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Changes to Provider Certification

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Providers can make changes to their current certification at any time by submitting their request in writing to their Provider Support Specialist.  An e-mail is acceptable.  They do not need to wait until their recertification date.

Changing (Moving) or Adding a Service Location Site

Examples of adding or changing service location sites include: adding new group homes, opening a second day habilitation site, or moving to a new home where a provider is going to provide waiver services. 

Providers shall notify the Division of the new location at least 30 calendar days prior to the location being used for any waiver services.

  1. Providers are required to obtain an inspection completed by an outside entity of the new location. 
  2. Address the recommendations identified in the inspection by writing a statement identifying what was done to correct the recommendation and the date that it was completed. The Division shall review the inspection report and verify that all recommendations have been addressed.
  3. This must be completed before services can be provided at that location. 
  4. The Division will complete a walk-through of the new location within a six-month period after a provider adds the location. 

Changing Address
  1. Providers who are changing their mailing address must contact the Division at least 30 days prior to the change, so that the Division can assure the provider has filled out the appropriate paperwork. 
  2. Providers may complete any address changes directly through the ACS website, but also need to contact the Provider Support Specialist for their area. Please note that ACS will suspend all payments to a provider if they do not have an accurate mailing address.

In order to complete the change of address, providers must submit to their local Provider Support Specialist the WOLFS-109b form with the updated information.

Adding a Service  

Providers can add a service to their certification at any time during their certification.  However, before providers can begin to provide the service, the Division must verify that they meet the requirements of the service.  Depending on the type of service being added, verification may include submitting verification of education, policies and procedures, background checks, completion of any open health and safety Quality Improvement Plans (QIPs), and/or the results of an inspection completed by an outside entity.

The Division reviews the information and notifies providers in writing when they are approved to begin providing the new service. However, providers must not begin to provide the service until they have been chosen by a participant, and received a copy of the pre-approval form and the individual plan of care signed by the Division, received participant specific training on the individual they are providing waiver services to, and have received a PA# from ACS. 

Deleting a Service  

Providers can delete a service from their certification at any time during the year.  However, before deleting a service, providers are required to give at least 30 days notice to participants they are currently serving.  Providers shall follow the Division’s transition process, when required. 

In order to delete a service, providers must:

  1. Contact their local Provider Support Specialist and submit the name of the service to be deleted from their certification with the effective date in writing or via e-mail.
  2. The provider will receive a revised certificate and their name will be removed from the list of available providers for that service.

Voluntary Decertification as a Provider

Providers can voluntarily decertify as a provider at any time during the year.  However, providers are required to give at least 30 days notice to participants they are currently serving.  Providers shall follow the Division’s transition process, when required.   

In order to voluntarily decertify from services, providers must contact their local Provider Support Specialist person and submit in writing or via e-mail when services will no longer be provided.