For first time applicants requesting provider enrollment into the DDA Home and Community Based Services (HCBS) Medicaid Waiver Program, the instructions to complete a Waiver Provider Application and other pertinent information is outlined in the General Provisions. Interested organizations and licensed clinicians must refer to the waiver service descriptions and rules for detailed requirements to become enrolled as a Home and Community Based Services (HCBS) Medicaid Waiver Provider.  Please read the materials carefully to determine what services you or your organization may be eligible to provide.
Prior to submitting an application, as a Microsoft Word attachment, potential providers must submit a letter of intent to [email protected] . In the subject line of the email, please include the name of your company and Letter of Intent (See example).

[Letter Head]

“Acme Agency Letter of Intent”

[First paragraph] 
An introduction of your company (organization and/or licensed clinicians) the name of the company, contact information including phone and email address. 

[Second paragraph]
What services that are currently being provided in the community and in what state, What services your company would like to provide as a DDA Home and Community Based Services (HCBS) Medicaid Waiver provider, how many years of experience you have providing services and supports for persons with I/DD. 

[Third paragraph]
What services your company would like to work toward providing in the future as a DDA Home and Community Based Services (HCBS) Medicaid Waiver provider. 

[Signature block]

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 provider agency’s compliance with the specific rules for each of the waiver services the provider agency is requesting enrollment. 

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 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 HCBS Medicaid Waiver Providers

All existing HCBS Medicaid Waiver providers requesting add-on waiver services are to submit a Supplemental Letter of Intent that includes initial PCR results, if applicable. Supplemental Application instructions will follow.

Existing providers may add new services if they have been providing services to beneficiaries of the HCBS Waiver for at least six months consecutively 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.