Coshocton DD - Provider Resources

Provider Resources



Become a Provider
Frequently Asked Questions
HIPAA - Privacy Practices
Individual Profiles
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Become a Provider

Persons or agencies who provide services to individuals with developmental disabilities must obtain certification from the Ohio Department of Developmental Disabilities. Applications for provider certification must include supporting documentation as evidence the applicant meets all qualifications and standards.

Please note that becoming a certified provider for waiver


services does not mean that you, as a provider, are an employee of the State of Ohio, the Ohio Department of Developmental Disabilities, or of the Coshocton County County Board of Developmental Disabilities. Providers are independent business owners who are certified to provide services to individuals on a Level One (L1) or Independent Options (IO) Medicaid Waiver.

Only the Ohio Department of Developmental Disabilities office for Provider Certification is authorized to approve a person as a certified provider.

To view the full process for provider certification please visit the Ohio Department of Developmental Disabilities (DODD) website at: http://dodd.ohio.gov/providers/new.htm

It is the expectation that you will download and complete all the forms from the above website.  The Coshocton County Board of DD and Ohio Department of DD will no longer send out application packets.  If you have additional questions or comments, please contact the Office of Provider Certification by e-mailing Provider.Certification@dodd.ohio.gov.

PLEASE NOTE: Once your application is submitted to the DODD, there is no way for the Coshocton County Board of Developmental Disabilities to track it for you. You must contact the DODD for any needed follow-up. The DODD will return the results of the submission, including any certification, to you.

Once you are a certified provider you must submit a copy of certification letter from the Ohio Department of Developmental Disabilities along with your contact information to the Coshocton County Board of DD receptionist or secretary before you will be considered as a provider.

Once you are a provider, you can search our individual profiles to see if individuals are requesting the services you are certified for. The individual and their supports may choose to interview you to see if you are a good match for their needs and/or tour your facility, if applicable. If you wish to be e-mailed provider notifications, individual profiles, training notices, etc. Please click here: Provider E-Mail List.



Frequently Asked Question






How long does it take to become certified as an HCBS waiver provider?
It takes a minimum of 10 working days to review, process, and approve completed applications. The process may be delayed if the application is not complete.


How do I obtain a criminal records background check? All requests for an Ohio civilian background check must be submitted electronically, through use of Web Check or other approved methods. There are over 550 Web Check locations available to persons seeking background checks. These locations are listed, by county, on the Attorney General's website: HERE


  • Applicants who have never lived in Ohio require a FBI check.

  • Applicants who have lived in Ohio from 1 day to 5 years require both BCI & FBI check.

  • Applicants who lived in Ohio for more than 5 years require a BCI check only.

  • Requirements for electronic submission applies only to BCI checks, FBI checks on mailed ink –rolled cards will still be accepted. All civilian background checks (both BCI & FBI) are processed through BCI & I. The FBI does not accept direct submissions for civilian background checks.

If I have a previous criminal conviction, can I become a certified HCBS waiver provider?
The fact that you have had a previous conviction does not automatically disqualify you as a provider. An applicant should fully disclose all convictions and provide a detailed explanation of the record when the application is submitted.


I am now certified. What is the next step?
Once you have received your initial approval letter listing the specific HCBS waiver, the waiver services, and your effective date of certification, present this letter to the local County Board of Developmental Disabilities where you would like to deliver services. The initial approval letter allows you to deliver services if selected by an individual enrolled on an HCBS waiver. This letter is important, as it verifies for the organizations you deliver it to, that you have completed the certification process and may begin service delivery.


How do I bill for non-Medicaid funded Supported Living services delivered?
Providers that deliver non-Medicaid funded Supported Living services are reimbursed directly by the County Board of Developmental Disabilities with whom you are contracting. It is recommended that you contact them directly to obtain reimbursement information.


What is the difference between a Contract Number and a Medicaid Billing Number?
A contract number is a 7-digit number assigned by the DODD. It is placed on a Payment Authorization for Waiver Services (PAWS) form to identify the various providers of service. A Medicaid Billing number is a 7-digit number issued by ODJFS. A Medicaid Billing Number indicates that the provider is officially enrolled as a Medicaid Provider, and may receive federal reimbursement through the waiver.


How Do I Bill For Medicaid Funded Services That I Provide?

A provider cannot bill for services until he/she has received a final approval letter from the DODD. The final approval letter indicates your Medicaid Provider number issued by the Ohio Department of Job and Family services (ODJFS). You may only submit claims after you and/or your billing agent have completed and returned to DODD a Security Affidavit. Once received, you will be assigned a log-in and temporary password. The DODD Security Affidavit Form is located on the DODD main website in the forms section or you can e-mail security.request@list.dodd.ohio.govComplete this form and fax to DODD at 614-752-4673 or mail the original to: Security Administrator, DODD, 30 East Broad Street, 12th Floor, Columbus, OH 43215-3434.


Who do I call when I have billing questions?
Please direct all billing questions to Provider Support Services via e-mail: provider.support@dodd.ohio.gov You also may call 1 (800) 617-6733, where you will be instructed by voice recording to leave a detailed message regarding your issue(s). A customer service representative from the billing area will return your call in the order it was received.


I am interested in obtaining CPR & First Aid Training to meet DODD certification requirements. Which organizations should I contact to schedule my training?

The DODD accepts First Aid and CPR training provided by organizations approved by the Ohio Dept. of Job and Family Services (ODJFS). A complete listing of those organizations is available by visiting the ODJFS website at www.jfs.ohio.gov and click on Child Care Resources. Then select ‘Provider Resources’, then ‘What’s New?’, and then ‘First Aid Training’. Applicants are encouraged to obtain CPR and or First Aid training from one of the organizations listed. To ensure your application to become a waiver provider is reviewed and approved as quickly as possible, verification of CPR and or First Aid certification must be submitted with your application. The County Board of Developmental Disabilities strives to post the trainings offered locally.


Who do I notify when I no longer wish to provide services?
Providers who no longer wish to provide waiver services or supported living services must write a letter to DODD stating that they are voluntarily relinquishing their waiver or supported living certification, effective immediately. The letter should be sent to:


35 East Chestnut Street, 5th Floor
Columbus, Ohio 43215
You must also mail a copy of this letter to the County Board(s) of Developmental Disabilities for whom you delivered services


HIPAA - Privacy Practices




  Coshocton County Board of Developmental Disabilities (CCBDD) ensures they safeguard the confidentiality of individuals served, pursuant to applicable state or federal regulations, including Ohio Department of Human Services rule 5101:1-03 of the Administrative Code and the Ohio Department of Education Model Policies and Procedures and Health Insurance Portability and Accountability Act (HIPAA) Read more HERE.adobe pdf courthouse



Individual Profiles





Some individuals with disabilities need qualified professionals to support them in various areas of their lives or with specific tasks. Below providers can find profiles of individuals seeking supports. Click the button next to the short identifier to see the profile (PDF).
POSTED: 12-12-13
DEADLINE: 12-31-2014




MUI/UI - Incident Reporting






As a provider, you are require to report incidents or suspected incidents that may negatively impact the health or safety of individuals with disabilities. In the event you become aware of an Emergency, Major Unusual Incident (MUI), or potential MUI, please use the following protocol for notifying the county board, 
as you need to actually speak with someone:

  1. Call the Coshocton DD SSA Emergency On-Call phone, (740) 502-1768, to make the report. 
  1. If the SSA does not answer the phone, leave your number, a message and request a return call. (This is the only phone it is OK to leave a message on, as it is checked at least every 30 minutes).
  1. All calls should be returned within 30 minutes on the SSA Emergency On-Call phone. 
  1. You may also try to reach the MUI Manager, Bambi Zinkon at 622-2674, 8:00am–4:00pm, Monday-Friday.  Please do not leave a message if Bambi is out of her office.  When reporting a MUI or suspected MUI, you need to speak directly with someone.

** Per MUI rule, the County Board needs a copy of the unusual incident report as soon as possible, or: agencies: by 3pm the next day (Monday for weekend incidents)
independent providers:  the same day (Monday for weekend incidents)

Unusual incident reports can be delivered in person to the Administrative Office at 646 Chestnut Road or faxed to Bambi Zinkon at 740-622-2679.

Questions concerning MUIs may be directed to Bambi Zinkon at 740-622-2674.


Click the link below to access the incident report form.

Unusual Incident Report Form 


What is a MUI?

People with Mental Retardation and Developmental Disabilities have rights guaranteed by the State of Ohio.  There are also laws that protect these individuals from abuse, neglect, misappropriation, financial abus eand other negative incidents. Together these laws help to ensure the health and safety of those we serve.  The Ohio Revised Code, ORC 5123: 2-17-02 INCIDENTS ADVERSELY AFFECTING HEALTH AND SAFETY defines and establishes “a system to report, investigate, review, remedy, and analyze incidents adversely affecting the health and safety of individuals and to monitor preventative actions taken to ensure health and safety.”

As defined by law, a Major Unusual Incident or MUI means:  “the alleged, suspected, or actual occurrence of an incident when there is reason to believe that health or safety of an individual may be adversely affected, or an individual may be placed at reasonable risk of harm if such individual is receiving services through the Developmental Disabilities system, or will be receiving services as a result of the incident”. This rule applies to any paid provider employee – private or agency - and county board staff.  The MUI Dept. also investigates allegations of abuse, neglect, misappropriation and suspicious death when the alleged suspect is a non-paid provider (parent, guardian, friend, community member, etc.).  Some MUI’s can be filed & investigated involving 2 individuals being served by the Board (Peer-to-Peer Acts). 

All allegations are reviewed by the MUI Dept. and, if warranted, filed with the state & investigated in an attempt to determine whether the allegation is substantiated (has been found to have likely occured) or not. 

All providers and employees of the County Board of Developmental Disabilities are responsible for ensuring that they meet an annual MUI training requirement and they have a legal responsibility to know what would constitute a MUI and report such an event to the proper board authority.  This is to ensure the health and safety of all persons served by the Knox County Board of Developmental Disabilities (KCBDD).

The immediate action of anyone involved in an incident that adversely affects the health and safety of an individual with disabilities should be to take measures to insure the immediate health and safety of the individual involved in the incident. If the incident involves abuse, neglect, or misappropriation make sure the individual is in a safe location (taken to ER, an office, etc.) and ensure the provider has removed the alleged offender (PPI) so they are not in contact with any individuals. Notify the SSA on Call and/or the MUI Dept. of the situation. Help the provider or “reporter” determine if Paramedics or Emergency Room treatment is needed and take necessary steps to help them obtain this treatment. 

Employees who witness the event should complete the KCBDD Unusual Incident Report (UIR). The UIR is to be completed immediately and hand delivered, e-mailed, or faxed to the MUI Dept. by no later than 4:00pm that day. If the incident qualifies as a MUI, it must be filed on a strict time schedule with the DODD MUI Department.

If you are not sure about a UIR being a MUI, and the following list may have applied to the situation at hand, please report the situation to the SSA On-Call and/or the MUI Dept. immediately.

  • Law Enforcement or Children’s Services Board notified about incidents.

  • Media inquiries received or incidents/actions likely to get media inquiries.

  • Major health and safety issues involved.

  • Accidental death or concerns of suspicious death.

An individual’s legal guardian must be informed that a MUI has been filed immediately to within 24 hours of incident.  If unable to contact the legal guardian, document all attempts made using the Unusual Incident Report.

    • SSA On-Call: 740-502-1768

    • Bambi Zinkon: 740-622-2674

    • MUI Fax, All UIs and MUI info: 740-622-2679




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