Persons or agencies who provide services to individuals with developmental disabilities must obtain certification from the Ohio Department of Developmental Disabilities. Applications for provider certification must include supporting documentation as evidence the applicant meets all qualifications and standards.
Please note that becoming a certified provider for waiver services does not mean that the provider is an employee of the State of Ohio, the Ohio Department of Developmental Disabilities, or of the provider’s local County Board of Developmental Disabilities. Providers are independent business owners who are certified to provide services to individuals on a Level One or Independent Options Medicaid Waiver.
Information on becoming a provider of Medicaid Funded Waiver Services [ + ]
Providers certified to deliver Medicaid Services are assigned a Medicaid number necessary to obtain federal reimbursement. Once certified, providers are responsible for contacting local County Boards of Developmental Disabilities (County Boards of DD) to notify them that they are eligible to provide services under the Level One (L1) and/or Individual Options (IO)Waivers.
If you are interested in being a certified Medicaid waiver provider, you must complete ALL of the following standard Medicaid enrollment forms listed under Apply to Become an Independent Provider or Apply to Become an Agency Provider section on this page. Additionally, you will need to submit the service application forms for the services you would like to provide.
-Please note: It is the expectation that you will download and complete all of the forms. You may fax (614-728-7836) or email the forms to Provider.Certification@dmr.state.oh.us. Forms may also be mailed to:
Office of Provider Certification
30 E. Broad Street
13th Floor
Columbus, Ohio 43215
Whether you are applying to become a Provider of Medicaid waiver services or a Provider of Non-Medicaid supported living services, you must complete the Provider Certification Application - CERT01.
Step 2 - Apply to Become an Independent Provider -please complete each form below and email with Cert-01 to Provider.Certification@dmr.state.oh.us [ + ]
Each independent provider and each CEO of an agency provider must submit evidence of the following standards upon application.
Proof that you are at least 18 years of age
Copy of a high school diploma or GED
Valid Social Security Number
A State of Ohio identification, a valid driver's license, or other government-issued photo identification
A current report from the Bureau of Criminal Identification and Investigation (BCII) which demonstrates he/she has not been convicted of or pleaded guilty to any of the offenses listed in division (E) of section 5126.28 of the Ohio Revised Code; a criminal record check by the Federal Bureau of Investigation is required for those who cannot present proof that they have been residents of Ohio for the five-year period prior to the date of the background investigation
Each independent provider and each CEO of an agency provider must submit evidence of the following standards upon application.
Proof that you are at least 18 years of age
Copy of a high school diploma or GED
Valid Social Security Number
A State of Ohio identification, a valid driver's license, or other government-issued photo identification
A current report from the Bureau of Criminal Identification and Investigation (BCII) which demonstrates he/she has not been convicted of or pleaded guilty to any of the offenses listed in division (E) of section 5126.28 of the Ohio Revised Code; a criminal record check by the Federal Bureau of Investigation is required for those who cannot present proof that they have been residents of Ohio for the five-year period prior to the date of the background investigation
Chief executive officer: Verification of at least one year of full-time, paid work experience in the provision of services to individuals with developmental disabilities which included responsibility for personnel matters, supervision of employees, program services, and financial management
Chief executive officer: A Bachelor's degree from an accredited institution or at least four years of full-time, paid work experience as a supervisor of programs or services for individuals with developmental disabilities
Step 3 – Medicaid Waiver Service Applications for Providers: -it is recommended that you apply for both IO & Level One Waiver Services when applying [ + ]
If you are applying as a new provider, select the service(s) for which you wish to be certified. You must fill out an initial certification application (PC01) before you can provide services:
Most Commonly Requested Service Applications -This is a list of the most commonly requested services.
Specialized Medical Equipment & Supplies, Independent/Agency Provider
Step 4 – Application Fee The Department is investigating to ability to accept automatic electronic payments in the future [ + ]
Effective October 1, 2009, Applicants seeking certification to provide Supported Living and/or Home and Community-Based Services waiver services are required to submit an application fee at the time of application for initial certification, application to renew certification, and application for certification to provide additional HCBS waiver services during the term of existing certification. The fee structure has three tiers:
independent providers and family consortia,
small agency providers (defined as those who serve or plan to serve 50 or fewer individuals), and
large agency providers (defined as those who serve or plan to serve 51 or more individuals).
Agencies applying for provider certification will self-report their status as a small agency or a large agency on their application form.
Initial Certification (1 year)
Renewal Certification (3 years)
Add Service(s) During Term of Certification
Independent Provider or Family Consortium
$ 50
$ 100
$ 15
Small Agency Provider (serving 50 or fewer individuals)
$ 300
$ 800
$ 50
Large Agency Provider (serving 51 or more individuals)
$ 700
$ 1,600
$ 100
The application fee must be paid in the form of a cashier's check, corporate check, or money order, payable to the Ohio Department of Developmental Disabilities. Payment in full is required at the time of application. Applications submitted without a check or money order will be returned to the applicant.Application fees are non-refundable. Therefore, an applicant who is uncertain about which fee applies should contact the Provider Certification Unit at provider.certification@dmr.state.oh.us before submitting his/her application.
Please send all application fees to:
The Ohio Department of Developmental Disabilities
Accounts Receivable
30 E. Broad Street
13th Floor
Columbus, Ohio 43215
What happens next?
-Onceyou have submitted your completed application for certification with your payment to The Ohio Department of Developmental Disabilities, Attention Provider Certification/Accounts Receivable, 30 East Broad Street, 13th Floor Columbus, Ohio 43215.
Step 5 – Initial Approval Notification[ + ]
If the application is complete, the department will review the application and notify the applicant in writing of its decision to approve or deny certification within 45 calendar days of receipt of the complete application. The notification will specify the effective date and expiration date of the certification and the specific service(s) for which the applicant is approved. As soon as you receive this initial certification approval letter you may begin providing services. However, you cannot submit claims for reimbursement until you have received a final approval letter with your Medicaid provider number; billing for authorized services can be submitted back to the date indicated on the initial certification approval letter.
The applicant will also receive a DODD Security Affidavit Form. Complete this form and fax to DODD at 614-752-4673 or mail the original to: Security Administrator, DODD, 30 East Broad Street, 12th Floor, Columbus, OH 43215-3434.
Step 6 – Final Approval Letter[ + ]
The department will obtain a Medicaid provider number from the Ohio Department of Job and Family Services for certified providers of HCBS waiver services; the department will notify the certified provider in writing within twenty calendar days of receipt of the Medicaid provider number.
In addition to the final approval letter with the Medicaid provider number listed, the applicant will also receive billing instructions, and form OBM-1234 Authorization Agreement for Direct Deposit of EFT Payments. This form requires an original signature, so it cannot be emailed or faxed. Please follow the instructions on the form as to how to submit this document.
It is the expectation that you will download and complete the forms. We will no longer send out application packets. If you have additional questions or comments, please contact the Office of Provider Certification at Provider.Certification@dmr.state.oh.us.