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HCBS Waiver Provider Application Process

If you are interest in becoming a provider of services for the DDA Home and Community Based Services Medicaid Waiver program the instructions to complete a Waiver Provider Application and other pertinent information you will need to know for the application process. Please read the materials carefully to determine what services you or your organization may be eligible to provide.

The completed application with original signatures and all required documentation must be mailed to the following address:

Medicaid Waiver Provider Application Processing
The Department on Disability Services
Developmental Disabilities Administration
1125 15th Street NW, 8th Floor
Washington, DC 20005

If you need additional assistance in completing your application, please contact the Provider Relations Specialist at (202) 730-1781.
Provided below is the information on the submission of the Medicaid waiver application for new and existing Home and Community Based Waiver providers.

Application for Medicaid Enrollment

Under the Authority of 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 (DCMED 4000).
  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

As an 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 (DCWAV 5000).
  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.

Application Review Process

The Department on Disability Services, Developmental Disabilities Administration (DDS/DDA) and the Department of Health Care Finance (DHCF) has a  three step application review process.