When you receive your application, make several copies in case you want to change information or use a rough draft for practice. Please enable JavaScript in your browser. Request an Intake Packet 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 You may be trying to access this site from a secured browser on the server. submitted the required documentation as outlined in the Medicaid Provider Application and General Provisions of the HCBS waiver regulations. All applications are in a fillable format and should be completed and saved to your computer. Complete the empty areas; concerned parties names, addresses and phone numbers etc. Step 3: Complete an application for Developmental Disabilities Agencies Certificate using the DDA-RH portal link found on this page. You should also review information about the Community Pathways Waiver, the Family Supports Waiver, and the Community Supports Waiver. To become a licensed provider for DDA services you must complete the appropriate DDA provider application. 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? %PDF-1.6 % Residential Quality Assurance Program Manager: Residential Quality Assurance Program Specialists. 258 0 obj <>stream Please review all of the information but the required forms can be found here: http://marylandpublicschools.org/programs/Pages/Special-Education/IRC/Forms.aspx. Please review the certification checklistfound at the bottom of this page to ensure completeness of this section. Developmentally Disabled Eligibility means: Applicants and their representatives will receive a formal letter from the DDA stating the eligibility and priority category determinations. Step 3: Submission of Application Packet 2829 0 obj <>/Filter/FlateDecode/ID[<7486B1C82E6F17469EE512D82C806907>]/Index[2709 181]/Info 2708 0 R/Length 234/Prev 807377/Root 2710 0 R/Size 2890/Type/XRef/W[1 3 1]>>stream a 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". Example: Yes, I would like to receive emails from Informing Families. GZA! Please contact unit staff for any questions or assistance. Thank you for your interest in contracting with the Developmental Disabilities Administration (DDA). endstream endobj startxref DDA Applicaton for Eligibility A person can complete the DDA Application for Eligibility. hbbd```b` "gHD0[ (Ia0yLI$W `+B .=8l !aBAUib~L*%#DF e=d.&jbzHhpa 5XDzQ`09LIc`4F`5 2`7X\Hkg`bd(6J?u 4) Please review COMAR 14.31.05-.07 for more information on the requirements for children's programs. Applicants who pass the DDA process will be referred to the Office of Health Care Quality (OHCQ) to obtain the license. megan.kwak@dshs.wa.gov. DDA will review the application packet and will let you know the status of your application by email. Tickets are available. Service providers are an integral part in Transforming Lives across Washington State! 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 . The following documentation is required to be uploaded with your application for it to be considered complete. 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. Once certified, if you are wanting to become a Medicaid provider, complete the Medicaid provider enrollment application. If you don't receive a letter, please call theRegional Office. 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. Click here for a listing of local DDA offices. +39\7VJ Submit your completed application with required attachments and the Provider Agreement to Conditions of Participation to providerapplications.dda@maryland.gov. %%EOF Please turn on JavaScript and try again. It looks like your browser does not have JavaScript enabled. 0 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. 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. It looks like your browser does not have JavaScript enabled. 04/12/23 Informing Families - Spring Newsletter, 04/10/23 2023 Community Summit -DSHS Developmental Disabilities Administration is proud to announce Community Summit 2023. All rights reserved. If needed they will consult with a subject matter expert. DSHS DDA Waiver Services: What services are available, how to find providers, and more. An application is considered complete when all required documents are received and in compliance with rules and regulations. Once you are licensed you will need to have a certified Program Administrator. hb``` cb/ 2g c pX;3g,b``h@ha` , National Human Trafficking Hotline - 24/7 Confidential. A person can complete the DDA Application for Eligibility. To request assistance, please contact the Regional Office. Once policies and procedures are approved you will be issued a license. Check List: List of Board Members and their affiliations. Prior to that visit, the following documents must be submitted. Depending on the number of hours and type of service provided, all others will complete a 30 or 70 hour basic training. For more information about our programs and services, see the 2022Developmental Disabilities Administration Caseload and Cost Report. Once you have received your Maryland Medicaid provider number you will need to complete the DDA contracts and other required forms. The contract is not valid until signed by DSHS staff. 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): 2786 0 obj <> endobj Enter your email in the field below, let us know you're not a robot, and click the SIGN UP button. 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. A written code of ethics policy required in IDAPA16.03.21. The DDA regional office Provider relations staff will reach out to you to schedule a time to meet with the regional office. 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. Additional Information Regarding Application Submission. A policy and procedure manual that contains all requirements found in IDAPA 16.03.21, https://adminrules.idaho.gov/rules/current/16/160321.pdf. You need the support of a team to help with your services and treatment. All rights reserved. {]Xb#1 C 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. Generally children's programs are funded by the Department of Human Services (DHS). Is guided by the principle that individuals with developmental disabilities have the right to direct their lives and services. 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. Change the blanks with smart fillable fields. JavaScript is required to use content on this page. Open it using the online editor and begin adjusting. You will also be able to access this hybrid event online. P.O. 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. , 5D0ed9#W5X=(I?% yC 6?i 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. 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 . K4%_My+_QO+VtJP6_H3]^,5xg{vWZ=p~GE,cK? If the result of the check indicates no record, no further information is needed. 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. 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. Please turn on JavaScript and try again. ), 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. A sample format can be found here: A copy of the proposed organizational chart or plan for staffing the agency. 2889 0 obj <>stream All rights reserved. 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. You may be trying to access this site from a secured browser on the server. People with developmental disabilities will have full lives in the communities of their choice where they are included, participate, and are active citizens. 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. From an accredited hospital Download Brochure Apply Today! 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. 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. 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. Copyright 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. t+baGbj^x1z|qn;t.a]r/j,#c{)'Wc$Or=P9U=U\eM%q,:$; JI_#Gz;32K =*8l#rx(c8qsqy>K2& There are some other very important steps in becoming a childrens provider. The following documentation is required to be uploaded with your application for it to be considered complete. A 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. 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 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. Frequently Asked Questions on IP Contracting with DDA. Box 83720 Secure .gov websites use HTTPS A lock( Lock A locked padlock Share sensitive information only on official, secure websites. 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. JavaScript is required to use content on this page. DDA Services Become a Provider for DDA Companion Home Provider Companion Home Provider Become a Companion Home Provider! Request a copy of the application for services. DDA requires that you have experience providing the services you are applying to provide and share the DDA vision for services. The DHS will only issue contracts when they have a need for services. For questions about the Supported Living program, please contact: Megan Kwak,Community Residential Services DDA provider applicants who are referred to OHCQ for licensing will need to submit their policies and procedures to OHCQ. 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 You may be trying to access this site from a secured browser on the server. 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. (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. 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 The CCS will submit the application or updates to the application, supporting documentation, and information obtained during the interview to the DDA. 2709 0 obj <> endobj 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; United States, Certification Process for Developmental Disabilities Agencies. 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. The process includes completing the DDA Application for Eligibility, submitting supporting documentation, an interview by a DDA representative, and a DDA determination. Step 3:Complete an application for Developmental Disabilities Agencies Certificateusing the DDA-RH portal link found on this page. A sample participant file that contains documents meeting the requirements of IDAPA 16.03.21.301.05.a-i. Documents and other materials of interest to residential providers will be posted here. hbbd``b`z$gXsuWH0'V$kbM{@ ?H2I@w `$br,F*? Information on the rate process can be found at: http://marylandpublicschools.org/programs/Pages/Special-Education/IRC/index.aspx. Partners with people with developmental disabilities and their families to provide leadership and resources to enable these individuals in living fulfilling lives. 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. endstream endobj startxref %%EOF 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). Start a DD Group Home in DC, Maryland or Virginia. To provide DDA funded services you must apply to be an approved Maryland Medicaid provider. Applicants and their representatives will receive a formal letter from the DDA stating the eligibility and priority category determinations. {))R,'wZ{nwx(==W:1*m!9jZ-g Please enable scripts and reload this page. They will also determine a priority category - Crisis Resolution, Crisis Prevention, Current Request, or that services are needed in the future. The process includes completing the DDA Application for Eligibility, submitting supporting documentation, an interview by a DDA representative, and a DDA determination. 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 review information on the DDA website regarding the services that we provide. 2967 0 obj <>stream Olga.Lutsyk@dshs.wa.gov. A samplefile for a direct service provider and a supervisor that contains documents meeting the requirements in section 301.04 of thisrule. In addition to the budget sheets you will need to submit a completed Level of Intensity Score Sheet. If the result indicates a review is required, contracts staff will request professional references and will send you the required paperwork. hbbd```b`6g"El$/3b/ m0lspC3 e;__ w..^$]8aXM.F.A0[D2C#Z E,LJU]t,Vf`0Ju2@2Qg? %%EOF 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/. National Human Trafficking Hotline - 24/7 Confidential. This web page is intended as a resource for residential providers who contract with DDA. 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 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. 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. 0 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. National Human Trafficking Hotline - 24/7 Confidential. 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 providers must adhere to regulations in COMAR 10.22. 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. If you have specific requests, contact us atDDAFeedback@dshs.wa.gov. DDA also requires that you have a board of directors so you will want to begin to form your board. 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 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. 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: 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. The application can be found on the Maryland Department of Health website. 04/04/2023 Informing Families - 2023 Summer Bulletin. @IF)DE(=`QfAX,B'mcfhj)}4M 9?,\|%H= Xur! 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 Services may be long-term, intermittent, or hourly. 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). DDA Provider Application Help in Maryland | Start a DD Group Home in Maryland. The 2023-2025 DDA Strategic Plan describes our work and expected outcomes to accomplish the mission. (360) 764-9909 Copyright Maryland.gov. 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. 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. Indicate the applicable DDA Regional Office where you or the agency would like to provide services in the subject line of the email. If you have any general questions about DDA Quality Assurance, contact Lori Gianetto Bare, Residential Quality Assurance Unit Manager. 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. The CCS will submit the application or updates to the application, supporting documentation, and information obtained during the interview to the DDA Regional Office. Companion homes are established in typical family settings. Interested providers should review the information below and submit the DDA Provider Application along with the Provider Agreement to Conditions of Participation and Checklist. Future Needs means the person does have a need for services within the next three years. 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. Unless exempt, all IPs are required to complete a basic training within 120 days of the first day they work. * Residential, day and supported employment services require a completed Developmental Disabilities Administration (DDA) application plus documentation of disability. 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 Developmental Disabilities Administration is transforming lives by providing support and fostering partnerships that empower people to live the lives they want. When center-based services are to be provided, a site visit is required. (4A\t}`-vlwsze;37sBb#}|8aE8rB73oOSOg1Bq^5@7W;q>Y>)f`Atfy+I%n6do\K8gp9g=%];mu_zGV=Wn8Yr-d.e|^t Any addendums, updates, or changes to the approved application will require an addendum to be submitted. 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. Add the date and place your e-signature. The full process is also available as a downlable PDF document. The DDA typically assigns an independent case manager referred to as a Coordinator of Community Services (CCS) to assist with the application process. Thank you for your interest in contracting with the Developmental Disabilities Administration (DDA). 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. 0 Service providers are an integral part in Transforming Lives across Washington State! They will also determine a priority category - Crisis Resolution, Crisis Prevention, Current Request, or that services are needed in the future. >x?m4 ]I`, i. JavaScript is required to use content on this page. Customer information is under Services and Programs. Both of these items must be completed using the DDA-RH portal link on this page. 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 Please enable JavaScript in your browser. o9`.=0 $%pH3@ D) %PDF-1.6 % Reviews add additional time to the process. Call our office at 410-543-6790 for general information, on how to obtain an application or apply for services. :sV^.U2}D=&^VFmSb4R\2WflAArj|WRxsI*t"(h-j.,#`FzLc FNT__. Use the certification checklist under Staff Requirementsfound at the bottom of this page to ensure completeness of this section. You are responsible for marketing your services. Only applications submitted to that email address will be considered. For questions about Companion Homes, please contact: Olga Lutysk,Community Residential Services Program Manager You will need to have a business name. Click on Done after double-checking everything. 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.
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