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Family and Social Services Administration

DDRS Home > Developmental Disability (BDDS) > Developmental Disabilities Bureau of Developmental Disabilities (BDDS) Provider Relations

BDDS New Providers

DDRS no longer holds New Provider Orientation Sessions; enrollment is now open year around. All components of the New Provider Proposal Packet must be completed in order for an application to be considered. If any portion of the packet is incomplete, the proposal will be denied.

An agency/individual may submit BDDS provider application proposals for approval up to three (3) times within a twelve (12) month timeframe. If the third and final proposal is also denied, twelve (12) full months must pass from the date of the last proposal submission before a new proposal will be accepted.

 

Proposals should be submitted to:
Director of Provider Relations
DDRS - Division of Disability and Rehabilitative Services
402 W. Washington St., RM 453, MS 18
Indianapolis, IN 46207
BDDSprovider@fssa.IN.gov

Becoming a DDRS Waiver provider entails a two part enrollment process.  Once a potential provider becomes approved through DDRS Provider Relations, they must then enroll with Indiana Health Coverage Programs (IHCP). In order to view the requirements, please reference http://www.indianamedicaid.com/.

Once a prospective provider receives the DDRS Waiver Service Certification Letter, the enrollment process with the IHCP begins. The enrollment application MUST be submitted within 90 days of certification. A prospective provider may obtain an IHCP Provider Enrollment Application by downloading it from the Provider Enrollment page at http://www.indianamedicaid.com/ or by contacting 1-877-707-5750 to request an application by mail.

Prospective providers must complete the enrollment application form and submit the completed application form along with the Waiver Service Certification Letter to the following address: Provider Enrollment P.O. Box 7263 Indianapolis, IN 46207-7263

 

BDDS New Provider Proposal Packet

Required Documentation (Open and print each of them to complete the packet)

  1. HCBS Provider Requirements Checklist - Effective Jan. 1, 2013
  2. Case Management Services Checklist (Only applicable for agencies applying for Case Management)
  3. Application for Approval to Become a Provider of BDDS Services for Individuals with Developmental Disabilities SF 53869 (R 11-10)
  4. Case Management Surety Bond form - (only for Case Management Proposals) (8-12)
  5. FSSA Provider Data Form
  6. State of Indiana Automated Direct Deposit Authorization Agreement SF 47551 (2/96)
  7. DDRS Provider Agreement SF 55006 (6-12)
  8. W-9, Taxpayer Identification Request Form (Revised 10/2007) Department of Treasury IRS

References

BDDS Existing Providers

Provider Re-Approval