Potential providers must complete KMAP provider enrolment packet application and submit their credentials and qualifications with the application, and complete the mandatory training. The fiscal agent reviews the application and forwards the application to the HCBS autism waiver program manager. Once the program manager determines the provider meets the qualification, the fiscal. agent notifies the potential provider of the enrollment determination. The following steps must be completed in order to become a service provider.

Information on the training requirements
Potential providers must complete KMAP provider enrolment packet application, submit their credentials and qualifications with the application and complete the mandatory training. The fiscal agent reviews the application and forwards the application to the HCBS autism waiver program manager. Once the program manager determines the provider meets the qualification, the fiscal agent notifies the potential provider of the enrollment determination. The following steps must be completed in order to become a service provider. State Requirements for SRS Waiver Providers

KMAPP Provider enrollment, NPI numbers, and manual's web site:
https://www.kmap-state-ks.us/

The HCBS Autism Waiver applications are available at: http://www.srs.ks.gov/agency/css/Documents/Autism/Autism_Preliminary_
Application.pdf

The full Community Supports & Services draft Policy & Procedure Manual web site is available at:
http://content.srs.ks.gov/CSS/Autism/Autism.htm

If you have already completed the Kansas Bureau of Investigation (KBI), Adult Protective Services (APS), and Child Protective Services (CPS) checks, the next step is to:

• fill out the Provider Application Packet,
• gather all needed supporting documents, and
• provide copies of all of the background checks in the packet. Please submit all information together in one packet.

If you have not sent in background checks yet, complete the required forms and mail them to address indicated on the documents. While you are waiting for the background checks to come back, work on completing the Provider Application Packet and gathering supporting documents. Then when you have all the paperwork completed, submit all information together in one packet.

Note: If you qualify for the Autism Specialist position you will probably qualify for the IIS worker and Respite worker as well. You may decide to check all three positions in order to become a service provider for all three of the positions (Autism Specialist, ILS worker, Respite Provider). If you don't check all three positions now and decide you want to be able to provide other positions at a later date, you will have to complete a whole new packet and re-submit the application.

Provider Application Packet:
https://www.kmap-state-ks.us/Documents/Content/Checklists/HCBS.PDF

National Provider Identifier: (Autism Specialist and IIS workers must complete)
https://nppes.cms.hhs.gov/NPPES/Welcome.do
Send in copy of e-mail stating you have requested an NPI number.

All providers will also need to complete the following in addition to the provider application packet above:

Kansas Bureau of Investigation
http://www.accesskansas.org/kbi/criminalhistory/index.shtml

Child Protective Services
http://www.srs.ks.gov/agency/cfs/Documents/PPM%20Forms/CFS_
1011_Child_Central_Registry_Release_of_Information_SPA.doc

Adult Protective Services
http://content.srs.ks.gov/ees/keesm/forms/es-1021_release_of_info_11-10
.pdf

Nurses Aide Registry
Go to the website
http://www.kdheks.gov/hoc/abuse_neglect_exploitation/ and print off the page where your name would be if it was on it and send that printed screen in with your application.

Motor Vehicle Screening
Go to local Department of Motor Vehicles (DMV) and request a motor vehicle screen which will cost $6. DMV professionals will print it out for you right there and provide a copy in your packet.

Security Clearance Documents to enter Plans of Care:
The staff member within an agency who is responsible for entering plans of care will need to complete the following forms:

• Cover Letter
• Agency Code
• POC form
• Security Agreement

Frequently Asked Questions for Providers
http://www.ksearlyautism.org/providers/questions.aspx