NADD Certifications Recognized in Pennsylvania

Three competency-based certifications offered by NADD for people providing services to individuals with intellectual/developmental disabilities co-occurring with mental illness have been written into Pennsylvania’s Section 1915(c) Home and Community Based Services waiver program rules:

  • NADD Competency-Based Clinical Certification
  • NADD Competency-Based Dual Diagnosis Specialist Certification
  • NADD Competency-Based Direct Support Professional Certification

These certifications are among the possible qualifications required in providing enhanced level of care.

Purpose of the Home and Community-Based Services Waiver Program

The Medicaid Home and Community-Based Services (HCBS) waiver program is authorized in §1915(c) of the Social Security Act. The program permits a State to furnish an array of home and community-based services that assist Medicaid beneficiaries to live in the community and avoid institutionalization. The State has broad discretion to design its waiver program to address the needs of the waiver’s target population. Waiver services complement and/or supplement the services that are available to participants through the Medicaid State plan and other federal, state and local public programs as well as the supports that families and communities provide.

The Centers for Medicare & Medicaid Services (CMS) recognizes that the design and operational features of a waiver program will vary depending on the specific needs of the target population, the resources available to the State, service delivery system structure, State goals and objectives, and other factors. A State has the latitude to design a waiver program that is cost-effective and employs a variety of service delivery approaches, including participant direction of services.

Under these three waivers in Pennsylvania — Consolidated, Person and Family Directed, and Community — providers can provide enhanced level of care in prevocational facilities, Adult training facilities, Community Participation Services, Employment services, In-home and Community Services and Respite Services.

Enhanced level of care provides 1:1 or 2:1 (staff to participant) staffing for a participant.  Enhanced level of care is based on a participant’s behavioral or medical support needs.

Effective 1/1/18, at least one staff person must have one of the following certifications or degrees to provide enhanced levels of service to participants who do not require a nurse to provide the enhanced level of service:

  • NADD Competency Based Clinical Certification.
  • NADD Competency-Based Dual Diagnosis Certification.
  • NADD Competency-Based Direct-Support Professional Certification.
  • Registered Behavior Technician.
  • Certified Nursing Assistant.
  • Board Certified Assistant Behavior Analyst.
  • Bachelor’s Degree in Psychology, Education, Special Education, Counseling, Social Work or Gerontology.

The Advantages of These Waiver Rules

 The requirement that at least one staff person must have one of the required certifications or degrees in order to provide enhanced levels of service is intended to help insure that these enhanced services are performed by qualified individuals.  By requiring individuals providing enhanced services to have an appropriate certification or degree, the State is attempting to raise the bar for the quality of services provided and thus to improve the quality of life of those receiving these services.

The NADD Competency-Based Certifications

In order to raise the bar for services provided to, as well as to recognize professionals providing quality services to individuals with co-occurring IDD and mental illness, NADD developed the following professional certifications:

The NADD Competency-Based Clinical Certification is available to state-licensed or governing board-certified clinicians.  NADD identified five competency areas in which clinicians should have proficiency:

  • Positive Behavior Supports and Effective Environment
  • Psychotherapy
  • Psychopharmacology
  • Assessment of Medical Conditions
  • Assessment

The NADD Competency-Based Dual Diagnosis Specialist Certification is available to individuals who deliver, manage, train and/or supervise services for persons with intellectual/developmental disabilities and mental health needs.  NADD identified six competency areas in which dual diagnosis specialists should have proficiency:

  • Multimodal bio-psycho-social approach
  • Application of emerging best practices;
  • Knowledge of therapeutic constructs;
  • Respectful and effective communication;
  • Knowledge of dual role service delivery & fiduciary responsibilities; and
  • Ability to apply administrative critical thinking.

The NADD Competency-Based Direct Support Professional Certification is available to people providing direct care to individuals with co-occurring IDD and mental illness.  NADD recognizes the importance of the direct support professional in the care of individuals with co-occurring IDD and mental illness.  NADD identified five competency areas in which the DSP should have proficiency:

  • Assessment and Observation
  • Behavior Support
  • Crisis Prevention and Intervention
  • Health and Wellness
  • Community Collaboration and Teamwork

Information about the NADD competency-based certification programs is available online at  For further information about the NADD certification programs, you can contact Edward Seliger, Project Coordinator at