​​​Care Coordination Agencies Provider Enrollment

Assisted Living Waiver Program 

Care Coordination Agencies (CCA) 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 Facilities for the Elderly (RCFE), 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.

CCA Basic Requirements

Enrolling agencies:

  • Must have completed 8-10 transitions over the previous 12 month period.
  • Must employ a Social Worker with either a master’s degree in social work, psychology, counseling, rehabilitation, gerontology, or sociology plus one year of related work experience.
  • Must employ a Registered Nurse (RN) to administer the Assessment Tool developed by the ALW program. The RN must have and maintain a current, unsuspended, unrevoked license to practice as an RN in the State of California. Work experience requirements include:
    • A minimum of 1,000 hours of experience in an acute care setting providing nursing care to patients with similar care needs.
    • A minimum of 2,000 hours experience in a home setting provider nursing care to patients with similar needs.
  • Are required to have mandatory in-service training programs for their staff. 
  • Are required to have a process for soliciting and/or obtaining feedback from clients regarding their satisfaction with service.
  • Must have a quality assurance program to track clients’ complaints and incidents reports.
  • Must maintain a service record/case file for each client containing all required program forms, completed assessments, signed care plans, and progress notes. Agencies must make these records available to DHCS for audit upon request.
  • Must demonstrate existing relationship with 4-6 Skilled Nursing Facilities and 4-6 Assisted Living Facilities, one of which must be an Adult Residential Care Facility (ARF).

CCA provide the following services:

  • Enrolling clients
  • Conducting assessments and reassessments using the ALW Assessment Tool
  • Determining each client’s level of care
  • Developing ISP
  • Arranging for services as determined necessary by the individual assessment
  • Monthly visits to participants

Refer to the HCBS Waiver for the complete ALW requirements.

CCA Provider Enrollment Steps:        

1.  In order to participate in the ALW program, the following application packet is required:
For a Change of Ownership or Change of Location contact: ProFacWAIVER@dhcs.ca.gov  
 

2.  Enrolling providers are required to have a National Provider Identifier (NPI). For more information and to apply for your NPI number, visit the NPPES NPI Registry website. 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.

3.  Upon review and approval of the ALW application, an onsite visit will be completed to verify the applicant's qualifications. Agencies will receive notification of their enrollment status.

Application Submission

Send application packet to: 

Provider and Facility Site Review Unit
Integrated Systems of Care Division
Department of Health Care Services
1501 Capitol Avenue, MS 4502
P.O. Box 997437
Sacramento, CA 95899-7437
 
Important note: Do not send application to the Provider Enrollment Division

Resources 

Last modified date: 7/7/2020 1:31 PM