Read Microsoft Word - STEPS TO BECOMING A CERT PROV 071510.doc text version


Ohio Dept of Developmental Disabilities:

Info link to NEON about becoming an independent provider and required training For assistance with the application forms and the process, plan to attend Precertification class. Certification Requirements · · · · · ·

Be at least 18 years of age Hold a high school diploma or GED (Note: Currently certified independent providers and currently engaged direct services employees of certified agency providers are exempted from this requirement.) Have a Social Security card and valid identification Have a Bureau of Criminal Identification and Investigation (BCII) report Not be on the Abuser Registry Not be on the Nurse Aide Registry indicating the Ohio Department of Health has made a determination of abuse, neglect, or misappropriation of property of a resident of a long-term care facility or residential care facility

· · · · ·

Be able to read, write, and understand English at a level sufficient to comply with rules governing the services provided Be able to effectively communicate with the individual served Hold valid First Aid certification Hold valid CPR certification Have completed eight hours of training in: Serving individuals with developmental disabilities, Individual rights, Providing HCBS waiver services, Requirements of rule 5123:2-17-02 (Incidents Adversely Affecting Health and Safety) and Universal Precautions for infection control

The 8 hour training is available for free: Training Classes are also available for a fee on line at: ategory=Training+Center&link=Training+Center+Home

Evidence of First Aid and CPR training is required. Training is available through: American Red Cross: American Heart Association: CPR Ohio: Shull Medical Educators:

CPR 1st aid Shull class announ...

Required application forms:

Form # ODJFS-6750 OBM-5657 Form W-9 (Rev. 10-2007) HLS-0038 Description Ohio Health Plan Provider Application/Agreement for Individual Practitioners OBM Vendor Information Form Taxpayer Identification Form Request form for the denial of funding or business contract Terrorist Exclusion List

Most Commonly Requested Service Applications -This is a list of the most commonly requested services. For the complete list of services, go to Description Form # CERT01 CERT-02 CERT-03 CERT-04 Provider Certification Application Homemaker/Personal Care, Independent/Agency Provider Transportation, Independent/Agency Provider Transportation Mileage Other Than to Access Adult Day Services, Independent/Agency Provider

BCII criminal background check is required. List of BCII locations is attached: Please ask them to have the results sent to your address and include the results with application materials. ODMRDD Certification Unit phone is 1-877-289-3636 for questions about the application. If help is needed with the application and process, plan to attend Precertification class, which is offered monthly. Go to the NEON website for the schedule of classes.

Mail application forms, application fee (Money Order or Check), evidence of training, BCII background check results, copy of Social Security card, copy of High school diploma or GED, copy of driver's license, and auto insurance (if applying to provide transportation services) to: OHIO DEPARTMENT OF MR/DD PROVIDER CERTIFICATION UNIT 30 E. Broad Street, 13th Floor Columbus, Ohio 43215-3434 Make a copy of everything before mailing. Upon certification, fax the Initial and Final approval letters to 216-736-4547. Plan to attend New Provider Orientation class to learn about the required documentation and billing process. Go to the NEON website for the schedule of training classes. Questions, please call the Provider Inquiry Line at 216-556-0062 and someone will return your call.

Revised by Aggie Girt, 7/15/10


Microsoft Word - STEPS TO BECOMING A CERT PROV 071510.doc

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