Application and Steps to Apply to Become a New Qualified Provider

Agency Qualified Providers

Steps to Apply to Become a New Qualified Provider

DDS is accepting new applications the first two full weeks in January, April, July and October.
Remote Support providers can apply throughout the year. Applications for all other services that are submitted other than the first 2 weeks of the quarter will be held for processing.

Providers who already submitted an application in the past and were instructed to submit documents using the DDS.QPAPenrollment@ct.gov and DDS.QPAPpolicies@ct.gov mailboxes should now submit documents to the new mailbox DDS.ProviderApplications@ct.gov

All new applicants should follow the steps below.

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:

a. Provider Minimum Qualifications
b. DDS Home and Community Based Waivers
c. HCBS Waiver Manual

Steps to Apply to Become a New Qualified Provider

Step	Description
1	Log into the eLicense system using the instructions DSAP Online Initial Application Instructions
2	Ensure you have the following documents ready to be uploaded to the eLicense website: Resumes Resumes for Principal of Entity AND member(s) of the Executive Management Team (see Provider Minimum Qualifications for requirements based on services applying to provide) Assurance Agreements and corporate documents See list of documents in the Agency Qualified Provider Checklist Policies Most of the required policies listed in the policy grid will be electronically signed as an attestation in the eLicense system that your agency will follow the DDS policies. Note: For provider who already started the application process, use the policy templates. The following policies are required for services in the categories of Family Supports, Individualized Home Supports (IHS), Days Supports, Residential Supports and Independent Support Brokers (see the policy grid for requirements): Continuity of Operations Planning (COOP) Medication Administration Quality Improvement Planning (including the self-assessment and CQIP attachments) Create your own policies using the templates in the policy grid. Have the applicable documents ready to be uploaded). Save each document with the Name of your Agency and the policy name, e.g. "ABC Agency - Continuity of Operations Planning (COOP) Policy" Healthcare Coordination If applying for Healthcare Coordination, the documents listed in the Healthcare Coordination Checklist should be ready to be uploaded. Clinical Behavioral Support If applying for Clinical Behavioral Support services, the documents listed in the Clinical Behavioral Support Checklist should be ready to be uploaded. Review training materials: Operations Information for Clinical Behavioral Providers (PowerPoint presentation) See the Psychology Services home page for Clinical Behavioral Support Services - Service Definitions and Billing Documentation Peer Support If applying for Peer Support, the documents listed in the Peer Support Service Definition and Checklist should be ready to be uploaded. Parenting Support If applying for Clinical Behavioral Support services, the documents listed in the Parenting Support Checklist should be ready to be uploaded. Subcontracting for Nursing Supports If applying as a Contractor for Nursing Supports, the documents listed in the Subcontracting for Nursing Supports Checklist should be ready to be uploaded. Remote Supports If applying for Remote Supports, the company that specializes in the provision of supports by staff at a remote location should submit a letter confirming the ability to provide the required systems. The Virtual Support Provider/monitoring staff agree to complete the trainings in the following document: List of Required Training when providing Remote Supports Instructions to Upload Documents to the eLicense website: Logon to the eLicense website (*https://www.elicense.ct.gov)using the provided information, then go to Online Services, then Upload Requested Document* and follow the instructions. User ID: [OnlineID] Password: [OnlinePW] Once logged in, select ‘Upload Requested Documents’ under ‘Document Upload’. To upload a document: Have the document scanned and stored on your device Select the Upload 'Upload Requested Documents' link. Select the start link and then complete the upload. Note: All documents must be uploaded at time of initial application, otherwise, the link to upload documents will not appear unless DDS requests additional information.
3	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. IMPORTANT: YOU MUST PRINT THE COMPLETED SERVICE CODE FORM CONTAINING THE TRACKING NUMBER AND BAR CODE AND BRING IT TO THE CONNECTICUT STATE POLICE TO CONDUCT THE FINGERPRINTING PROCESS/CRIMINAL BACKGROUND CHECK. Some local police departments offer fingerprinting services (they can electronically submit the fingerprinting or may hand you the hard copy of the fingerprinting cards to bring them to the State Police). Please review CCHRS-Pre-Enrollment-User-Manual. Contact DDS.ProviderApplications@ct.gov for the SERVICE CODE Fingerprinting is by appointment only. See Connecticut State Police website: State-Police-Bureau-of-Identification 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 (dds.ProviderApplications@ct.gov). BE SURE TO ENTER A VALID EMAIL ADDRESS WHEN COMPLETING THE PRE-ENROLLMENT. Reports will also be electronically sent to DDS.
4	Interview Once all documents have been accepted, DDS will schedule an interview with your agency and the Qualified Provider Interview Committee.
5	Attend Provider Orientation The Principal of Entity must attend mandatory Provider Orientation and view the training videos. (See the Training Materials section located at the bottom of the page). If you have any questions, please email DDS Provider Applications Mailbox IMPORTANT: All emails must include your agency name in the subject line.