HHAs are licensed and regulated by the California Department of Public Health, Licensing and Certification Division (L&C). The HHA renders Assisted Living Waiver (ALW) services in the Public Subsidized Housing (PSH) setting. The HHA is responsible for meeting the needs of the participant equivalent to the services delivered by Residential Care Facility providers.
1. To be considered for enrollment as an HHA\ALW provider, the following preliminary application package is required:
HHA 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/HHA application, a site visit will be completed by DHCS to verify applicants' qualifications.
4. Upon DHCS approval of the branch office site, the applicant submits a completed Branch Application to CDPH Central Applications Unit (CAU) with a cover letter requesting participation as an “ALW branch office only” (CDPH Branch Application).
NOTE: No application fee is required for the CDPH enrollment of a branch office.
5. In order to render ALW services, branch sites meeting all program requirements will then be required to enroll as a Medi-Cal provider. NOTE: Medi-Cal applications received prior to program approval will not be considered. The complete Medi-Cal 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 DHCS Medi-Cal provider application.
Do not send any application to the Provider Enrollment Division.
Send all application packets to:
Assisted Living Waiver UnitLong-Term Care DivisionDepartment of Health Care Services1501 Capitol Avenue, MS 4503P.O. Box 997437Sacramento, CA 95899-7437