You will be given instructions on how to complete this step when you come in to sign your contract. You are required to submit the completed application with all required attachments. DDA Services Become a Provider for DDA Companion Home Provider Companion Home Provider Become a Companion Home Provider! In addition to the budget sheets you will need to submit a completed Level of Intensity Score Sheet. Find the Maryland Dda Ohcds Form you require. 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. After you have submitted a completed intake packet, contracts staff will send a fingerprint appointment form along with instructions on how to contact a DSHS contracted fingerprint technician. Frequently Asked Questions on IP Contracting with DDA. 258 0 obj <>stream 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. This web page is intended as a resource for residential providers who contract with DDA. Add the date and place your e-signature. If needed they will consult with a subject matter expert. For questions about the Group Training Home or Group Home program contact: This unit can help providers in a variety of different quality assurance areas. Please review information on the DDA website regarding the services that we provide. Developmentally Disabled Eligibility means: Applicants and their representatives will receive a formal letter from the DDA stating the eligibility and priority category determinations. %PDF-1.5 % Complete the empty areas; concerned parties names, addresses and phone numbers etc. All applications are in a fillable format and should be completed and saved to your computer. Please enable JavaScript in your browser. You need the support of a team to help with your services and treatment. DDA Application effective 10 01 2022 Final Version (2).pdf Person-Centered Thinking Person-centered thinking is a philosophy behind service provision that supports positive control and self-direction of people's own lives. Reviews add additional time to the process. %%EOF Additional Information Regarding Application Submission. 04/04/2023 Informing Families - 2023 Summer Bulletin. 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 enable scripts and reload this page. To open an ICF/IDD home funded through the Medicaid State Plan, interested providers must contact DHCF and Department of Health, Health Regulatory and Licensing Administration (DOH/HRLA) license and certification. Please review the certification checklistfound at the bottom of this page to ensure completeness of this section. DDA PROVIDER APPLICATION I. The saved file and any required attachments should be attached to the email and emailed to: providerapplications.dda@maryland.gov. 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. All rights reserved. Thank you for your interest in contracting with the Developmental Disabilities Administration (DDA). t+baGbj^x1z|qn;t.a]r/j,#c{)'Wc$Or=P9U=U\eM%q,:$; JI_#Gz;32K =*8l#rx(c8qsqy>K2& When you receive your application, make several copies in case you want to change information or use a rough draft for practice. To become a licensed provider for DDA services you must complete the appropriate DDA provider application. To provide DDA funded services you must apply to be an approved Maryland Medicaid provider. hW{4k!TN )DSrB$ITD$A8S:~V}\~: @ ? 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. 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. *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. They will publish a statement of need in the Maryland Register. 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 DDA provider applicants who are referred to OHCQ for licensing will need to submit their policies and procedures to OHCQ. The application can also be downloaded from the DDAs website, mailed to you, or you can pick one up from any of DDAs four (4) regional offices located in Central, Eastern, Southern, and Western Maryland. endstream endobj startxref , We do this by focusing on six areas: Self-Determination, Self-Advocacy, Supporting Families, Housing, Employment, and Assistive Technology.. The 2023-2025 DDA Strategic Plan describes our work and expected outcomes to accomplish the mission. 2709 0 obj <> endobj If needed they will consult with a subject matter expert. 0 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): 2883 0 obj <>/Filter/FlateDecode/ID[]/Index[2786 182]/Info 2785 0 R/Length 245/Prev 938893/Root 2787 0 R/Size 2968/Type/XRef/W[1 3 1]>>stream (4A\t}`-vlwsze;37sBb#}|8aE8rB73oOSOg1Bq^5@7W;q>Y>)f`Atfy+I%n6do\K8gp9g=%];mu_zGV=Wn8Yr-d.e|^t 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. Prior to that visit, the following documents must be submitted. Copyright Maryland.gov. 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. Please enable JavaScript in your browser. The department will notify the agency with a written decision regarding certification. Customer information is under Services and Programs. Menu Federal Policy Guidance Developmental Disabilities Administration (DDA), Washington State Department of Social and Health Services, Aging and Long-Term Support Administration (ALTSA), Facilities, Finance and Analytics Administration (FFA), Developmental Disabilities Guiding Values, 2022Developmental Disabilities Administration Caseload and Cost Report. Enter your email in the field below, let us know you're not a robot, and click the SIGN UP button. The following documentation is required to be uploaded with your application for it to be considered complete. Please enable scripts and reload this page. The department will review the application form and materials to determine if the agency has met all of the regulatory requirements and has the necessary systems in place to ensure the implementation of those requirements. {))R,'wZ{nwx(==W:1*m!9jZ-g Check List: List of Board Members and their affiliations. K4%_My+_QO+VtJP6_H3]^,5xg{vWZ=p~GE,cK? Step 3: Submission of Application Packet endstream endobj startxref 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. The following description and applications are available for review and completion: DDA Waiver Provider Application Review Process. Open it using the online editor and begin adjusting. Click on Done after double-checking everything. %PDF-1.6 % Please turn on JavaScript and try again. 0 You will then receive information about login to the DDA data and billing system and will be scheduled for training in using the system. JavaScript is required to use content on this page. Written description of the agencys quality assurance program developed to meet requirements in IDAPA 16.03.21.500.01-03. Review the certification checklist under Administrative/Facilities Requirements at the bottom of this page to ensure completeness of this section. 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. Any addendums, updates, or changes to the approved application will require an addendum to be submitted. National Human Trafficking Hotline - 24/7 Confidential. 241 0 obj <>/Filter/FlateDecode/ID[<2414CF6C61C62F4791FEB0FCEDD5844A>]/Index[222 37]/Info 221 0 R/Length 93/Prev 98777/Root 223 0 R/Size 259/Type/XRef/W[1 2 1]>>stream Click here for a listing of local DDA offices. GZA! Remote Support: A new waiver service from DSHS Developmental Disabilities Administration, Employment and Community Inclusion Services, Low-Income Home Energy Assistance Program (LIHEAP) and Air Conditioning Units for DDA Clients. A sample format can be found here: A copy of the proposed organizational chart or plan for staffing the agency. Once you are licensed you will need to have a certified Program Administrator. 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". 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 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. 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/. You may be trying to access this site from a secured browser on the server. For questions about Companion Homes, please contact: Olga Lutysk,Community Residential Services Program Manager Submit your completed application with required attachments and the Provider Agreement to Conditions of Participation to providerapplications.dda@maryland.gov. Olga.Lutsyk@dshs.wa.gov. DDA PROVIDER APPLICATION I. United States, Certification Process for Developmental Disabilities Agencies. DSHS DDA Waiver Services: What services are available, how to find providers, and more. 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. 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. Boise, ID 83720 If the result indicates automatic disqualification, the process ends. 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. Change the blanks with smart fillable fields. You will need to have a business name. A samplefile for a direct service provider and a supervisor that contains documents meeting the requirements in section 301.04 of thisrule. Example: Yes, I would like to receive emails from Informing Families. 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 . For questions about the Supported Living program, please contact: Megan Kwak,Community Residential Services Future Needs means the person does have a need for services within the next three years. %PDF-1.6 % 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? Depending on the number of hours and type of service provided, all others will complete a 30 or 70 hour basic training. The approval process will include a site visit from Medicaid staff as well as vetting the applicant and all administrative staff against the Medicaid exclusion list. Indicate the applicable DDA Regional Office where you or the agency would like to provide services in the subject line of the email. DDA requires that you have experience providing the services you are applying to provide and share the DDA vision for services. Partners with people with developmental disabilities and their families to provide leadership and resources to enable these individuals in living fulfilling lives.

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