Contracts for Providers

Providers who are interested in providing services in Utah, Wasatch and Summit Counties, and who can offer one or more of the following non-medical services:  Homemaking, Chore, Transportation, Adult Day Health, Respite, Overnight Respite, Emergency Response, etc., may be eligible to contract through one or more of our in-home programs.

New Choices Waiver Program – Enrollment is through Utah Department of Health, Medicaid, through the PRISM portal, https://medicaid.utah.gov/prism.  Select Health Care Provider, Become a Medicaid Provider, and complete the enrollment process as instructed.  Providers are managed by the Utah New Choice Waiver Program.

Medicaid Aging Waiver Program – Enrollment is through Utah Department of Health, Medicaid, through the PRISM portal, https://medicaid.utah.gov/prism.  Select Health Care Provider, Become a Medicaid Provider, and complete the enrollment process as instructed. 

Once enrollment is completed and approved, providers will receive a letter of notification from Medicaid.  Upon receipt of that letter, the following information must be provided to MAG to complete your enrollment:

  • Current license to support enrolled activity (examples: Home Health Agency, Personal Care Agency, Adult Day Health, Assisted Living Facility, Nursing Home Facility).  A current business license may also be required depending upon the service to be provided.
  • Signed Negotiated Waiver Rate Sheet (NRS) identifying services, HCPC Code and rates to be charged (rate for service must be within Medicaid approved guidelines, and license requirements must be met for any services to be provided).
  • Transportation Affidavit if transportation service to be provided.
  • MAG must also receive a copy of enrollment letter received from Medicaid to confirm Medicaid Provider Number and provider type.
  • Providers are managed by MAG.  
  • Once enrollment process is complete and all additional documentation is provided to MAG, enrolled Providers will be listed on Provider Choice Form.

In-Home Alternatives, IIIB and Caregiver Support Programs – Providers contract directly with MAG Aging and Family Services Department.  Requirements for these contracts include the following:

  • Current license to support enrolled activity (see examples above under Aging Medicaid Waiver Program).  A current business license may also be required depending upon the service to be provided.
  • Current W-9 form
  • General Liability Insurance -- $3,000,000 aggregate
  • Worker’s Compensation Insurance
  • Transportation Affidavit if transportation service to be provided.
  • Willingness to accept MAG-approved reimbursement rates for service.
  • Ability to submit billings through MAG database.

Once Provider has confirmed their ability to meet these criteria, duplicate original contract documents will be sent to provider during open enrollment periods (contract start date July 1 and January 1).  Once contracts are completed by provider and returned to MAG, including all required attachments, MAG will complete contract review and signature process for approval.  One copy of the contract will be returned to Provider for their record, and Provider will be listed on Provider Choice form.

Interested providers for MAG contract should email the following information to contracts@mountainland.org :

  • Agency Name (as listed on appropriate license)
  • Mailing Address
  • Contact Name, Email and Phone Number
  • A list of services to be provided
  • A copy of current License

A list of interested Providers will be maintained until the next available enrollment period.