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​​​​​​​​​​​​​​​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 be established and in operation for at least 12 months.
  • 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).

Home Health Agency applicants are not eligible to enroll to become a CCA provider under the Medi-Cal ALW program. CCA providers under the Medi-Cal ALW program are not eligible to provide direct Home Health Agency services (with the exception of the Public Subsidized Housing HHA) as it would be deemed a conflict of interest. As a CCA provider case managing ALW participants, please see below:

CMS Guidance: “Case management activities must be independent of service provision. An entity agency or organization (or their employees) cannot provide both direct service and case management activities to the same individual except in very unique circumstances set forth in regulation. Conflict occurs not just if they are a provider but if the entity has an interest in a provider or if they are employed by a provider." ​


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: 

The Department of Health Care Services (DHCS) has received a large volume of applications from providers interested in becoming an approved ALW program provider as a Care Coordination Agency (CCA). DHCS is experiencing a longer than normal timeline in processing applications, and is prioritizing applications based on geographic coverage and beneficiary care coordination needs. 
 
DHCS apologizes for any inconvenience this development may cause and look forward to working with your organization in the future.  

If you are interested in becoming an approved ALW CCA, please submit an email with your interest to WaiveProEnroll@dhcs.ca.gov prior to submitting your application for review. The email shall include but not limited to the following information: 

  1. Name of CCA 
  2. Location of CCA (city and county) 
  3. Coverage area CCA is intending to serve (cities and counties) 
  4. Contact Person 
Once the inquiry is reviewed and it is identified that there is a need for a CCA in a particular geographic area, the DHCS team will inform you to submit an application packet. ​

In order to participate in the ALW program, the following application packages are required:


  • The Medi-Cal Enrollment Packet – This portion of the application must be mailed in as our office needs original wet signatures. Questions regarding this portion of the application can be sent to the Provider Enrollment Unit (PEU): WaiveProEnroll@dhcs.ca.gov.

Mail your complete Medi-Cal Enrollment application package to the address listed below. Disregard the address indicated on the Medi-Cal forms. IMPORTANT NOTE: Do not send applications to the Provider Enrollment Division.

Mail to:
Department of Health Care Services
Integrated Systems of Care Division
Provider Enrollment Unit
1501 Capitol Avenue, MS 4502
P.O. Box 997437
Sacramento, CA 95899-7437

For a Change of Ownership or Change of Location, contact: ProFacWAIVER@dhcs.ca.gov.

For Revalidations, contact: WaiveProEnroll@dhcs.ca.gov.

Application Submission

When preparing to mail out your application package, send all paper documents in the following manner:

  • DO NOT USE staples.
  • DO NOT USE binders, dividers, or file organizers.
  • DO NOT USE sticky tabs, sticky notes, or labels.
  • DO NOT USE paper that is any size larger than Letter size (8.5 x 11 inches).
  • DO NOT USE correction tape, white out, or highlighter pen or ink of a similar type. If you must make corrections, please line through, date, and initial in ink.
  • OKAY TO USE paper clips, binder clips, and rubber bands.
  • Ensure that all Medi-Cal form pages are in the correct order.

Resources 

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Last modified date: 6/27/2024 1:19 PM