Step 3: Submission of Application Packet %%EOF All rights reserved. The DDA Regional Office will assess all the information to determine whether the applicant meets either of the DDA eligibility categories - Developmentally Disabled or Supports Only. 0 HCBS Waiver Provider Application Process | dds Add the date and place your e-signature. Customer information is under Services and Programs. Box 83720 You must have a detailed business plan and a line of credit that will allow you to provide services until you receive payment from DDA. For questions about Companion Homes, please contact: Olga Lutysk,Community Residential Services Program Manager PDF DDA PROVIDER APPLICATION - Maryland.gov Enterprise Agency Template DDA Intake Application English | dds Applicants who pass the DDA process will be referred to the Office of Health Care Quality (OHCQ) to obtain the license. The following description and applications are available for review and completion: DDA Waiver Provider Application Review Process. All new providers are required to submit a completed DDA Medicaid Waiver Provider Application and submit the required supporting documentation in the form of policies and procedures, licensure and/or certification that demonstrates the provider agency's compliance with the specific rules for each of the waiver services the provider agency is . DDA Companion Home Provider Application (Developmental Disabilities Administration) English (Word) English (Adobe PDF) 14-550 : Job Foundation Application (Developmental Disabilities Administration) English (Word) English (Adobe PDF) 14-551 : Adult Family Homes (AFH) State Civil Penalty Reinvestment Program Grant Application . The DDA typically assigns an independent case manager referred to as a Coordinator of Community Services (CCS) to assist with the application process. Pages - Become A Provider - Maryland.gov Enterprise Agency Template Be sure to fill out and sign everything according to the directions and return all required documents as soon as possible to avoid delays. The 2023-2025 DDA Strategic Plan describes our work and expected outcomes to accomplish the mission. P.O. Please review COMAR 14.31.05-.07 for more information on the requirements for children's programs. When you receive your application, make several copies in case you want to change information or use a rough draft for practice. A sample format can be found here: A copy of the proposed organizational chart or plan for staffing the agency. Partners with people with developmental disabilities and their families to provide leadership and resources to enable these individuals in living fulfilling lives. Provider Qualifications Licensed Practical Nurse or Registered Nurse acting within the scope of the standards of nursing conduct per Chapter 246-700 WAC Contracted with DDA to provide the service Sample Contract 1789XP: DDA Nursing Services - Statement of Work GZA! DDA will review the application packet and will let you know the status of your application by email. This web page is intended as a resource for residential providers who contract with DDA. National Human Trafficking Hotline - 24/7 Confidential. A developmental disabilities agency is a certified entity that provides center and/or home and community-based services to adults and/or children with intellectual disabilities. Please join us as we return to an in-person conference with a Hybrid option for attendees. Please review information on the DDA website regarding the services that we provide. Step 3:Complete an application for Developmental Disabilities Agencies Certificateusing the DDA-RH portal link found on this page. Thank you for your interest in contracting with the Developmental Disabilities Administration (DDA). If needed they will consult with a subject matter expert. 2709 0 obj <> endobj Please turn on JavaScript and try again. hbbd``b`z$gXsuWH0'V$kbM{@ ?H2I@w `$br,F*? 201 W. Preston Street, Baltimore, MD 21201-2399, Developmental Disabilities Administration, Home and Community-Based Services (HCBS) final rule, https://health.maryland.gov/crccp/Pages/administrators.aspx, http://marylandpublicschools.org/programs/Pages/Special-Education/IRC/index.aspx, http://marylandpublicschools.org/programs/Pages/Special-Education/IRC/Forms.aspx. endstream endobj startxref Developmental Disabilities Administration: How to Apply Olga.Lutsyk@dshs.wa.gov. You will need to have a business name. Create a flexible, person-centered, family-oriented system of support so people can have full lives., 201 W. Preston Street, 4th FloorBaltimore, MD 21201Phone: (410) 767-5600Fax: (410) 767-5850Toll Free: (844) 253-8694. Click here for a listing of local DDA offices. Secure .gov websites use HTTPS A lock( Lock A locked padlock Share sensitive information only on official, secure websites. * Residential, day and supported employment services require a completed Developmental Disabilities Administration (DDA) application plus documentation of disability. Developmental Disabilities Administration Contracts | DSHS It is important for you to keep the DDA updated on any changes in your circumstances or contact information including phone numbers, addresses, and caretakers. If you are interested in becoming a contracted provider, please call your local DDA office and ask for the contracts department: Contracts Types of DDA Contracts The department will notify the agency with a written decision regarding certification. Both of these items must be completed using the DDA-RH portal link on this page. The CCS will submit the application or updates to the application, supporting documentation, and information obtained during the interview to the DDA. You are responsible for marketing your services. If the result of the check indicates no record, no further information is needed. *Clarification Note An interested provider who currently does not have an identified qualified clinician may still submit the Behavioral Supports Provider application but must provide Janet Furman, Director of Provider Relations, for approval the qualified clinicians name, copy of license and training/experience in applied behavior analysis, as well as a sample behavior assessment and behavior plan the qualified clinician authored, before starting to provide behavior support services. An application is considered complete when all required documents are received and in compliance with rules and regulations. You can complete this by visiting, Death, Stillbirth, and Miscarriage Records, Child and Family Services and Foster Care, Aid to the Aged, Blind, and Disabled Cash Assistance (AABD), Temporary Assistance for Families in Idaho (TAFI), Supplemental Nutrition Assistance Program (SNAP), Per and Polyfluoroalkyl Substances (PFAS), Alzheimers Disease and Related Dementias, Women's Cancer Screening (Women's Health Check), National Accreditation Center Inspections, National Accreditation Staffing Requirements, National Accreditation Current Verification of Report. Please review COMAR 14.31.05-.07 for more information on the requirements for children's programs. 201 W. Preston Street, Baltimore, MD 21201-2399, Developmental Disabilities Administration, After the initial request for assistance or the application has been received, a DDA representative will contact you to schedule an interview and review the information. 0 DDA Applicaton for Eligibility A person can complete the DDA Application for Eligibility. All prospective providers are required to submit a completed DDA Medicaid Waiver Provider Application to the Provider Application Specialist in the Provider Resource Management Unit, and must include all supplemental information requested on the provider application checklist. The contract is not valid until signed by DSHS staff. By DDA Application Process Developmental Disabilities Administration Website Call the DDA office for the Region (Central, Western, Southern, or Eastern) in which you live. Maryland Dda Ohcds Form - Fill and Sign Printable Template Online Enter your email in the field below, let us know you're not a robot, and click the SIGN UP button. The application can be found on the Maryland Department of Health website. Maryland Dda Provider Application Download Fillable PDF Pages - Developmental Disabilities Administration There are some other very important steps in becoming a childrens provider. Please review all of the information but the required forms can be found here: http://marylandpublicschools.org/programs/Pages/Special-Education/IRC/Forms.aspx. ), Community Residential Training Evaluation, Residential Training Roster / Reimbursement, Training and CE Tracking Tool for Supported Living, Group Training Home,and Group Home Providers, Community Residential Services Quality Assurance Tool, Community Residential Services Quality Assurance Tool Tracker, Home Environment QA Tool and Routine Maintenance Schedule, Infection Control/Response Quality Assurance Tool, Plan Due Date Tracking tool for Supported Living, Group Home, LSR and Crisis Diversion Providers, Residential Transition Exchange of Information, Alternative Living (AL) Services Overview, Supported Living, Group Training Home, and Group Home Program Locator, AL Services Initial Training Requirements, AL Services Ongoing Training Requirements, Request Certified Community Residential Service and Support Initial Application and Instructions at. The letter includes information related to requesting a reconsideration and appeal rights. Information on the process to become certified can be found at https://health.maryland.gov/crccp/Pages/administrators.aspx, You will also need to submit a budget to obtain a rate from the Interagency Rate Committee. How to Become a Provider of Services Funded in Whole or in Part by DDA Application Review Process Waiver Service Description Vendor Identification Form Attachment (s): Vendor Identification Form - 68.4 KB (docx) Contact Email: dds@dc.gov Contact Phone: (202) 730-1700 Contact TTY: (202) 730-1516 Office Hours: Monday to Friday, 8:15 am to 4:45 pm Pages - DDA Eligibility Application Process - Maryland.gov Enterprise Please enable scripts and reload this page. How do I become licensed to provide services to people with developmental disabilities? Maryland Waiver Factsheet | Medicaid PDF Instructions for Completing the DDA Provider Application Please enable scripts and reload this page. The employee file for the current administrator. submitted the required documentation as outlined in the Medicaid Provider Application and General Provisions of the HCBS waiver regulations. Individual Provider Contracting for DDA | Informing Families The DDS/DDA Provider Relations Specialist or designated staff reviews the application to determine whether an applicant submitted the required documentation as outlined in the Medicaid Provider Application and General Provisions of the HCBS waiver regulations. Once you have received your Maryland Medicaid provider number you will need to complete the DDA contracts and other required forms. A written code of ethics policy required in IDAPA16.03.21. @IF)DE(=`QfAX,B'mcfhj)}4M 9?,\|%H= Xur! The process includes completing the DDA Application for Eligibility, submitting supporting documentation, an interview by a DDA representative, and a DDA determination. 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