DDA | Connected

In order to be contracted with the Developmental Disabilities Administration (DDA, the below paperwork needs to be completed and returned:

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Mandatory Background for any individual with authorization to sign contracts:

Background - Please go to website: https://fortress.wa.gov/dshs/bcs/ once questions are completed, you will be asked to include any emails you would like to have your confirmation sent to, please include pamela.sanders@dshs.wa.gov .

Complete the download and receive the DDA package of the following forms:
 

•  BCS Account 2023: if you have employees who also will be working with clients (unsupervised), they will also need to have a background ran, which will be your responsibility. This form is for you to set up a background account for yourself to run your employee backgrounds.

• Contractor Intake: if you are a “Sole Proprietor” you must include your Driver’s License and Social Security Card

• Medicaid Provider Disclosure Statement – You must complete and submit the MPDS before being contracted with the Aging and Disability Services (ADS) whether you will be accepting Medicaid or not. This is a federal and state requirement. You must provide full and accurate disclosure of ownership as well as financial, managerial, and controlling interests. Any Board Members with input on business or financial must be listed with both Social Security numbers and Date of Births, this is also mandatory. Failure to submit this information may cause ADS to refuse to contract with you and/or terminate any existing contracts.

• Teleservice - Complete the Service Delivery Verification Form. Provide license number or other valid proof of HIPAA-compliant technology platform at the time of the contract’s start date and every 12 months after.

• W-9 (nonprofit, copy of 501C)

• List of counties you are willing to work in

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In addition to the forms above, you will need to submit current copies of the following:

• Your current Washington State business license (AFH, Foster Care, or another applicable license)

• Program/Business Brochure (if not available, a brief written description of the types of services you would like to provide so DDA can issue the appropriate contract)

• Web Address (mandatory for this business, where individuals interested in your services can find information and fee schedule)

• Professional/Commercial insurance certificate listing the Department of Social and Health Services (DSHS) as an additional insured with required coverages and amounts.

• At least $4 Million General Aggregate and $2 Million Each Occurrence - Detail coverage required depending on type of contract.

• May request approval to utilize the DDA Waiver for small business to lower insurance to $2 Million General Aggregate and $1 Million Each Occurrence. The waiver currently expires June 2026, at that time, it may be extended. If it is not, DDA will reach out to you with information at the time.

• Requirements for waiver approval:

• Considered a small business – instate business, including sole proprietorship, corporation, partnership, or other legal entity.

• Certifies, under penalty of perjury, that is owned and operated independently from all business and has either:

• Fifty or fewer employees

• Gross revenue less than seven million annually as reported on its federal income tax return or its return filed with the Department of Revenue or the previous three consecutive years: or

• Is certified with the office of Women and Minority Business Enterprises under Chapter 39.19 RCW

• Certificate of Liability Holder as shown

• Department of Social & Health Services

  • DDA Contract Department, PO Box 12500 Yakima, WA 98909​

• Return your completed application packet for contract consideration and if eligible, you will receive a contract for signature. Please remember, you may not provide services prior to having a fully executed and signed contract in place.

 

Please return documents to:

DSHS Region 1, Yakima

Attention: Contracts

PO Box 12500 MS: B39-7

Yakima, WA 98909

Scan email: pamela.sanders@dshs.wa.gov

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Please contact (509) 571-0359, or email pamela.sanders@dshs.wa.gov with any questions regarding the contract process.