Submit the following:
a. Agency Application
Notification of meeting minimum qualifications: You will receive an email with the status of your application.
When notified as meeting the minimum requirements:
If applying to provide Clinical Behavioral Supports or Healthcare Coordination, in addition to the corporate documents and policies, submit the documents in the applicable checklist via email to firstname.lastname@example.org:
Note: For other supports, see detailed service definitions on the Waiver Services page.
DDS review of policies and procedures.
Once all the policies have been reviewed, you will receive an email with the status of the policies.
Background Check and Verification of Credentials:
New private providers applying to become a DDS qualified provider are required to complete a Connecticut State Police criminal background check. This applies to the Principal of the entity, Connecticut Administrator, any managing partners/owners once all application documents have been accepted.
Out of state providers may utilize their state agency for the criminal background check and fingerprinting process. All reports must be submitted directly to DDS at (email@example.com).
Connecticut Criminal History Record Request Form:
IMPORTANT: You must bring the Connecticut Criminal History Record Request Form along with a valid state-issued photo identification card, valid driver license, or valid US passport, and the appropriate payment with you when being fingerprinted and present it to DESPP personnel. When fingerprinting is completed, bring the completed request form and the fingerprints back to the window where you made your payments.
Connecticut State Police website http://www.ct.gov/despp/cwp/view.asp?a=4212&q=494530
Once all documents have been accepted, DDS will schedule an Interview with Qualified Provider Interview Committee.
|7||Attend mandatory Provider Orientation (scheduled quarterly)|
Notification of Qualified Provider Status. You will receive an email.
Agency Qualified Providers
Application and Steps to Apply to Become a New Qualified Provider
All providers must be incorporated in the United States and Connecticut.
A provider may move to a Purchase of Service (POS) contract when DDS revenue for qualified services reaches $200,000. For more information on the similarities and differences providing services through Individual Budgets and POS Contract, review the following document: Similarities and Differences in services through Individual Budgets and POS Contract
Review the following important resources:
Steps to Apply to Become a New Qualified Provider