DHS COVID-19 PROVIDER GUIDANCE // ODP
ODP Announcement 20-085: Provider Attestation Form for Retainer Payments
Issued: July 20, 2020; Updated: August 11, 2020
Community Participation Support Providers
To introduce the Provider Attestation Form to be completed by eligible CPS providers seeking to receive retainer payments under the 1915(c) Home and Community-Based Services Waivers, Appendix K.
Per ODP Announcement 20-074, ODP intends to provide retainer payments beginning in the month of July 2020 for eligible providers of CPS services. In order to be eligible for these payments, providers must complete the attached Provider Attestation Form as required by CMS. It is ODP’s intention to begin processing July payments during the third week of August in the order in which these attestation forms are received. Completed forms may be e-mailed to Rick Smith at firstname.lastname@example.org.
To Community Participation Support Providers (CPS):
Regarding the second statement on the CPS Provider Attestation Form (Provider has not
and will not lay off staff), ODP has received additional information from CMS and will
interpret this statement as follows: The provider is attesting that any layoffs after July
1, 2020 will not cause staff levels to fall below x% of pre-covid levels, where x is the
current monthly retainer percentage plus current month billing percent of pre-covid
levels. For example, if the July retainer payment is 50 percent and a provider’s actual July
billing is 10 percent of pre-COVID levels, staff levels would be expected to be at 60 percent or more of
As a reminder, CPS providers must submit a completed attestation form prior to
receiving any retainer payments. Completed forms should be emailed to Rick Smith at