Waiver Service Provider Application
Thank you for your interest in becoming a provider for the Alternative Community Service (ACS) Waiver program for individuals with developmental disabilities.
Please carefully read and familiarize yourself with the requirements contained in the attached Certification Standards and the Home and Community Based Waiver document.
Based upon your organization’s capacity and expertise, you should determine which Waiver services you will offer. You may offer services directly by your own staff or through a contractual arrangement with other qualified and certified providers. Additionally, based upon your capacity, you must determine what counties and the maximum number of people you propose to serve. Your application and attachments must describe services as they are explained and defined in the Standards and the Waiver documents.
Please be aware that the application process is how you convey to DDS your understanding of and your ability to provide ACS Waiver services. Your policy statements should reflect a clear knowledge of how you will operate your organization in accordance with the regulations contained in the DDS Certification Standards and the Arkansas Waiver document. Your service descriptions should incorporate all of the requirements and describe how your organization will approach provision of services to individuals.
It is through this process that you convince us that you have the expertise and capacity to become a certified ACS Waiver provider.
If you do not have a clear understanding of the regulations and requirements, you may want to contact another provider on the Community Program List, the Arkansas Waiver Association (AWA), or the Developmental Disabilities Provider Association (DDPA). The links for this information may be found below. The Division of Medical Services, ACS Home and Community Based Waiver provider’s manual is a valuable resource. You should review that carefully, as well.
Please be aware that review and approval of your application may take up to 90 days. For additional information, call 501-320-6415.
Return the completed application and all requested documents to:
Division of Developmental Disabilities Services
P.O. Box 1437, Slot N-203
Little Rock, AR 72203-1437