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​​​​​​​Qualified Autism Service (QAS) Provider Organization and Individual ​Application Information

QAS provider organizations and individuals offering behavioral health treatment services may apply for enrollment in the Medi-Cal program. QAS provider organizations and individual applicants must apply to enroll in the Medi-Cal program by submitting an electronic application through the Provider Application and Validation for Enrollment (PAVE) online enrollment portal, along with all supporting documentation.

Based upon the authority granted to the Director of the Department of Health Care Services (DHCS) in accordance with Welfare & Institutions Code (W&I) Section 14043.75(b), the DHCS Director is establishing the specific application and enrollment requirements for QAS provider organizations and individuals who apply for enrollment in the Medi-Cal program to be reimbursed for the covered behavioral health treatment services they provide to Medi-Cal members. These requirements implement and make specific W&I Code Sections 14043.15 and 14043.26, and as such have the full force and effect of law. For more information, please see the regulatory provider bulletin titled, “Medi-Cal Enrollment Requirements and Procedures for Qualified Autism Service Provider Organizations and Individuals Offering Behavioral Health Treatment Services​.” Also, this bulletin does not substitute for, or eliminate, all other enrollment requirements set forth in W&I Code Section 14043.26.​

Medi-Cal Program Requirements ​

Behavioral health treatment services consist of Applied Behavioral Analysis and other evidence-based behavioral intervention services. These services include Behavioral-Analytic Assessment and development of behavioral treatment plans. In addition, behavioral health treatment intervention services are identified in the Behavioral Health Treatment Services Chart in the State Plan. Behavioral health treatment services must be provided by a QAS provider, QAS professionals, or QAS paraprofessionals as defined in the State Plan​. 

A QAS provider organization or individual is defined as the applicant that submits the Medi-Cal application for enrollment to provide behavioral health treatment services. Note, QAS providers who currently have an enrollment pathway, including physician and surgeons, 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 as a QAS provider to provide and bill for behavioral health treatment services. Individual Board Certified Behavior Analysts (BCBAs) and educational psychologists may enroll using the QAS application. The QAS applicant may be an individual or an entity such as a corporation and must meet all of the Medi-Cal enrollment requirements as specified in the Medi-Cal Enrollment Requirements and Procedures section of the aforementioned provider bulletin. Additionally, the enrolling QAS individual or organization must attest that all individuals providing services are reported to the DHCS and that all individuals meet the qualifications and follow supervision requirements listed in accordance with the State Plan for behavioral health treatment services. Please refer to the Attestation Requirement section of the aforementioned provider bulletin for more information.

Required Documents 

Gather the required documents listed below, as applicable, in order to upload them into PAVE as you complete your PAVE application. Please ensure the uploaded documents are legible.  

  1. Federal Employer Identification Number (FEIN) or Individual Taxpayer Identification Number (ITIN) verification, if a social security number is not used, by submitting a current Internal Revenue Service (IRS) generated document. The only acceptable documents include an IRS-generated Letter 147-C, IRS-generated Form 941 (Employer’s Quarterly Federal Tax Return), IRS-generated Form 8109-C (Deposit Coupon), or IRS-generated Form SS-4 (only the official Confirmation Notification of FEIN/ITIN assignment). Note: The legal name of the applicant or provider on the application must exactly match the name on the IRS-generated document; and the applicant/provider must be an owner or officer of the entity listed on the IRS document. For further information, please visit the IRS call them at (800) 829-4933.
  2. Driver’s License or state-issued identification card (issued within the 50 United States or the District of Columbia) of the provider, or person signing the application who has the authority to legally bind the applicant or provider. The signature must be that of the provider, unless the provider is a corporation. If the provider is a corporation and the application is going to be signed by a person other than the provider, please submit a copy of the section of the corporation’s bylaws that identifies the signing person’s authority to legally bind the corporation.​
  3. Local Business License, Tax Certificate, and Permit for any city and/or county where business activities are conducted. Note: The name and business address of the applicant or provider on the application must exactly match the business name and business address on all local licenses and permits. If a business license/permit is not required, please submit a written statement from your local city/county indicating that your business does not require any license or permit. For further information, please contact your city business license office and/or visit the California State Association of Counties and click on the "California’s Counties" link, and select "County Web Sites."
  4. Recorded/stamped Fictitious Business Name Statement (FBNS), issued by the county where the principal place of business is located, if using a fictitious business name AND the business name is different from the legal name on your application. For example, in the case of a corporation, any name other than the corporation name on record with the Secretary of State requires a FBNS. Note: The business name and business address of the applicant or provider on the application, all local business licenses/permits, and the FBNS must exactly match. To determine the applicable county agency where fictitious business names are filed, please visit the California State Association of Counties and  click on the "California’s Counties" link, and select "County Web Sites."
  5. ​​If your business is a corporation, processing delays may be avoided by attaching a copy of the filed Articles of Incorporation from the California Secretary of State (or a Statement of Domestic Stock Corporation if your corporation is based outside of California), and a list of directors’ and officers’ names and titles, with percent of ownership and control interest for each. To verify or change the name and/or status of your corporation or for further information, please visit the Secretary of State California Business Portal​ ​and click on the "California Business Search" link or other appropriate link.​
  6. Certificate of Commercial Liability Insurance (business, general, or comprehensive liability, or office premises insurance) in an amount of not less than $100,000 per claim and a minimum annual aggregate of $300,000. Acceptable verification is either evidence of being self-insured, or a certificate of insurance or declaration sheet issued by the insurance company that contains the name of the insurance company, the name and business address of the insured, effective dates, and limits of coverage. Note: The name and business address, including suite number if applicable, of the applicant or provider on the application must exactly match the insured’s name and address on the certificate of insurance or declaration sheet.
  7. Certificate of Workers’ Compensation Insurance is required by California law, if your business has one or more employees. Acceptable verification is either evidence of being self-insured, or a certificate of insurance or declaration sheet issued by the insurance company that contains the name of the insurance company, the name of the insured, and effective dates. If no Workers’ Compensation insurance is required, an explanation must be provided. Note: The name of the applicant or provider must exactly match the insured’s name on the certificate of insurance.
  8. Signed Lease Agreement, if business premises are not owned by the applicant or provider. Note: The name and business address of the applicant or provider must exactly match the lessee’s name and address on the lease agreement.
  9. Successor Liability with Joint and Several Liability Agreement (DHCS 6217​), if applicable.

Resource

PAVE Portal

Proceed to the PAVE​ portal.

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Last modified date: 5/20/2025 8:51 AM