This enrollment checklist is only for Board Certified Behavioral Analysts and Educational Psychologists to assist them with Medi-Cal enrollment as a QAS provider. Please note that QAS professionals and QAS paraprofessionals (technicians) do not need to apply for Medi-Cal enrollment.​​ 

Prior to enrolling as a QAS provider (individual or organization) in the Medi-Cal provider enrollment system, please have the documents, certificates and licenses in the checklist below available. The checklist includes local or state business requirements in addition to qualifications established by the Department of Health Care Services (DHCS) to enroll as a QAS provider. Please see the Behavioral Health TreatmentFrequently Asked Questions for Providers, Question No. 3, for information about attesting to the qualifications of rendering QAS providers, QAS professionals, and QAS paraprofessionals as part of the application, starting in mid-November, 2025.​​ 

The checklist will help you determine what documents you will need to upload as part of your Medi-Cal provider application, depending on how you are enrolling and in which counties you will provide services to Medi-Cal members.​​ 

QAS providers who currently have an enrollment pathway, including physicians, psychologists, physical therapists, occupational therapists, licensed marriage and family therapists, licensed clinical social workers, licensed professional clinical counselors, speech-language pathologists, and audiologists, do not need to enroll again as a QAS provider to bill for BHT services. These providers will not need to report BCBAs, QAS professionals, or QAS paraprofessionals.​​ 

Note: Medi-Cal currently requires that QAS providers have an established place of business (EPOB), in compliance with section 51000.60 of Title 22 of the Code of Federal Regulations. DHCS intends to publish a regulatory bulletin later in 2025 to waive this requirement for individual BCBAs who work out of their home and do have an EPOB where they see clients. Individual BCBAs who are contracted with a Medi-Cal managed care plan and do not have an EPOB do not currently need to enroll. DHCS is working to publish a new regulatory bulletin to waive the EPOB requirement for individual BCBAs. Once published, individual BCBAs would then need to enroll.​​ 

Section A – Mandatory Documentation​​ 

This section includes all documents that you are required to submit as part of your Medi-Cal provider enrollment application as a QAS provider in Medi-Cal.​​ 

• ສຳເນົາໃບຂັບຂີ່ປັດຈຸບັນ ຫຼືບັດປະຈຳຕົວທີ່ລັດອອກໃຫ້ສຳລັບບຸກຄົນທັງໝົດທີ່ມີ 5 ເປີເຊັນ ຫຼືຫຼາຍກວ່ານັ້ນເປັນເຈົ້າຂອງສຳລັບບຸກຄົນທີ່ລົງນາມໃນນາມຂອງນິຕິບຸກຄົນ.​​ 
• Document identifying how you operate your business, which includes asole-proprietorship, corporation, Limited Liability Company (LLC) or partnership (See definitions in Appendix A: Definitions)​​ 
• ໝາຍເລກປະຈຳຕົວຜູ້ໃຫ້ບໍລິການແຫ່ງຊາດ (NPI)​​ 

• • To apply and receive an NPI online, visit the National Plan & Provider Enumeration System website.​​ 
  • ຖ້າທ່ານໄດ້ສ້າງຕັ້ງ LLC ຫຼືບໍລິສັດ, ທ່ານຕ້ອງໄດ້ຮັບແລະນໍາໃຊ້ NPI ປະເພດ 2 ສໍາລັບ LLC ຫຼືບໍລິສັດ, ເຖິງແມ່ນວ່າທ່ານຈະເປັນເຈົ້າຂອງແຕ່ຜູ້ດຽວ.​​ 

Section B – Potential Additional Documentation​​ 

This section includes all documentation that may be required based upon additional city, county and/or state requirements to operate a business in California. Note that all of these additional documents may not apply to your application, so review each item carefully to determine if you need to submit additional documentation.​​ 

• ການປະກັນໄພຄ່າຈ້າງແຮງງານ (ທີ່ມາ: ກົດໝາຍຂອງລັດ)​​ 
  • ການປະກັນໄພຄ່າຊົດເຊີຍແຮງງານແມ່ນຕ້ອງການສໍາລັບບາງທຸລະກິດ. ຖ້າກົດໝາຍຂອງລັດຄາລິຟໍເນຍຮຽກຮ້ອງໃຫ້ທຸລະກິດຂອງທ່ານມີປະກັນໄພຄ່າຊົດເຊີຍຂອງຜູ້ອອກແຮງງານ, ຫຼັງຈາກນັ້ນທ່ານຕ້ອງແນບຫຼັກຖານຂອງການຄຸ້ມຄອງກັບໃບຄໍາຮ້ອງຂອງທ່ານ.​​ 
  • If you are not otherwise required to have Workers’ Compensation insurance, you do not have to obtain insurance to enroll as a Medi-Cal provider.​​ 
  • For more information on Workers’ Compensation Insurance, visit the Workers’ Compensation Insurance website.​​ 
• ໃບ​ອະ​ນຸ​ຍາດ​ທຸ​ລະ​ກິດ (ທີ່​ມາ​: ລະ​ບຽບ​ການ​ເມືອງ / county​)​​ 
  • ເມືອງສ່ວນໃຫຍ່ຕ້ອງການໃຫ້ທຸລະກິດທັງຫມົດທີ່ຈະໄດ້ຮັບໃບອະນຸຍາດທຸລະກິດ. ນີ້ແມ່ນຄວາມຈິງເຖິງແມ່ນວ່າທຸລະກິດຈະດໍາເນີນການໂດຍຄົນດຽວ.​​ 
  • ໃນບາງເມືອງ, ໃບອະນຸຍາດທຸລະກິດອາດຈະເອີ້ນວ່າໃບຢັ້ງຢືນພາສີທຸລະກິດຫຼືໃບຢັ້ງຢືນການລົງທະບຽນທຸລະກິດ.​​ 
  • ຖ້າທ່ານບໍ່ມີໃບອະນຸຍາດທຸລະກິດ, ກວດເບິ່ງເວັບໄຊທ໌ສໍາລັບເມືອງຂອງທ່ານແລະໄດ້ຮັບໃບອະນຸຍາດທຸລະກິດກ່ອນທີ່ຈະສົ່ງຄໍາຮ້ອງຂໍຂອງທ່ານ.​​ 
  • ຖ້າເມືອງຂອງທ່ານບໍ່ຕ້ອງການໃບອະນຸຍາດທຸລະກິດ, ທ່ານອາດຈະສັງເກດເຫັນນີ້ຢູ່ໃນຄໍາຮ້ອງສະຫມັກຂອງທ່ານ, ແຕ່ສັງເກດວ່າເມືອງສ່ວນໃຫຍ່ຕ້ອງການສິ່ງເຫຼົ່ານີ້ສໍາລັບທຸກປະເພດທຸລະກິດ.​​ 
  • ຖ້າທ່ານບໍ່ຢູ່ໃນຂອບເຂດຈໍາກັດຂອງເມືອງທີ່ປະກອບ, ຄາວຕີ້ຂອງທ່ານອາດຈະຕ້ອງການໃບອະນຸຍາດທຸລະກິດ. ກວດເບິ່ງເວັບໄຊທ໌ສໍາລັບຄາວຕີ້ຂອງທ່ານເພື່ອຢັ້ງຢືນຄວາມຕ້ອງການ.​​ 

Note: The name and address on the business license must match the name and service address reported on the application.​​ 

• ຖະແຫຼງການຊື່ທຸລະກິດປອມ (FBNS) (ທີ່ມາ: ກົດໝາຍຂອງລັດ)​​ 
  • ຄວາມຕ້ອງການທີ່ຈະໄດ້ຮັບ FBNS ແມ່ນຢູ່ໃນກົດຫມາຍຂອງລັດ. ຢ່າງໃດກໍຕາມ, ຂະບວນການທີ່ຈະໄດ້ຮັບ FBNS ແມ່ນຜ່ານທາງຄາວຕີ້. ຖ້າບຸກຄົນໃດຫນຶ່ງອາໄສຢູ່ພາຍໃນເມືອງແລະຕ້ອງການທັງໃບອະນຸຍາດທຸລະກິດແລະ FBNS, ພວກເຂົາຈໍາເປັນຕ້ອງໄດ້ຮັບໃບອະນຸຍາດທຸລະກິດຈາກເມືອງແລະ FBNS ຈາກຄາວຕີ້.​​ 
  • ທ່ານຕ້ອງໄດ້ຮັບ FBNS ເມື່ອ:​​ 
    • ທ່ານກໍາລັງດໍາເນີນການເປັນເຈົ້າຂອງ sole ແລະນໍາໃຊ້ຊື່ສໍາລັບທຸລະກິດຂອງທ່ານທີ່ບໍ່ມີນາມສະກຸນຂອງທ່ານ.​​ 
    • ທ່ານກໍາລັງດໍາເນີນການເປັນ LLC ຫຼືບໍລິສັດແລະໃຊ້ຊື່ທຸລະກິດທີ່ບໍ່ກົງກັບຊື່ທີ່ລະບຸໄວ້ໃນບົດຄວາມຂອງບໍລິສັດຫຼືບົດຄວາມຂອງອົງການຈັດຕັ້ງທີ່ຍື່ນຕໍ່ລັດຖະມົນຕີຂອງລັດຄາລິຟໍເນຍ.​​ 
    • ທ່ານກໍາລັງດໍາເນີນການເປັນຄູ່ຮ່ວມງານແລະນໍາໃຊ້ຊື່ທຸລະກິດທີ່ບໍ່ມີນາມສະກຸນຂອງຄູ່ຮ່ວມງານແຕ່ລະຄົນ.​​ 
  • ເຂົ້າໄປເບິ່ງເວັບໄຊທ໌ສຳລັບຄາວຕີ້ຂອງເຈົ້າສຳລັບຂໍ້ມູນເພີ່ມເຕີມ ແລະຄຳແນະນຳກ່ຽວກັບການໄດ້ຮັບ FBNS.​​