Steps 5 thru 7 of the DDA Medicaid Waiver Provider Application Review Process walks potential service providers through the application committee review, interview and decision processes. The full process is also available as a downloadable PDF document.

Step 5: Provider Review Committee (functions)

The Provider Review Committee is a standing committee composed of representatives of business units within DDS/DDA (Medicaid Waiver, Quality Management (including staff from the DC Health Resources Partnership (DCHRP), Service Coordination, Contracts, and Provider Resource Management) charged with the responsibility to review each “new” and “supplemental” Waiver provider applications.

The Provider Review Committee assists in making the following determinations regarding potential providers: 1) determine that DDS has verified that prospective providers meet required licensing and/or certification standards and adhere to other jurisdiction standards; 2) assure adherence to waiver and District requirements; 3) identify providers who do not meet the requirements and 4) verify that decisions for approval are in accordance with District, federal and jurisdictional requirements. The Committee adheres to these standards and requirements during the face-to-face meeting phase.

The Committee Chair is responsible for coordinating and scheduling all activities that are to take place before, during, and after the team meeting. This includes all interviews, supplemental materials need along with logistics, face-to-face interview, and written tests.

Step 6: The Review (face-to-face meetings & written test)

Each committee member is responsible for reading and evaluating each application prior to the meeting. During these meetings, each team member will drill down to validate that prospective provider satisfies the requirements described in the Certification Criteria.

Each panel member will be in attendance for the face-to-face meeting with the provider applicant and his/her executive team. The meeting is a formal interview where a set of questions are asked, and panel members evaluate each response on a scale of 1-5 with 5 being the highest score. At the conclusion of the face-to-face meeting, a written timed test is given to the provider applicant team, and the test is scored at the end of the timed period.

The panel reconvenes after the scoring of the test to make a decision to approve or deny an applicant.

Step 7: Recommendation/Decision

At the end of the review, the panel’s recommendations are forwarded to the Provider Resource Management Manager and the Operations Division Director for their review.

A final submission recommendation for approval/denial is forwarded to the Department of Health Care Finance (DHCF) which is the agency that enrolls a new District Medicaid Waiver provider. After a provider has been approved and enrolled as a Medicaid Waiver provider in the District, they will be invited to a New Provider Orientation before a provider can begin to provide services.

Expected Outcomes

This process ensures that prospective providers:

• Are afforded the opportunity to understand what’s involved in becoming a DC Medicaid Waiver provider,
• Are informed about DDS/DDA’s expectation of its service providers,
• Have the opportunity to ask pertinent questions prior to completing and submitting a Waiver provider application, given their informed choice on becoming a DC Medicaid Waiver provider
• Are ready to begin serving individuals with Intellectual/developmental disabilities as identified, qualified providers.