Residential Care Facilities (RCF) and Adult Residential Care Facilities (ARF) 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 RCF\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 semi-private 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.

Services that RCF/ARF providers are responsible for supplying include:

• 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

RCF/ARF Enrollment Steps

1. To be considered for enrollment as an RCF\ARF ALW provider, the following preliminary application package is required:

• RCF/ARF Provider Initial Application

• Assisted Living Waiver Program Provider Agreement

• Residential Provider Verification (42 CFR § 441.301(c)(4))

2. Enrolling providers are required to have a National Provider Identifier (NPI).  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.  For more information and to apply for your NPI number, visit the NPI Overview webpage.
3. Upon review and approval of the initial ALW application, a site visit will be completed to verify applicants' qualifications.  Facilities will
   receive notification of their enrollment status.  Medi-Cal applications received prior to program approval will not be considered.
4. Facilities that have met all program requirements will then be instructed to enroll as a Medi-Cal provider.  The complete Medi-Cal
   provider enrollment package consists of the following:
• Provider Agreement (DHCS 6208) 
• Provider Application (DHCS 6204)
• Medi-Cal Disclosure Statement (DHCS 6207)
• A non-refundable application fee of $586.00 in the form of a cashier's check, made payable to the California Department of
  Health Care Services is required and must accompany the Medi-Cal application.

Application Submission

Send all application packets 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 applications to the Provider Enrollment Division

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