Information by HCBS Service Provided

Instructions for Step 1.5

Unless otherwise noted below, each service location must be enrolled separately by submitting a separate application, and paying an additional application fee (if applicable). In instances where services are provided in a Medicaid or CHP+ member’s residence or other non-provider owned setting, providers will need to use their main office location as the service address. Additional office locations, where no services are provided to members, do not need to be enrolled.

Please also be sure to review each of the specialties/services below for all requirements, including whether you are required to contact the Department of Public Health and Environment for additional requirements or approvals. To contact DPHE to submit a Letter of Intent go to www.healthfacilities.info, then click "get licensed or certified", then "submit letter of intent."

Did You Know?

You should only submit one application for the HCBS provider type that includes all of your specialties or the services you provide. You do not need to submit a separate application for each type of waiver (DD/SLS/CES, EBD/BI, etc).

You only need to submit additional applications if you have additional service locations or if you are applying for an additional provider type outside of HCBS.

For HCBS providers completing an application for revalidation

When selecting specialties, be sure to select all specialties/services that you have been previously approved to provide; your revalidation approval will only be for the specialties you select. Beginning March 1, 2017 you will no longer be able to bill for the service(s) you didn't revalidate.

HCBS Service Provided