​​​​​​​​​​​​​​​​​Residential Care Facilities for the Elderly and Adult Residential Care Facilities Provider Enrollment

Assisted Living Waiver Program 

 Basic Requirements

• All facilities enrolling in the ALW program must meet licensure and certification requirements set forth by the Department  of Social Services, Community Care Licensing (CCL). Participating facilities must be in substantial compliance and good  standing with licensing regulations (Ref: Title 22, § 87101(s)(9)). Facilities on probation with and/or have pending accusation against the licensee are not in substantial compliance for the purpose of the ALW (Ref. H&S § 1569.33).
• Participating ALW facilities are not regarded as healthcare facilities, but social-based facilities. Although the RCFE/ARF is a licensed facility, ALW residents are considered as living in their own home, not in a healthcare setting.
• ALW facilities are required to have licensed nursing staff, either on call or employed, in order to provide skilled nursing services as needed to waiver participants. 
• Facilities shall employ staff as necessary to ensure provision of care and supervision to meet client health and safety needs. 
• Facilities are required to provide private or semi-private bathrooms, a dining room, or common activities room that may also serve as a dining room.
• Facilities must be able to offer private or shared bedrooms. 
• Facilities housing more than six participants are required to have an Individual Response System (IRS) enabling individuals to summon for assistance at any time.

RCFE/ARF provide the following services:

• Provision and oversight of personal and supportive services
• Assist with self-administration of medication
• Provide three meals per day plus snacks
• Housekeeping and laundry
• Transportation or arrangement of transportation
• Activities
• Skilled nursing services as needed

Refer to the HCBS Waiver for the complete ALW requirements.​

RCFE/ARF Provider Enrollment Steps

1. Submission of Initial Application – This portion of the application must be emailed. There is no need to mail this in. Email your applications, comments, and questions to the Provider and Facility Site Review Unit (PFSRU): ProFacWAIVER@dhcs.ca.gov.
   
   
   • RCFE/ARF Provider Initial Application
   • Assisted Living Waiver Program Provider Agreement
   • Residential Provider Verification (42 CFR § 441.301(c)(4))
     
     
2. Submission of 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.​
   
   
   • Medi-Cal Enrollment Packet​
     

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   Mail your complete Medi-Cal 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​

   
   
3. Upon review and approval of the ALW application (steps 1 and 2), an “on or offsite" visit will be completed to verify the applicant's qualifications. Facilities will receive final notification of their enrollment status.
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For a Change of Ownership or Change of Location, contact: ProFacWAIVER@dhcs.ca.gov. To process this type of request, our office requires a complete application package as mentioned above. On page 7 of the DHCS 6204 form, ensure to mark the correct box for “Change of ownership" or “Change of business address".

For Revalidations, contact: WaiveProEnroll@dhcs.ca.gov. To process this type of request, our office requires the Medi-Cal enrollment packet only. On page 7 of the DHCS 6204, ensure to mark the box for “Continued enrollment".​

Application Submission

• 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

• Provider Resources, Forms, and Memorandums
• Care Coordination Agency Enrollment
• Home-Health Agency Enrollment
• ALW Provider Enrollment
• Medi-Cal Member Enrollment Information
• Assisted Living Waiver Home Page