Who Do I Become a Provider for the CFR Project

How do I become a treatment provider for the Access to Recovery (ATR) program?

1. You must be a certified ODADAS treatment provider.

2. Complete the Treatment Rate Sheet document.

****PLEASE NOTE all rates are capped or limited ****

3. Please include a letter on company letterhead, signed by the Executive Director that includes the following information: a. Include a brief description of your program, the days and times the services are available. b. The contact Person(s) with contact information (telephone, email and fax numbers for each contact) c. Services to be provided d. Agency business addresses for billing purposes, along with the fiscal staff persons name and contact information. e. Agency service address for service delivery (please be sure to label which services are to be delivered at which location) f. Medicaid provider number g. Indicate if your agency is faith based (please provide denomination), community based, and/or a non-profit organization. h. If your agency is a minority vendor, or a disadvantaged vendor.

If your agency is interested in providing recovery support services please see the document entitled “How do I become a Recovery Support provider” and complete numbers 3 and 4. Also please complete the Recovery Support rate sheet document.

If the agency is approved as an ATR III provider you will be responsible for completing the Office of Budget Management vendor requirements.

If there are any questions or concerns please contacts Alisia Clark, ATR Project Director, 614-466-8036 or at [email protected] Please submit the application requirements to Alisia Clark at the address listed below: (please do not email application requirements at this time)

Alisia Clark Ohio Department of Alcohol and Drug Addiction Services 280 North High St. 12th Floor Columbus, Ohio 43215 Ph. - 614-466-8036 Fax: 614-728-8031

The DEADLINE for all applications is November 31, 2011. Please do not mail incomplete information or mail the information separately it will not be accepted. If you are a current provider and wish to amend your services October 1 through October 31, 2011 we will be accepting amended information that includes steps 2 and 3 above for adding or adjusting treatment services. If your agency is adding or adjusting RSS services please follow the instructions above.

ATR III 09/15/11