Application Information on How to Become a Qualified Provider
Thank you for your interest in becoming a qualified provider. The Department of Developmental Services is committed to quality services and supports for the individuals we serve. Qualified providers are essential to accomplish our goal of delivering quality services.
The Department enrolls qualified providers for the following services: Adult Companion, Adult Day Health, Clinical Behavioral Consultant, Group Day, Healthcare Coordination, Individualized Day Supports, Individualized Home Supports, Interpreter Service, Nutrition, Personnel Support, Residential Habilitation-including Community Training Homes, Community Living Arrangements (CLA) and Continuous Residential Supports, Respite Care, Supported Employment, and Transportation.
Applicants interested in developing a Community Living Arrangement (formerly known as a group home) must apply to provide this service through a Request for Proposal (RFP) process. RFP’s are announced on the Department of Administrative Services website when there is a need for a new CLA. Providers chosen to develop a CLA will work with the region where the need exists to determine the location that best meets the needs of the individuals who will reside in the CLA. There are extensive requirements for the building and it is advisable to not purchase a property unless an agency has been awarded a CLA through the RFP process.
The links below provide useful information for those seeking to become qualified.
- Provider Minimum Qualifications for Support Categories (PDF, 50 KB)
- Supports and Services Policy and Procedure Guide (DOC, 75 KB)
- How to Become an Individual Practitioner Qualified Provider (PDF, 38 KB)
- How to Apply to Become an Agency Qualified Provider (PDF, 31 KB)
- HCBS Waiver Manual
- Service Definitions (PDF, 170 KB)
- Family and Individual Consultation and Support Guidelines (PDF, 45 KB)
- Family and Individual Consultation and Support Definitions (PDF, 26 KB)
- Service Rates (DOC, 28 KB)
- Provider Guidelines (DOC, 175 KB)
- DDS Policy and Procedures
- Agency with Choice Assurance Form (PDF, 56 KB)
- Agency With Choice FAQs (PDF, 34 KB)
- Qualified Provider Agency with Choice Description (PDF, 723 KB)
- Provider Documentation Guidelines
- Agency Assurance Agreement (DOC, 8 KB)
- Application to Amend Services (PDF, 68 KB)
- Clincial Behavioral Consultant Assurance Agreement (PDF, 9 KB)
- Existing Provider Application (PDF, 15 KB)
- Health Care Coordinator Assurance Agreement (PDF, 9 KB)
- HIPAA Assurance Agreement (PDF, 218 KB)
- Provider Agreement (PDF, 14 KB)
- Provider Application (DOC, 88 KB)
Provider Application (PDF, 17 KB)
- Provider Profile Correction Form (XLS, 25 KB)
- Provider Profile Town List (DOC, 11 KB)
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Content Last Modified on 10/8/2014 2:33:18 PM