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 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). Thank you for your interest in contracting with the Developmental Disabilities Administration (DDA). Please turn on JavaScript and try again. Please join us as we return to an in-person conference with a Hybrid option for attendees. Please enable scripts and reload this page. DDA requires that you have experience providing the services you are applying to provide and share the DDA vision for services. When you receive your application, make several copies in case you want to change information or use a rough draft for practice. 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). The DHS will only issue contracts when they have a need for services. (360) 764-9909 The full process is also available as a downlable PDF document. o9`.=0 $%pH3@ D) All prospective providers are required to submit a completed DDA Medicaid Waiver Provider Application to the Provider Application Specialist in the Provider Resource Management Unit, and must include all supplemental information requested on the provider application checklist. (360) 407-1518 Submit your completed application with required attachments and the Provider Agreement to Conditions of Participation to providerapplications.dda@maryland.gov. 6?i Department on Disability Services - A + A Listen Waiver Application for IDD The full package is available as a PDF document: Request for a Renewal to a 1915 (c) Home and Community-Based Services Waiver The Medicaid Home and Community-Based Services (HCBS) waiver program is authorized in 1915 (c) of the Social Security Act. K4%_My+_QO+VtJP6_H3]^,5xg{vWZ=p~GE,cK? DDA Services Become a Provider for DDA Companion Home Provider Companion Home Provider Become a Companion Home Provider! Generally children's programs are funded by the Department of Human Services (DHS). The following documentation is required to be uploaded with your application for it to be considered complete. hbbd``b`z$gXsuWH0'V$kbM{@ ?H2I@w `$br,F*? JavaScript is required to use content on this page. From an accredited hospital Download Brochure Apply Today! Please turn on JavaScript and try again. Step 3: Submission of Application Packet Please contact unit staff for any questions or assistance. Step 3: Complete an application for Developmental Disabilities Agencies Certificate using the DDA-RH portal link found on this page. Tickets are available. People with developmental disabilities and their families are valued citizens of the state of Washington. Unless exempt, all IPs are required to complete a basic training within 120 days of the first day they work. In addition to the budget sheets you will need to submit a completed Level of Intensity Score Sheet. 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. Change the blanks with smart fillable fields. Partners with people with developmental disabilities and their families to provide leadership and resources to enable these individuals in living fulfilling lives. DDA Provider Application Help in Maryland | Start a DD Group Home in Maryland. 04/12/23 Informing Families - Spring Newsletter, 04/10/23 2023 Community Summit -DSHS Developmental Disabilities Administration is proud to announce Community Summit 2023. 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. To become a licensed provider for DDA services you must complete the appropriate DDA provider application. DDA PROVIDER APPLICATION I. You are required to submit the completed application with all required attachments. You may be trying to access this site from a secured browser on the server. Service providers are an integral part in Transforming Lives across Washington State! GZA! :sV^.U2}D=&^VFmSb4R\2WflAArj|WRxsI*t"(h-j.,#`FzLc FNT__. Click on Done after double-checking everything. 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. Reviews add additional time to the process. 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". hWTW"I@;P 2709 0 obj <> endobj Prior to that visit, the following documents must be submitted. Check List: List of Board Members and their affiliations. 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. You will also be able to access this hybrid event online. 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 . You will need to have a business name. {))R,'wZ{nwx(==W:1*m!9jZ-g Copyright Maryland.gov. , 5D0ed9#W5X=(I?% yC 222 0 obj <> endobj * Residential, day and supported employment services require a completed Developmental Disabilities Administration (DDA) application plus documentation of disability. DDA will review the application packet and will let you know the status of your application by email. >x?m4 ]I`, i. Services may be long-term, intermittent, or hourly. endstream endobj startxref Add the date and place your e-signature. hbbd```b` "gHD0[ (Ia0yLI$W `+B .=8l !aBAUib~L*%#DF e=d.&jbzHhpa 5XDzQ`09LIc`4F`5 2`7X\Hkg`bd(6J?u 4) You can complete this by visitinghttps://www.idmedicaid.com/default.aspxor if you are applying to provide children's DD Medicaid services, review these instructions. The letter includes information related to requesting a reconsideration and, DDA Eligibility Application Process - At A Glance, You need supports or assistance to live independently; and. Companion homes are established in typical family settings. The contract is not valid until signed by DSHS staff. %%EOF Please turn on JavaScript and try again. Please review all of the information but the required forms can be found here: http://marylandpublicschools.org/programs/Pages/Special-Education/IRC/Forms.aspx. Copyright Maryland.gov. hbbd```b`6g"El$/3b/ m0lspC3 e;__ w..^$]8aXM.F.A0[D2C#Z E,LJU]t,Vf`0Ju2@2Qg? Please review COMAR 14.31.05-.07 for more information on the requirements for children's programs. DDA provider applicants who are referred to OHCQ for licensing will need to submit their policies and procedures to OHCQ. A sample participant file that contains documents meeting the requirements of IDAPA 16.03.21.301.05.a-i. 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. Open it using the online editor and begin adjusting. will assess all the information to determine whether the applicant meets either of the DDA eligibility categories - Developmentally Disabled or Supports Only. All rights reserved. Please enable JavaScript in your browser. If the result indicates a review is required, contracts staff will request professional references and will send you the required paperwork. You are responsible for marketing your services. 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. *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. All rights reserved. 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. 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; 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. Please enable JavaScript in your browser. Steps 3 and 4 of the DDA Medicaid Waiver Provider Application Review Process walks potential service providers through the application packet submission, checklist and pre-screening processes. 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. 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. 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. Applicants who pass the DDA process will be referred to the Office of Health Care Quality (OHCQ) to obtain the license. Use the certification checklist under Staff Requirementsfound at the bottom of this page to ensure completeness of this section. National Human Trafficking Hotline - 24/7 Confidential. Make sure your agency is registered with the Idaho Secretary of State by visiting their website: Complete an application for Developmental Disabilities Agencies Certificateusing the DDA-RH portal link found on this page. endstream endobj startxref (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. ), 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. If you don't receive a letter, please call theRegional Office. 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. If you have specific requests, contact us atDDAFeedback@dshs.wa.gov. Click here for a listing of local DDA offices. The 2023-2025 DDA Strategic Plan describes our work and expected outcomes to accomplish the mission. You will then receive information about login to the DDA data and billing system and will be scheduled for training in using the system. Frequently Asked Questions on IP Contracting with DDA. 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. The saved file and any required attachments should be attached to the email and emailed to: providerapplications.dda@maryland.gov. An official website of the United States governmentHere's how you know Official websites use .gov A .govwebsite belongs to an official government organization in the United States. How do I become licensed to provide services to people with developmental disabilities? 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. For questions about the Supported Living program, please contact: Megan Kwak,Community Residential Services It looks like your browser does not have JavaScript enabled. Please enable scripts and reload this page. Once policies and procedures are approved you will be issued a license. Please review information on the DDA website regarding the services that we provide. 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. Request an Intake Packet The department will notify the agency with a written decision regarding certification. JavaScript is required to use content on this page. Find the Maryland Dda Ohcds Form you require. 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. If needed they will consult with a subject matter expert. For more information about our programs and services, see the 2022Developmental Disabilities Administration Caseload and Cost Report. Please enable scripts and reload this page. 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 +39\7VJ Boise, ID 83720 Enter your email in the field below, let us know you're not a robot, and click the SIGN UP button. 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. National Human Trafficking Hotline - 24/7 Confidential. The Developmental Disabilities Administration is transforming lives by providing support and fostering partnerships that empower people to live the lives they want. 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. The following description and applications are available for review and completion: DDA Waiver Provider Application Review Process. (4A\t}`-vlwsze;37sBb#}|8aE8rB73oOSOg1Bq^5@7W;q>Y>)f`Atfy+I%n6do\K8gp9g=%];mu_zGV=Wn8Yr-d.e|^t %%EOF National Human Trafficking Hotline - 24/7 Confidential. 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. It looks like your browser does not have JavaScript enabled. Be sure to fill out and sign everything according to the directions and return all required documents as soon as possible to avoid delays. Our firm License and Cert. @IF)DE(=`QfAX,B'mcfhj)}4M 9?,\|%H= Xur! 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. endstream endobj 223 0 obj <. t+baGbj^x1z|qn;t.a]r/j,#c{)'Wc$Or=P9U=U\eM%q,:$; JI_#Gz;32K =*8l#rx(c8qsqy>K2& A person can complete the DDA Application for Eligibility. %PDF-1.6 % Request Certified Community Residential Service and Support Initial Application and Instructions at ccrssapplicationsrequest@dshs.wa.gov For questions about the Supported Living program, please contact: Megan Kwak, Community Residential Services (360) 764-9909 megan.kwak@dshs.wa.gov The CCS will submit the application or updates to the application, supporting documentation, and information obtained during the interview to the DDA Regional Office. When center-based services are to be provided, a site visit is required. The Developmental Disabilities Administration is transforming lives by providing support and fostering partnerships that empower people to live the lives they want. DDA Application effective 10 01 2022 Final Version (2).pdf Person-Centered Thinking Person-centered thinking is a philosophy behind service provision that supports positive control and self-direction of people's own lives. A samplefile for a direct service provider and a supervisor that contains documents meeting the requirements in section 301.04 of thisrule. All rights reserved. The process includes completing the DDA Application for Eligibility, submitting supporting documentation, an interview by a DDA representative, and a DDA determination. J[Q0}i$U9aEcU(W|e)i]INcU&QMoL29 `BZLh{du'Zk}AS>&o>\c(rKjPmY-i^XH^N(J4w?J2OtEfgWYZthc;XE6hKsa4&YKsTp,=CRBG$?4F~n? Follow directions given by contracts staff and wait for results to be received by DDA. Request a copy of the application for services. 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. 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. Menu Federal Policy Guidance If you have any general questions about DDA Quality Assurance, contact Lori Gianetto Bare, Residential Quality Assurance Unit Manager. Indicate the applicable DDA Regional Office where you or the agency would like to provide services in the subject line of the email. Example: Yes, I would like to receive emails from Informing Families. JavaScript is required to use content on this page. 0 Both of these items must be completed using the DDA-RH portal link on this page. Start a DD Group Home in DC, Maryland or Virginia. 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. The following documentation is required to be uploaded with your application for it to be considered complete. Please enable JavaScript in your browser. Please review the certification checklistfound at the bottom of this page to ensure completeness of this section. Only applications submitted to that email address will be considered. Customer information is under Services and Programs. The DDA regional office Provider relations staff will reach out to you to schedule a time to meet with the regional office. All applications are in a fillable format and should be completed and saved to your computer. 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. Future Needs means the person does have a need for services within the next three years. DDA PROVIDER APPLICATION I. This web page is intended as a resource for residential providers who contract with DDA. 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. 0 Call our office at 410-543-6790 for general information, on how to obtain an application or apply for services. Step 4:Once certified, if you are wanting to become a Medicaid provider, complete the Medicaid provider enrollment application. a A sample format can be found here: A copy of the proposed organizational chart or plan for staffing the agency. You need the support of a team to help with your services and treatment. DDA Applicaton for Eligibility A person can complete the DDA Application for Eligibility. Copyright Maryland.gov. 0 Olga.Lutsyk@dshs.wa.gov. 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 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. 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. Depending on the number of hours and type of service provided, all others will complete a 30 or 70 hour basic training. If needed they will consult with a subject matter expert. Person-Centered Planning Provides a coordinated service delivery system for people with developmental disabilities Partners with people with developmental disabilities and their families to provide leadership and resources to enable these individuals in living fulfilling lives. The letter includes information related to requesting a reconsideration and appeal rights. A policy and procedure manual that contains all requirements found in IDAPA 16.03.21, https://adminrules.idaho.gov/rules/current/16/160321.pdf. If needed an individual can request assistance in completing the DDA Application for Eligibility. DDA also requires that you have a board of directors so you will want to begin to form your board. RSVP for the event by April 12. P.O. 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. 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. The employee file for the current administrator. Residential Quality Assurance Program Manager: Residential Quality Assurance Program Specialists. Thank you for your interest in contracting with the Developmental Disabilities Administration (DDA). Once you are licensed you will need to have a certified Program Administrator. Once the application is submitted, you should receive a letter in about 5-7 business days informing you of the date your application was received. Secure .gov websites use HTTPS A lock( Lock A locked padlock Share sensitive information only on official, secure websites. DDA Intake Application Amharic DDA Intake Application French Eligibility and Intake Process for RSA Contact Email: dds-dda.intake@dc.gov Contact Phone: (202) 730-1791 Contact TTY: (202) 730-1516 Office Hours: Monday to Friday, 8:15 am to 4:45 pm Service Location: GIS Address: 250 E Street, SW City: Washington State: DC Zip: 20024 Contact Email: hb``` cb/ 2g c pX;3g,b``h@ha` , 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? The application can be found on the Maryland Department of Health website. 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. 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. 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): You may be trying to access this site from a secured browser on the server. 2889 0 obj <>stream 2786 0 obj <> endobj By DDA Application Process Developmental Disabilities Administration Website Call the DDA office for the Region (Central, Western, Southern, or Eastern) in which you live. 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/. If the result indicates automatic disqualification, the process ends. Developmentally Disabled Eligibility means: Applicants and their representatives will receive a formal letter from the DDA stating the eligibility and priority category determinations.