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Virginia Provider Readiness Assessment

Tell us where you are in the Virginia licensing process. This short assessment helps us recommend the right level of support. It takes about 5 minutes.

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Full name *

Your role *Select oneOwnerAdministrator or Executive DirectorClinical DirectorCompliance leadOther

Organization legal name *

Email *

Phone *

What are you seeking help with? *Select oneStart a new Virginia behavioral health serviceAdd a service to an existing DBHDS-licensed organizationAdd or change a service locationModify an existing license or serviceChange ownership or organizational structurePrepare for renewal or ongoing complianceRespond to a licensing citation or corrective action planClose or discontinue a serviceRequest a varianceNot sure yet

Which specific service? *Be as specific as possible, for example Mental Health Skill-Building. Enter "unsure" if you don't know. We currently support behavioral health, mental health, and substance use services.

Is this service currently listed by DBHDS as Priority 1, Priority 2, or non-priority? *Select onePriority 1Priority 2Non-priorityI haven't checkedUnsure

Have you created your application in CONNECT? *Select oneNoYesUnsure

Which of these are substantially prepared? *

Legal and entity documentsService descriptionOrganizational chartAdministrator informationStaffing planOperating budgetPolicy and procedure manualHuman rights policiesRisk management and quality improvement materialsService location securedNone yet

How would you describe your policy manual? *Select oneDeveloped for our organizationPartially completePurchased templateAdapted from a template or other sourceWe don't have one yetUnsure whether it's current

After licensure, how do you expect to be paid? *

Virginia MedicaidManaged care plansCommercial insurancePrivate payContracts or grantsUnsure

Is there any current or past licensing, Medicaid, or other government regulatory matter involving your organization or its owners that we should discuss before working together? *

Please don't include details here.

YesNoPrefer to discuss by phone

When do you hope to be ready for submission or review? *Select oneWithin 2 weeksWithin 30 daysWithin 60 daysWithin 90 daysMore than 90 daysUnsure

How did you hear about us?

I understand that submitting this form does not create a consulting engagement or constitute legal advice; that Mid-Atlantic Behavioral Health Desk is an independent consulting firm, not affiliated with any government agency, and does not guarantee licensure, enrollment, processing time, or any regulatory outcome; and that I will not submit client records or health information through this form. *

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Start My Virginia Readiness Assessment