Get Md Medical Assistance Program Application 2020-2025

The MD Medical Assistance Program Application is an essential document for individuals or organizations seeking to provide medical assistance services in Maryland. This guide offers step-by-step instructions to ensure your application is completed accurately and efficiently.

Follow the steps to fill out the application online.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Complete the Provider Information section. You will need to provide your National Provider Identifier (NPI), Tax ID, and Medical Assistance Provider Number if previously enrolled in Maryland Medicaid.
3. In Section I, upload the required documentation, including the completed Adult Residential SUD Provider Attestation Form, professional licenses, criminal history records for staff employed or under contract, and organizational policies.
4. Fill in the Program Requirements section, certifying that your organization meets the necessary criteria defined by the American Society of Addictions Medicine (ASAM) and has the required licenses.
5. Mark the services offered by your facility under the Evidence-Based Practice (EBP) Services section and provide evidence of competency in those practices.
6. Indicate your employed staff qualifications as per the ASAM levels available at your facility. Ensure to tick ‘Yes’ or ‘No’ as appropriate for each staff member listed.
7. Finally, review all information for accuracy, confirm consent, sign, and date the form. Ensure you have included all required documentation.
8. After reviewing your application, save any changes, download it for your records, and print or share the document as needed through the appropriate channels.

Start your application online today to ensure timely processing of your Maryland Medical Assistance Program enrollment.