Department on Disability Services - A + A Listen Waiver Application for IDD The full package is available as a PDF document: Request for a Renewal to a 1915 (c) Home and Community-Based Services Waiver The Medicaid Home and Community-Based Services (HCBS) waiver program is authorized in 1915 (c) of the Social Security Act. It looks like your browser does not have JavaScript enabled. Please enable JavaScript in your browser. Thank you for your interest in contracting with the Developmental Disabilities Administration (DDA). All current providers must seek approval from DDA and be re-enrolled as Medical Assistance Providers using new categories of service(s) and procedure codes in the . DDA Provider Application Help in Maryland | Start a DD Group Home in Maryland. If you have specific requests, contact us atDDAFeedback@dshs.wa.gov. Add the date and place your e-signature. Residential Quality Assurance Program Manager: Residential Quality Assurance Program Specialists. National Human Trafficking Hotline - 24/7 Confidential. Join us for a screening of the film and panel discussion from 2 to 4 p.m. on Wednesday, April 19, at the Washington State Department of Labor and Industries conference area, 7273 Linderson Way SW, Tumwater. How to Become an Individual Provider (IP) for a Client of the Developmental Disabilities Administration (DDA) For eligible clients of DDA who have identified a potential care giver, or for individuals who have been asked to provide personal care or respite services by a client of DDA. 222 0 obj <> endobj You may be trying to access this site from a secured browser on the server. The Developmental Disabilities Administration is transforming lives by providing support and fostering partnerships that empower people to live the lives they want. will assess all the information to determine whether the applicant meets either of the DDA eligibility categories - Developmentally Disabled or Supports Only. Please enable scripts and reload this page. For more information, visitwww.communitysymmit.ws, 04/04/23 Get your tickets to our premiere of "UNSEEN: How We're Failing Parent Caregivers & Why It Matters". (360) 764-9909 Show details How it works Open the wa dshs dda and follow the instructions Easily sign the dshs individual provider with your finger Send filled & signed dshs intake form or save Be sure to fill out and sign everything according to the directions and return all required documents as soon as possible to avoid delays. * Residential, day and supported employment services require a completed Developmental Disabilities Administration (DDA) application plus documentation of disability. Once you are licensed you will need to have a certified Program Administrator. Dshs Individual Provider 2018-2023 Get the dshs individual provider application 2018 template, fill it out, eSign it, and share it in minutes. hW{4k!TN )DSrB$ITD$A8S:~V}\~: @ ? 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. DDA also requires that you have a board of directors so you will want to begin to form your board. The DDA typically assigns an independent case manager referred to as a Coordinator of Community Services (CCS) to assist with the application process. hbbd```b` "gHD0[ (Ia0yLI$W `+B .=8l !aBAUib~L*%#DF e=d.&jbzHhpa 5XDzQ`09LIc`4F`5 2`7X\Hkg`bd(6J?u 4) Customer information is under Services and Programs. Please review information on the DDA website regarding the services that we provide. Please enable JavaScript in your browser. 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. The following documentation is required to be uploaded with your application for it to be considered complete. Follow directions given by contracts staff and wait for results to be received by DDA. Dda Provider Application is a legal document that was released by the Maryland Department of Health - a government authority operating within Maryland.. Form Details: Released on June 2, 2022; The latest edition currently provided by the Maryland Department of Health; Ready to use and print; If the result indicates a review is required, contracts staff will request professional references and will send you the required paperwork. It looks like your browser does not have JavaScript enabled. Please turn on JavaScript and try again. GovDelivery Sign Up for News & Updates Information and resources for counties and providers: County Best Practices DDA Contracts Environmental Adaptation Providers Individual Providers Office of Rates Management Policy Manual Archives Residential Provider Resources Rules & Laws Forms Interested in becoming a Supported Living, Group Home or Group Training Home provider? 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. Our firm License and Cert. A sample format can be found here: A copy of the proposed organizational chart or plan for staffing the agency. submitted the required documentation as outlined in the Medicaid Provider Application and General Provisions of the HCBS waiver regulations. 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 State of Maryland pledges to provide constituents, businesses, customers, and stakeholders with friendly and courteous, timely and responsive, accurate and consistent, accessible and convenient, and truthful and transparent services. megan.kwak@dshs.wa.gov. Step 3: Complete an application for Developmental Disabilities Agencies Certificate using the DDA-RH portal link found on this page. If needed an individual can request assistance in completing the DDA Application for Eligibility. The letter includes information related to requesting a reconsideration and appeal rights. hbbd```b`6g"El$/3b/ m0lspC3 e;__ w..^$]8aXM.F.A0[D2C#Z E,LJU]t,Vf`0Ju2@2Qg? 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 Reviews add additional time to the process. Please enable scripts and reload this page. Request a copy of the application for services. Service providers are an integral part in Transforming Lives across Washington State! The following documentation is required to be uploaded with your application for it to be considered complete. DDA requires that you have experience providing the services you are applying to provide and share the DDA vision for services. A person can complete the DDA Application for Eligibility. Crisis Resolution means the person is in crisis or emergency situation (for example - abuse, neglect, homeless), Crisis Prevention means the person is or will be in a health or safety crisis within the next year, Current Request means the person needs/wants services; health and safety are not the immediate issues. To file a complaint, click DDA-RH Portal on the right side of this page; once in the portal click on "Complaint Form," follow the directions from there. If you are interested in becoming a contracted provider, please call your localDDAoffice and ask for the contracts department: Developmental Disabilities Administration Contracts, Washington State Department of Social and Health Services, Aging and Long-Term Support Administration (ALTSA), Developmental Disabilities Administration (DDA), Facilities, Finance and Analytics Administration (FFA). 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. DDA Providers Impacted by COVID-19 Pandemic Received Federal and State Support: The COVID-19 pandemic and the resulting social distancing measures caused significant changes to community-based service delivery as many day and supported employment programs closed, and other providers had to meet new public health and safety guidelines. Tickets are available. DDA providers must adhere to regulations in COMAR 10.22. Please contact unit staff for any questions or assistance. Services may be long-term, intermittent, or hourly. The Developmental Disabilities Administration is transforming lives by providing support and fostering partnerships that empower people to live the lives they want. You are required to submit the completed application with all required attachments. 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. Once certified as a developmental disabilities agency, you will be required to submit a request for request for renewal of certification 90 days before the certificate expires. Please review all of the information but the required forms can be found here: http://marylandpublicschools.org/programs/Pages/Special-Education/IRC/Forms.aspx. Individuals seeking certification of a developmental disabilities agency must complete the following: Step 1:Make sure your agency is registered with the Idaho Secretary of State by visiting their website:https://www.sos.idaho.gov/. The full process is also available as a downlable PDF document. ), 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. Any addendums, updates, or changes to the approved application will require an addendum to be submitted. Applicants that fail to submit the required documentation will receive a letter from the DDS/DDA Provider Relations Specialist, requesting the information be sent to DDS/DDA within three (3) business days. They will also determine a priority category - Crisis Resolution, Crisis Prevention, Current Request, or that services are needed in the future. DDA PROVIDER APPLICATION I. (You can unsubscribe anytime), Designed, developed and hosted by cloudPWR 2023, Frequently Asked Questions on IP Contracting with DDA, DDA/HCS/AAA Individual Contractor Intake Form, A request for a copy of government-issued photo ID and Social Security Card. Washington State Department of Social and Health Services, Aging and Long-Term Support Administration (ALTSA), Developmental Disabilities Administration (DDA), Facilities, Finance and Analytics Administration (FFA), Rates and Reimbursement Documents forSupported Living, Group Homes, and Group Training Homes, Supported Living, Group Homes, and Group Training Homes, Background Check Tracking Tool for Supported Living and Group Home Providers, Background Check Frequently Asked Questions, Character, Competency, and Suitability Review Form, Actions to Take Before and After Someone Passes Away, Estate Recovery: Repaying the State for Medical and Long Term Services and Supports, Making The Most Of Social Security Benefits, Resource Guide: Managing Finances for Clients in Community Residential Services Programs, Plan of Correction (POC) Template- Region 1, Plan of Correction (POC)Template - Region 2, Plan of Correction (POC) Template - Region 3, Positive Behavior Support Data Collection Tool, Food Management and Health Promotion Strategies, Residential Provider Information Changes Form (Name, Address, etc. In order for the DDA to determine whether a person is eligible, the person or someone acting on their behalf must complete the DDA application process. 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. National Human Trafficking Hotline - 24/7 Confidential. If the result of the check indicates no record, no further information is needed. Depending on the number of hours and type of service provided, all others will complete a 30 or 70 hour basic training. Washington State Voter Registration for applicants age 18 or older Documents that support that you have a developmental disability, as described in DSHS Form 14-459 Eligible Conditions Specific to Age and Type of Evidence such as: Educational records Psychological records Medical records Request Certified Community Residential Service and Support Initial Application and Instructions at ccrssapplicationsrequest@dshs.wa.gov For questions about the Supported Living program, please contact: Megan Kwak, Community Residential Services (360) 764-9909 megan.kwak@dshs.wa.gov %PDF-1.5 % There are some other very important steps in becoming a childrens provider. Indicate the applicable DDA Regional Office where you or the agency would like to provide services in the subject line of the email. Please join us as we return to an in-person conference with a Hybrid option for attendees. The first step in becoming a DDA licensed provider is to register your business as a Maryland corporation with the Maryland State Department of Assessment and Taxation (SDAT). Step 4:Once certified, if you are wanting to become a Medicaid provider, complete the Medicaid provider enrollment application. Partners with people with developmental disabilities and their families to provide leadership and resources to enable these individuals in living fulfilling lives. The State of Maryland pledges to provide constituents, businesses, customers, and stakeholders with friendly and courteous, timely and responsive, accurate and consistent, accessible and convenient, and truthful and transparent services. laint, click DDA-RH Portal on the right side of this page; once in the portal click on "Complaint Form," follow the directions from there. Please review COMAR 14.31.05-.07 for more information on the requirements for children's programs. Unless exempt, all IPs are required to complete S & O after they have completed the contract process (DSHS has signed their contract) and before beginning to work for a client of DDA. BACKGROUND INFORMATION Application is for (select one): Individual Applicant (Sole Applicant registered with SDAT proposing to render waiver services and Applicant hasno employees) Agency (An entity registered with SDAT with 1 or more employees, excluding the owner) Application is for (check all that apply): DDA PROVIDER APPLICATION I. If you have any general questions about DDA Quality Assurance, contact Lori Gianetto Bare, Residential Quality Assurance Unit Manager. The contract is not valid until signed by DSHS staff. Any provider interested in becoming a DDA licensed program for Children with Developmental Disabilities or a DDA licensed program for Medically Fragile Children should complete the DDA provider application for children's services. All rights reserved. endstream endobj startxref You will be given instructions on how to complete this step when you come in to sign your contract. a To provide DDA funded services you must apply to be an approved Maryland Medicaid provider. +39\7VJ DDA Applicaton for Eligibility A person can complete the DDA Application for Eligibility. Documents and other materials of interest to residential providers will be posted here. If you don't receive a letter, please call theRegional Office. The letter includes information related to requesting a reconsideration and, DDA Eligibility Application Process - At A Glance, You need supports or assistance to live independently; and. Applicants and their representatives will receive a formal letter from the DDA stating the eligibility and priority category determinations. The department will notify the agency with a written decision regarding certification. You can request an Intake Packet from the clients DDA Case Resource Manager, local DDA office staff, or the DDA contract staff for your region. 201 W. Preston Street, Baltimore, MD 21201-2399, Developmental Disabilities Administration, Home and Community-Based Services (HCBS) final rule, Provides a coordinated service delivery system for people with developmental disabilities. To request assistance, please contact the Regional Office. If the result indicates automatic disqualification, the process ends. 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. Those who are required to complete the 70-hour training will also be required to become certified as a Home Care Aide through the Department of Health. {]Xb#1 C Prior to that visit, the following documents must be submitted. A sample participant file that contains documents meeting the requirements of IDAPA 16.03.21.301.05.a-i. The employee file for the current administrator. %PDF-1.6 % Find the Maryland Dda Ohcds Form you require. Any provider interested in becoming a DDA licensed program for Children with Developmental Disabilities or a DDA licensed program for Medically Fragile Children should complete the DDA provider application for childrens services. JavaScript is required to use content on this page. 2889 0 obj <>stream Please enable JavaScript in your browser. DDA Services Become a Provider for DDA Companion Home Provider Companion Home Provider Become a Companion Home Provider! Step 2:Register as an agency with the DHW's Background Check Unit to receive an ID for criminal history as all employees accessing or working with participants will need to have a criminal history clearance for your agency. @IF)DE(=`QfAX,B'mcfhj)}4M 9?,\|%H= Xur! Thank you for your interest in contracting with the Developmental Disabilities Administration (DDA). Call our office at 410-543-6790 for general information, on how to obtain an application or apply for services. You must have a contract with DHR to be funded for these services. The Developmental Disabilities Administration strives to develop and implement public policies that will promote individual worth, self-respect, and dignity such that each individual is valued as a contributing member of the community. >x?m4 ]I`, i. Open it using the online editor and begin adjusting. 258 0 obj <>stream Please review COMAR 14.31.05-.07 for more information on the requirements for children's programs. A Request an Intake Packet People with developmental disabilities will have full lives in the communities of their choice where they are included, participate, and are active citizens. An application is considered complete when all required documents are received and in compliance with rules and regulations. You may be trying to access this site from a secured browser on the server. Olga.Lutsyk@dshs.wa.gov. Boise, ID 83720 Additional Information Regarding Application Submission.