RTC Waiver Program - Prospective Providers
Important Notices (Listed in order of posting)
- Notice 6/1/2010 - Contact Information and Application Process
- Notice 1/12/2010 - Provider Appliation Review Process
- Notice 5/20/2009 - Legal Status of RTC Waiver Service Providers
- Notice 4/20/2009 - Submission of Application Unbound
- Notice 4/16/2009 - Submission of Applications to UMB, not to CMEs
Instructions & Guidance:
- Contact Information and Application Process
- Provider Application Packet Checklist
- Frequent Mistakes Made by Prospective Providers
- Criminal Background Check and Child Abuse and Neglect Clearance Instructions
- Instructions for the completion of the Medical Care Program Provider Application
Service Descriptions & Rates:
- RTC Waiver Services Overview
- RTC Waiver Service Provider Rates
- Medical Necessity Criteria for Waiver Services
- Caregiver Peer to Peer Support Overview
- Crisis and Stabilization Overview
- Expressive Overview
- Family Youth Training Overview
- Respite Overview
- Youth Peer to Peer Overview
Miscellaneous/General Information:
- RTC Waiver Overview for Prospective Providers
- Prospective Provider Letter
- Frequently Asked Questions
- Training Requirements for Caregiver Peer-to-Peer Support, Youth Peer-to Peer Support, and Family & Youth Training Provider
- Evidence of Compliance Chart
- General Resources
- RTC Waiver Provider Forum PowerPoint Presentation - March 2009
- Provider Forum Follow Up Questions and Answers - April 2009
- What is a Family Support Organization?
RTC Waiver Provider Application
There is no single "application form" for the RTC Waiver. Please use the Provider Application Checklist to guide you in identifying all the necessary and relevant forms, depending on the provider type.
Forms Required for All Applications:
- Provider Application Face Sheet
- Medical Care Program Provider Application & Provider Agreement for Participation in Maryland’s Medical Assistance Program
- General Conditions for Provider Participation
- Consent for Release of Information/Background Clearance Request (Use in accordance with background check instructions)
Forms Specific to Provider Type:
- Certificate of Eligibility to be designated a Family Support Organization
- Attestation of Age, Experience & Training of Caregiver Peer-to-Peer Support Providers
- Attestation of Age, Experience & Training of Family and Youth Training Providers
- Attestation of Age, Experience & Training of Youth Peer-to-Peer Support Providers
- Attestation of Age, Experience, and Training of Crisis and Stabilization Service Providers
- Attestation of Experience & Training of a Provider of Expressive & Experiential Behavioral Services
- Attestation of Age, Experience & Training of In-Home and Out-of-Home Respite Providers
To learn more about becoming a waiver service provider, contact the provider network director or community resource manager in one of the Care Management Entity (CME) Regions (you only need to apply through one CME in order to serve multiple regions of the state):
Baltimore City Region (Baltimore City only)
Marcia Glass-Siegel, Provider Network Director
Wraparound Maryland
2300 N. Charles Street, 3rd Floor
Baltimore, MD 21218
Office: 443-835-1167
Cell: 443-509-4141
Fax: 443-835-1171
mglass@wraparoundmd.com
North West Region (Allegany, Baltimore, Carroll, Frederick, Garrett, Harford, Howard, Montgomery and Washington Counties)
Sheila Philip, Provider Network Director
Maryland Choices
5 Choke Cherry Road, Suite 280
Rockville, MD 20850
Office: 240-683-7309
Cell: 301-648-7824
Fax: 301-947-0199
sphilip@mdchoices.org
South East Region (Anne Arundel, Calvert, Caroline, Cecil, Charles, Dorchester, Kent, Prince George’s, Queen Anne’s, St. Mary’s, Somerset, Talbot, Wicomico & Worcester Counties)
Krystyn Niski, Provider Network Director
Wraparound Maryland
314 Civic Avenue
Salisbury, MD 21804
Office: 410-219-5070
Cell: 410-603-7748
Fax: 410-219-5072
kniski@wraparoundmd.com