DSAAPD Initial Application for Medicaid Waiver Contractors
General Information
The Division of Services for Aging and Adults with Physical Disabilities (DSAAPD) carries out a pre-enrollment screening process for vendors interested in providing services under under the Medicaid Waiver for the Elderly and Disabled As part of this process, vendors are required to submit a brief, initial application to DSAAPD.
The application can be assembled in a format of the vendor's choosing. DSAAPD requests, however, that vendors be brief in their presentations.
A separate application should be prepared for each service that the vendor intends to provide under the waiver(s).
Required Content
The following sections should be addressed in the provider's application:
Provider Qualifications
Providers should describe their expertise in the delivery of the service and specify how long they have been in business serving the target population. A summary of similar current and/or past programs should be included.
Work Plan
This section must explain the provider’s approach to operating a program that meets the Service Specification requirements. The following areas should be addressed:
- Service Area (geographic)
- Service Location (address)
- Hours/Days of operation
- Plans to meet the service standards of the program
- Provider's internal program evaluation and monitoring
Project Staffing and Organization
This section must document the provider’s organization chart and staffing to provide waiver services.
Civil Rights
The 1964 Civil Rights Act prohibits discrimination regarding race, color, sex, religion, national origin or age. All programs must be in compliance with this Act. Providers must supply a statement of compliance with the 1964 Civil Rights Act.
Grievance/Complaint Procedure
Programs must have a written grievance/complaint procedures for all aspects of care, including but not limited to; abuse, neglect, exploitation, denial of service, quality of care, facility management, or other matters of concern. Providers must include a copy of this procedure with this submission.
Emergency Preparedness Plan
Providers must include a plan of action describing how they would ensure that waiver participants are cared for during an emergency or catastrophic event, including a state of emergency which results from a natural or man-made disaster.
Budget
Providers will need to submit a budget sheet detailing the requested rate for the planned service.
Audit
Providers are required to submit an annual independent audited financial statement, a tax return, or their A-133 audit (required for providers who receive more than $500,000 in federal funds) for review. All contracts are subject to a general audit of the program to be conducted by the state; therefore, no audit costs are to be included in the program budget. The state reserves the right to review such financial records of the agency as deemed necessary in order to determine the appropriateness of the distribution of costs which are jointly covered by this program and other agency funds.
Where to Submit Application Materials
Materials can be submitted to DSAAPD by way of e-mail, postal mail, or fax to:
Medicaid Waiver Provider Enrollment Coordinator
Division of Services for Aging and Adults with Physical Disabilities
Herman M. Holloway, Sr. Campus
Main Administration Building
1901 N. DuPont Highway
New Castle, DE 19720
Phone: 1-800-223-9074
FAX (302) 255-4445
E-mail: DSAAPDinfo@state.de.us
Additional Information
For more information about the contracting process, please see the Contracting for Services under the Medicaid Waiver for the Elderly and Disabled Operated by DSAAPD page of this web site or contact DSAAPD's Medicaid Waiver Provider Enrollment Coordinator.
