Certification for Home & Community Based Services (HCBS) enables individuals with developmental disabilities to live at home andreceive care from qualified care providers in their community. Medicaid/AHCCCS offerscompensation tomore than 3,000 care providersin Arizona who meet the HCBS certification standards in Title 6, Chapter 6, Article 15 of the Arizona Administrative Code.
The Office of Licensing, Certification, & Regulation (OLCR) is responsible for issuing certification to individuals, therapists, and agencies providing HCBSfor consumers with developmental disabilities.HCBSincludes:
- Attendant Care
- Day Programs
- Personal Care
- Respite Care
- Therapy Services
An individual care provider has the option of working for an HCBS certified agency and/or contracting directly with DDD as an HCBS certified Independent Provider.The process of contracting with DDD and applying for certification as an independent provider starts with the DDD Independent Provider Coordinator assigned to your zip code. Need more information? Please contact us directly at (602) 771-4861 or [email protected].
An HCBS agency or therapist must first become a Qualified Vendor for DDD before applying for HCBS Certification. DDD provides information on their Qualified Vendor website or you may contact DDD at(602) 542-6874for additional guidance on becoming a Qualified Vendor. Once the process is completed for becoming a Qualified Vendor, the agency or therapist will need to submit an application packetto OLCR for HCBS Certification and AHCCCS enrollment. This Letter of Introduction (250 KB PDF) from OLCR explains thecertification process and documentation requirements for applicants who are Qualified Vendors. Need more information? Please contact us directly at (602) 771-4861 or [email protected].
For additional information on therules andrequirements for Qualified Vendors, please review this presentation on HCBS Certification(434 KB PDF).
All individuals contracted to render HCBS services must maintain a valid Arizona Fingerprint Clearance Card, issued by the Department of Public Safety (DPS). For more information, interested applicants should review the DPS Fingerprint Clearance Card FAQs.
Effective January 1, 2013, every site licensed as a Group Home for the Developmentally Disabled by the Arizona Department of Health Services (DHS) must be registered with AHCCCS via OLCR and assigned an AHCCCS identification number. In November/December 2012, Qualified Vendors submitted registration packets to OLCR for the registration ofnearly 1,000 of these group homes. Please contact OLCR for direction on the forms that must be submitted to keep registration current as group homes close or relocate to a new address and as new group homes are established.
Frequently used forms for HCBS Certification
Application for Initial HCBS Certification (211 KB DOC)
Provider Registration Form (165 KB DOC)
Provider Participation Agreement (37 KB PDF)
W-9(735 KB PDF)
Disclosure of Ownership Form(34.1 KB PDF)
Instructions for Disclosure of Ownership(8.84 KB PDF)
Statement of Understanding (54.5 KB DOC)
Criminal History Self-Disclosure (40.17 KB PDF)
Agency Staff Matrix (194 KB DOC)
Life-Safety Inspection Request (57.5 KB DOC)
A complete list offorms used for HCBS certification is available in the DES Digital Forms Library.
With the exception of Group Homes for the Developmentally Disabled* and the home of a consumer, each address used to provide HCBS must pass a life-safety inspection conducted by OLCR. Additionally, these settings must be inspected at least every two years. If you need a life-safetyinspection for a site to provideHCBS, please visit the Regulatory Support Unit/ Life-Safety Inspectionswebsite for information on the process for requesting an inspection, as well as the inspection requirements.
*Group Homes licensed by the Arizona Department of Health Services (DHS)must be inspectedby DHS.
All information for the OLCR HCBS Certification Unit may be submitted via email to [email protected], faxed to (602) 257-7045, or sent via U.S. Postal Service to P.O. Box 6123-077F, Phoenix, AZ 85005.
Have questions right now? Give us a call during business hours at (602) 771-4861.