Common Contracts
1 similar Provider Enrollment Application and Agreement contracts
Child Foster Home Medicaid Provider Enrollment Application and Agreement (PEA)Provider Enrollment Application and Agreement • November 15th, 2016
This PEA sets forth the conditions and agreements for being enrolled as a Child Foster Home provider (Provider) with the State of Oregon Department of Human Services (DHS), Office of Developmental Disabilities (ODDS), and to receive a provider number. The provider number is required prior to receiving authorization to provide services to Medicaid-eligible children with intellectual or developmental disabilities in Oregon home and community-based settings and to receive payment for Medicaid services delivered by Provider. Payment for services is made using federal Medicaid and state funds. Complete this PEA in its entirety. If the answer is “none” or “n/a” indicate that in the section.
