1. GOVERNING AGENCIES

Agency: Maryland Department of Health (MDH)
Role: Oversees regulatory standards for DDA Waiver services

Agency: Developmental Disabilities Administration (DDA)
Role: Administers the Family Supports Waiver, which includes Therapeutic Integration services

Agency: Office of Long-Term Services and Supports (LTSS Maryland)
Role: Tracks data, documents service delivery, and manages Medicaid billing for DDA programs

Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Ensures compliance with federal Home and Community-Based Services (HCBS) standards

2. THERAPEUTIC INTEGRATION SERVICE OVERVIEW

Therapeutic Integration (TI) provides structured after-school or day programming for children and adolescents that:

• Incorporates therapy-informed activities
• Fosters communication, peer relationships, and behavior regulation
• Builds community engagement skills through group activities and outings
• Offers support with social-emotional learning and sensory needs
• May include individual goal planning as outlined in the Person-Centered Plan (PCP)

TI programs typically operate before or after school, on weekends, and during school breaks, with staff support ratios based on individual needs.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register your agency with the Maryland Department of Assessments and Taxation (SDAT)
• Obtain EIN and Type 2 NPI
• Apply to become a DDA-approved provider through the DDA Provider Application Portal
• Secure a program location (site-based facility) that meets safety and accessibility requirements
• Submit policies for therapeutic curriculum, behavior management, and supervision
• Hire qualified staff trained in developmental disabilities, behavioral health, or child development
• Obtain commercial liability insurance and ensure compliance with transportation and safety protocols (if applicable)

4. DDA PROVIDER ENROLLMENT & SERVICE APPROVAL

Step 1: Develop Program Design

• Define therapeutic goals, daily schedules, and activity types
• Include group ratios, staffing structure, and behavior support practices

Step 2: Submit DDA Provider Application

• Select “Therapeutic Integration” under the Family Supports Waiver
• Include location details and staffing credentials

Step 3: Site Visit & Review

• Prepare for DDA pre-approval inspection if operating from a physical facility
• Submit floor plans, emergency exits, and environmental safety documentation

Step 4: Receive Approval and Accept Referrals

• Begin service delivery once referrals are received from Coordination of Community Services (CCS) agencies
• Document attendance, outcomes, and behavioral incidents as required

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or LLC paperwork (via SDAT)
• IRS EIN and NPI confirmation
• DDA provider enrollment approval
• Facility lease or ownership documentation (for site-based services)

Policy & procedure manual including:

• Participant intake and individualized support planning
• Therapeutic activity schedule and curriculum outline
• Behavior support protocols and de-escalation strategies
• Incident reporting, medication management (if applicable)
• Supervision policies and staff ratios
• Parent communication procedures
• Transportation safety plans (if providing community outings)
• Staff training logs and background checks

6. STAFFING REQUIREMENTS

Role: Therapeutic Integration Specialist / DSP
Requirements: Minimum high school diploma or GED, experience with youth or disabilities, background check, CPR/First Aid, and DDA Core Competency training

Role: Clinical Supervisor or Program Manager
Requirements: Bachelor’s or Master’s degree in education, psychology, or related field, responsible for planning, supervision, and behavioral oversight

Role: Behavioral Health Consultant (optional)
Requirements: BCBA, LCSW, or similar, supports behavioral planning and training

Training Requirements for All Staff:

• DDA Orientation and Core Competencies
• Behavior intervention and de-escalation techniques
• Trauma-informed care
• Documentation and safety protocols
• Parent/caregiver communication skills
• Annual continuing education

7. MEDICAID WAIVER SERVICES

Therapeutic Integration is reimbursable under:

• Family Supports Waiver – Children under 21 with intellectual/developmental disabilities
• Community Supports Waiver – Transition-aged youth not enrolled in full-day services
• Community Pathways Waiver (case-by-case for youth with high needs)
• Self-Directed Services (in limited cases) – TI may be accessed through individualized arrangements

Covered services include:

• Therapeutic group activities and community outings
• Structured recreational engagement
• Social-emotional learning support
• Crisis response and behavior support (if outlined in PCP)
• Transition-to-adulthood skills (as applicable)

8. TIMELINE TO LAUNCH

Phase: Business and Facility Setup
Timeline: 2–3 weeks

Phase: Staff Hiring and Curriculum Development
Timeline: 2–4 weeks

Phase: DDA Provider Application and Site Inspection
Timeline: 6–10 weeks

Phase: Service Activation and Referral Enrollment
Timeline: Ongoing

9. CONTACT INFORMATION

Maryland Developmental Disabilities Administration (DDA)
Website: https://dda.health.maryland.gov
Email: dda.providerapps@maryland.gov

​Maryland Medicaid Provider Enrollment (ePREP)
Website: https://eprep.health.maryland.gov

​Maryland State Department of Education (MSDE) (if providing coordination with IEPs)
Website: https://marylandpublicschools.org

​Maryland Department of Assessments and Taxation (SDAT)
Website: https://egov.maryland.gov/BusinessExpress

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10. SCOPE OF WORK

• Business formation (LLC, EIN, NPI)
• DDA enrollment under the Family Supports Waiver
• Policy & procedure manual for therapeutic group settings
• Curriculum design tools and daily schedule templates
• Staff credentialing, onboarding, and Core Competency tracking
• Safety and emergency procedures for site-based services
• Parent consent forms, communication logs, and intake packets
• Website, email, and scheduling setup
• Referral networking with CCS and local IEP teams

WAIVER CONSULTING GROUP'S START-UP ASSISTANCE SERVICE — MARYLAND THERAPEUTIC INTEGRATION PROVIDER

We help educators, behavioral specialists, and youth service providers launch impactful Therapeutic Integration programs for children with developmental disabilities across Maryland.

To get started, click the link to request portal access