As we approach the end of the year, the department is actively working to confirm and post the 2025 Home and Community-Based Services (HCBS) Reimbursement Rates for specific provider types and procedure codes. This increase is due to the enactment of Senate Bill 3 which established a minimum pay rate increases over a 5-year period for certain provider types and procedure codes. In turn, DHCS is providing a list of the maximum payable rates that are applicable to HCBS programs.
T1019
| HHA (14)
| $5.16
| 15 Minutes
| HCBA Waiver, ALW, CCT
|
T1019
| Personal Care Agency (66)
| $5.16
| 15 Minutes
| HCBA Waiver, ALW
|
T1019
| HCBS Benefit Provider
| $5.16
| 15 Minutes
| HCBA Waiver
|
T1019
| Employment Agency (64)
| $5.16
| 15 Minutes
| HCBA Waiver, ALW
|
T1019
| Professional Corporation (95)
| $5.16
| 15 Minutes
| HCBA Waiver, ALW, CCT
|
T1005
| Personal Care Agency (66)
| $5.16
| 15 Minutes
| HCBA Waiver, ALW
|
T1005
| Personal Care Agency (66)
| $5.16
| 15 Minutes
| HCBA Waiver
|
T1005
| Employment Agency (64)
| $5.16
| 15 Minutes
| HCBA Waiver
|
In order to be reimbursed at the new rate, agencies will need to submit claims using the higher rates listed above for all services provided effective January 1, 2025. This will allow your agency to be reimbursed the new rates once they are implemented, as opposed to needing to resubmit claims. DHCS will automatically issue an Erroneous Payment Correction (EPC) once the system is updated to reprocess any claims submitted for Dates of Service January 1, 2025, to the date of system implementation.
Please email the ALW vanity inbox with any additional questions.
Overview
The Home and Community-Based Alternatives (HCBA) Waiver is approved by the Centers for Medicare & Medicaid Services (CMS) in five year increments and was most recently approved on February 2, 2023 for the 2023-2027 waiver period. Home and Community-Based Services (HCBS) Waiver programs, including the HCBA Waiver, are authorized under Section 1915(c) of the Social Security Act; governed by Title 42, Code of Federal Regulations (CFR); and administered by CMS.
The HCBA Waiver provides care management services to persons at risk of nursing home or institutional placement. The care management services are provided by a multidisciplinary Care Management Team (CMT) comprised of a nurse and social worker. The CMT coordinates Waiver and State Plan services (such as medical, behavioral health, In-Home Supportive Services, etc.), and arranges for other long-term services and supports available in the local community. Care management and Waiver services are provided in the participant's community-based residence. This residence can be privately owned, secured through a tenant lease arrangement, or the residence of a participant's family member.
Enrollment
Current enrollment and waitlist information for the HCBA Waiver can be found on the enrollment dashboard, which is updated monthly.
New applicants to the HCBA Waiver should be aware that the program has reached maximum capacity and a waiting list has been implemented effective July 12, 2023.
New applicants are encouraged to apply and secure a placement on the waiting list with the assigned Waiver Agency in their area of residence. When a slot becomes available, applicants on the waiting list who meet Reserve Capacity criteria will be prioritized for intake processing. Reserve Capacity criteria includes applicants transitioning from similar Home and Community Based Services (HCBS) Waivers because their needs can no longer be met, applicants under 21 years of age, or applicants who have been residing in a health care facility for at least 60 days at the time the HCBA Waiver application is submitted.
Complete applications submitted to DHCS for enrollment review prior to July 12, 2023 will continue to be processed with priority given to Reserve Capacity eligible applicants. DHCS is currently taking steps necessary to request an increase in waiver capacity as soon as possible. If you have questions about the status of your application, please contact your assigned Waiver Agency.
HCBA Waiver Renewal
HCBA Waiver Approval Letter
2023-2027 HCBA Waiver
Approved Amendments
- Waiver Personal Care Service (WPCS) Providers Sick Leave Amendment (Effective July 1, 2024), this amendment increases the number of paid sick leave hours available for WPCS providers.
- Corrective Slot Increase Amendment (Effective January 1, 2024), this corrective amendment removes Waiver Personal Care Services (WPCS) as an approved telehealth service. This amendment also removes a duplicative performance measure.
- Waiver Slot Increase (Effective January 1, 2024), this amendment increases the number of participants served for waiver years 2-5.
- Corrective Telehealth Amendment (Effective November 12, 2023), this corrective amendment removes Waiver Personal Care Services (WPCS) as an approved telehealth service.
- Telehealth Amendment (Effective November 12, 2023), this amendment adds telehealth as a permanent service delivery option for the following waiver services: Case Management; Community Transition Service; Comprehensive Care Management; Family/Caregiver Training; and Transitional Case Management.
Expired Amendments
Home and Community-Based Alternatives Waiver Expired Amendments
Approved Emergency Amendments
- DHCS obtained approval for flexibilities accepted under the federal 1135 waiver authority which will expire January 7, 2026, for Los Angeles and Ventura Counties. The following flexibilities are available immediately.
- Permit evacuating facilities (such as ICF-DDs, SNFs) to be fully reimbursed for services rendered to affected beneficiaries in alternative physical settings, such as temporary shelters or other care facilities.
- Permit some services to continue to be provided without a requirement for a new or renewed prior authorization.
- Temporarily allow services to be provided in settings that have not been determined to meet the HCBS Settings Rule criteria.
- Temporarily extend the timeframe to reinstate services and benefits to an individual who files a fair hearing request.
HCBA Waiver Agencies
Most service areas are identified by county and include all of the zip codes within the county. However, individuals residing in Los Angeles and Orange Counties should refer to the links below to identify the Waiver Agency that covers their zip code.
Recent Change in Waiver Agency County Assignments:
Several
counties have new Waiver Agency Assignments as of mid-2024. Alpine, Inyo,
Marin, Mono, Napa, Inyo, San Francisco and San Mateo have new Wavier Agency
Assignments. Additionally starting 2025
Imperial County will also have a new assignment. Please see the chart below for
current assignments.
All impacted Waiver Agencies have been working closely together in coordination with ISCD to assure these transfers do not affect the quality of care of current beneficiaries and applicants. Furthermore, any new applications received from San Francisco and San Mateo counties shall be submitted to the newly assigned Waiver Agency.
Access TLC | Santa Barbara County, and sections of Los Angeles and Orange Counties
(service area defined by zip codes)
|
Centers for Elders’ Independence | Alameda and Contra Costa Counties |
Home Health Care Management
| Butte, Colusa, Del Norte, El Dorado, Glenn, Humboldt,
Lake, Lassen, Marin, Mendocino, Modoc, Napa, Nevada, Placer, Plumas, Sacramento, San Francisco, San Joaquin, Shasta, Sierra,
Siskiyou, Solano, Sutter, Tehama, Trinity, Yolo, and Yuba Counties
|
Institute on Aging | Riverside and San Bernardino Counties
|
Libertana Home Health
| Alpine, Amador, Calaveras, Fresno, Inyo, Kern, Kings, Madera, Mariposa, Merced, Mono, Monterey, San Benito, San Luis Obispo, San Mateo, Santa Clara, Santa Cruz, Stanislaus, Tulare, Tuolumne and sections of Los Angeles and Orange Counties
(service area defined by zip codes) |
Partners in Care | Sections of Los Angeles County
(service area defined by zip codes) |
San Ysidro Health | Imperial, San Diego Counties
|
Sonoma County Human Services Department
| Sonoma County |
Ventura County Agency on Aging
| Ventura County |
Participant Enrollment Information
How to submit an application for the HCBA Waiver:
- Refer to the table above to see which Waiver Agency serves your county/zip code. Click on the Waiver Agency name to be directed to their webpage
- Contact the Waiver Agency to request an application
- Complete the application and submit it to the Waiver Agency
Other Participant Enrollment Information and Documents
Spanish translation of HCBA Waiver Participant Application/Solicitud del Programa de Exención de Alternativas Basadas en el Hogar y la Comunidad (HCBA)
HCBA Grievances
If you are dissatisfied with your HCBA Care Management Team, or the HCBA services you receive, you may submit a grievance in the following ways:
- Grievances regarding the quality or receipt of HCBA services must be submitted to your Waiver Agency via email, mail, or telephone. Your Waiver Agency's contact information can be found linked in the “HCBA Waiver Agencies" section above.
- Grievances regarding the coordination of care by your Waiver Agency must be submitted to DHCS via email at: ISCDCompliance@dhcs.ca.gov.
- Grievances regarding your Congregate Living Health Facility must be submitted to DHCS via email at: ISCDCompliance@dhcs.ca.gov.
For more information about HCBA grievances, please review the HCBA Grievance Fact Sheet, here.
For more information about HCBS grievances and Hearings, please reference the website Home-and-Community-Based-Services-(HCBS)–Grievance-and-Hearings.
Additional Resources
DHCS is experiencing longer than normal processing times for WPCS requests and phone calls due to a high volume of requests. Please allow additional time for processing and continue to work with the HCBA Waiver Agency assigned to your service area.
Waiver Personal Care Services Resources
Contact Us
Waiver participants and providers, please email your comments and questions regarding the HCBA Waiver to: HCBAlternatives@dhcs.ca.gov or call toll-free (833) 388-4551.
WPCS participants and providers can call the WPCS Hotline (916) 552-9214.
DHCS is experiencing longer than normal processing times for WPCS requests and phone calls due to a high volume of requests. Please allow additional time for processing and continue to work with the HCBA Waiver Agency assigned to your service area.
