ODP Updated Provider Closure Notification Form

ODP Announcement 20-009 provides an updated Provider Closure Notification Form (DP 1061) and instructions to comply with 55 Pa. Code § 6100 requirements. The Provider Closure Notification Form is used to ensure that all ODP waiver and system requirements are met for any provider who no longer intends to provide ODP Consolidated, Person/Family Directed Support (P/FDS), and/or Community Living Waiver services. This includes ensuring that participants who are receiving services from the closing provider are properly transferred to a willing and qualified provider of their choice, according to 55 Pa. Code § 6100.303, and that the closing provider is properly removed from the ODP systems, including but not limited to HCSIS and PROMISe.

Providers are required to use the Provider Closure Notification Form (DP 1061) to ensure that ODP and all authorizing AEs are notified of their closing, in accordance with 55 Pa. Code § 6100.304. The 11/19 revised version of the DP 1061 can be found on the “Forms” page of MyODP.org and has been formatted to be submitted electronically. This new version of the form (11/19) should be used going forward effective immediately.

This form is not to be used when providers are ONLY discharging individuals. Providers shall adhere to requirements contained in 55 Pa. Code § 6100.304.

With the release of this announcement, ODP Communication Number: 050-17 Provider Closure Notification Form (DP 1061) is obsoleted. COMMENTS relating to the Provider Closure Notification Form (DP 1061) may be directed to the ODP Provider Qualification mailbox.