New York Support Broker Authorization Sample Completed Form

New York Support Broker Authorization Form (Completed)

All Prospective Support Brokers must complete an OPWDD-approved curriculum utilizing qualified trainers, or a training method, approved by OPWDD. All New York Self Direction Support Brokers who demonstrate that they meet the New York State OPWDD training requirements will be listed in a centralized authorization record and recognized as “Authorized”. While authorization demonstrates the Support Broker’s adherence to OPWDD standards, it does not demonstrate adherence to background checks and other billing standards.

Before completing the authorization form, complete the six additional courses.

1. Privacy and Security of Health Information
2. Overview of Developmental Disabilities
3. Medicaid Compliance
4. PICA
5. PRAISE (replaces Incident and Abuse Reporting)
6. Rights and Responsibilities of Persons Receiving Services

Simply send an email to your regional office requesting the PDF documents.

Sample email below;

Hi,

To Whom it May Concern

My name is xxxxx (First and LastName), and I am a new Self-Direction Broker in your region. I successfully completed my Self-Direction Budget/Template course and was required to complete the program with the six additional courses listed below:

1. Privacy and Security of Health Information
2. Overview of Developmental Disabilities
3. Medicaid Compliance
4. PICA
5. PRAISE (replaces Incident and Abuse Reporting)
6. Rights and Responsibilities of Persons Receiving Services

Kind Regards

See the Guide below;

Learn how to complete the Self Direction Support Broker form using the sample below;