CCAs are responsible for developing and implementing the Individualized Service Plan (ISP) to identify the participant's needs and the methodology to meet those needs while participating in the Assisted Living Waiver (ALW) program. They will explain to individuals or their legal representative, the services offered through the waiver. CCAs can help individuals make decisions about their choices of living arrangements by explaining the differences between receiving long-term services and supports in a nursing facility, a Residential Care Facility (RCF), or the public subsidized housing (PSH) setting. The CCA is also responsible for informing individuals about resources available to them for determining financial eligibility for long-term services and supports.
1. To be considered for enrollment as a CCA/ALW provider, the following preliminary application package is required:
ALW Care Coordinator Initial Provider Application
Assisted Living Waiver Program Provider Agreement
2. Enrolling providers are required to have a National Provider Identifier (NPI). The unique 10-digit number allows universal recognition of individual health care providers. Once enrolled as a Medi-Cal provider in the ALW program, the NPI number is used in administrative and financial (billing) transactions. For more information and to apply for your NPI number, follow the link provided:
National Provider Identifier
3. Upon review and approval of the initial ALW application, a site visit will be completed to verify applicants' qualifications. Agencies will receive notification of their enrollment status. Medi-Cal applications received prior to program approval will not be considered.
4. Agencies will receive notification of their enrollment status. Agencies that have met all program requirements will then be instructed to enroll as a Medi-Cal provider. The complete enrollment package consists of the following:
Provider Agreement (DHCS 6208)
Provider Application (DHCS 6204)
Medi-Cal Disclosure Statement (DHCS 6207)
A non-refundable application fee of $560.00 in the form of a cashier's check, made payable to the California Department of Health Care Services is required and must accompany the Medi-Cal application.
Do not send any application to the Provider Enrollment Division.
Send all application packets to:
ALW Provider Enrollment