Certification for Home & Community-Based Services (HCBS)

Certification for Home & Community Based Services (HCBS) enables individuals with developmental disabilities to live at home and receive care from qualified care providers in their community.  Medicaid/AHCCCS offers compensation to more than 3,000 care providers in Arizona who meet the HCBS certification standards in  Title 6, Chapter 6, Article 15External Link Icon of the Arizona Administrative Code. 

The Office of Licensing, Certification, & Regulation (OLCR) is responsible for issuing certification to individuals, therapists, and agencies providing HCBS for consumers with developmental disabilities.  HCBS includes:

  •  Attendant Care
  •  Day Programs
  •  Habilitation
  •  Personal Care
  •  Respite Care
  •  Therapy Services
  •  Transportation  

An individual care provider has the option of working for an HCBS certified agency and/or contracting directly with DDD as an HCBS certified Independent Provider. The process of contracting with DDD and applying for certification as an independent provider starts with the DDD Independent Provider Coordinator assigned to your zip code.  Please contact any of the Certification Specialists listed at the bottom of this page for more information.

An HCBS agency or therapist must first become a Qualified Vendor for DDD before applying for HCBS Certification. DDD provides information on their  Qualified Vendor website or you may contact DDD at (602) 542-6874 for additional guidance on becoming a Qualified Vendor. Once the process is completed for becoming a Qualified Vendor, the agency or therapist will need to submit an application packet to OLCR for HCBS Certification and AHCCCS enrollment.  This Letter of Introduction (250 KB PDF) from OLCR explains the certification process and documentation requirements for applicants who are Qualified Vendors. 

For additional information on the rules and requirements for Qualified Vendors, please review this presentation on HCBS Certification (434 KB PDF).

Effective January 1, 2013, every site licensed as a Group Home for the Developmentally Disabled by the Arizona Department of Health Services (DHS) External Link Icon must be registered with AHCCCS via OLCR and assigned an AHCCCS identification number.  In November/December 2012, Qualified Vendors submitted registration packets to OLCR for the registration of nearly 1,000 of these group homes. Please contact OLCR for direction on the forms that must be submitted to keep registration current as group homes close or relocate to a new address and as new group homes are established.

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 Frequently used forms for HCBS Certification

Application for Initial HCBS Certification (211 KB DOC)
Provider Registration Form (165 KB DOC)
Provider Participation Agreement (37 KB PDF)
W-9 (735 KB PDF)
Disclosure of Ownership Form (34.1 KB PDF)
Instructions for Disclosure of Ownership (8.84 KB PDF)
Statement of Understanding (54.5 KB DOC)
Criminal History Self-Disclosure (40.17 KB PDF)
Agency Staff Matrix (194 KB DOC)
Life-Safety Inspection Request (57.5 KB DOC)
 

 A complete list of forms used for HCBS certification is available in the  DES Digital Forms Library


With the exception of Group Homes for the Developmentally Disabled* and the home of a consumer, each address used to provide HCBS must pass a life-safety inspection conducted by OLCR.  Additionally, these  settings must be inspected at least every two years.  If you need a life-safety inspection for a site to provide HCBS, please visit the Regulatory Support Unit/ Life-Safety Inspections website for information on the process for requesting an inspection, as well as the inspection requirements.  
    *Group Homes licensed by the Arizona Department of Health Services (DHS) must be inspected by DHS External Link Icon

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 The caseload for HCBS certification is divided across 4 specialists in OLCR using the first letter(s of an agency's name or a care provider's last name.  For questions and information about certification, please use the following contact list: 

 Alpha

 Certification Specialist

 Email Address

 Telephone

A - C

Patti Shiroma

   PShiroma@azdes.gov 

(602) 771-8285  

D - J

Jenna Garcia

   JuanitaGarcia@azdes.gov 

(602) 771-8766

K - Ra

Sandra James

   SJames@azdes.gov 

(602) 771-8288

Re - Z

Bonnie Swan

   BSwan@azdes.gov 

(602) 771-8760

 A - Z

Administrative Assistants

 HCBScertification@azdes.gov

(602) 771-8765

    

All information for the OLCR HCBS Certification Unit may be submitted via email to  HCBScertification@azdes.gov, faxed to 602-257-7045, or sent via U.S. Postal Service to P.O. Box 6123-076A, Phoenix, AZ 85005.

The HCBS Certification Unit is managed by Norma Lewis: NLewis@azdes.gov or (602) 771-8761.

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