https://vamedicaid.dmas.virginia.gov/provider
• DMAS Provider Helpline: 800-552-8627
• Cardinal Care MCO Contacts: https://www.dmas.virginia.gov/for-providers/managed-care/cardinal-care-managed-care/

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