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Department on Disability Services
 

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Application for Medicaid Enrollment

Authority: Title 29DCMR Chapter 19 Home and Community-Based Waiver Services for Persons with Mental Retardation and Developmental Disabilities.

New Medicaid Home & Community-Based Waiver Providers*
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 agency’s compliance with the specific rules for each of the waiver services the agency is requesting approval to provide.

A prospective provider must  complete the following steps:

1. Complete and sign the District of Columbia’s Medicaid Provider Application (DCWAV4000).

2. Attach all required supporting documentation as specified in the application instructions.

NOTE: New agencies that are interested in enrolling to become a qualified provider through the Home and Community Based Medicaid Waiver program must review and comply with the DDS Provider Readiness Review Policy and Procedure, Provider Certification Review Policy, Title 29 Public Welfare of DCMR: Chapter 19, Section 1900, General Provision and the Home and Community Based Waiver rules for the specific service(s).

Existing Home & Community-Based Medicaid Waiver Providers

Existing providers may add new services if they have been providing services to persons enrolled the HCBS waiver for more than six months and are in good standing with DDS/DDA policy and procedures; have passed initial PCR, if applicable; are not currently on any sanctions opposed by DDS/DDA; DHCF; DHLR: or any federal, state, and local entities governing HCBS waiver providers and program. Existing Home & Community Based Medicaid Waiver Provider, you are required to submit a Supplemental Application and submit supporting documentation in the form of policies and procedures, licensure and/or certification that will demonstrate your compliance with the specific rules and regulations for the waiver services which you are requesting to provide before an approval for enrollment is issued.
The following must be completed:

1. You must complete and sign the District of Columbia’s Medicaid Home & Community-Based Services Waiver Supplemental application (DCWAV5000).

2. Follow the instructions found in the application and attached all required supporting documentation.

3. Complete steps one and two of the Application approval process as outlined below.

4. DDA will forward a copy of the approval/denial letter from DHCF for providers the successfully complete steps one and two.

Contact Phone: 
(202) 730-1700
Contact TTY: 
(202) 730-1516
Office Hours: 
Monday to Friday, 8:15 am to 4:45 pm
Service Location: 

1125 15th Street, NW

GIS Address: 
1125 15th Street, NW
City: 
Washington
State: 
DC
Zip: 
20005