To become a participant, the provider must:

  • Currently hold license/certification in the state of Pennsylvania;
  • Be board certified if a specialist;
  • Participate in Medical Assistance;
  • Be willing to receive education in Autism Spectrum Disorders;
  • Sign a Participating Provider Agreement

Information Requested and Enrollment Process:

To have your Provider participate in the Adult Community Autism Program (ACAP) Provider Network, please complete the nomination form and submit to Keystone Autism Services. This will initiate the nomination process and you can then expect the following steps to occur:

  1. The Director of Family and Provider Relations will contact your physician, dentist and/or specialist with a brochure and information regarding the ACAP program after receiving the Provider information you have provided;
  2. Your physician, dentist or other specialist will be contacted in order to provide them with further information regarding ACAP and to determine their interest in joining the Provider Network;
  3. If the Provider you have nominated is interested in joining ACAP's Provider Network, the Director of Family and Provider Relations will then coordinate times and dates to meet with the physician, dentist or other specialist to review Provider Network responsibilities and expectations and to sign the Provider Agreement;
  4. The physician, dentist or other specialist, as well as their office staff, will receive education regarding Autism Spectrum Disorders.

* = required

Provider Information
Accepting New Patients?
Are they a MA provider?
Nominator Information