提供行为健康治疗服务的 QAS 提供商组织和个人可以申请加入 Medi-Cal 计划。QAS 提供商组织和个人申请人必须通过提供商申请和注册验证 (PAVE) 在线注册门户提交电子申请以及所有支持文件，申请加入 Medi-Cal 计划。​​ 

根据福利和机构法典 (W&I) 第 14043.75(b) 节授予卫生保健服务部 (DHCS) 主任的权力，DHCS 主任正在为申请加入 Medi-Cal 计划的 QAS 提供商组织和个人制定具体的申请和加入要求，以便报销他们向 Medi-Cal 成员提供的承保行为健康治疗服务。这些要求实施并具体化了 W&I 法规第 14043.15 和 14043.26 条，并因此具有法律的全部效力。欲了解更多信息，请参阅监管机构公告“针对提供行为健康治疗服务的合格自闭症服务提供者组织和个人的 Medi-Cal 注册要求和程序”。此外，本公告不会取代或取消《W&I 法典》第 14043.26 节中规定的所有其他注册要求。
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Medi-Cal 计划要求​​  

Behavioral health treatment services consist of Applied Behavioral Analysis and other evidence-based behavioral intervention services. These services include Behavioral-Analytic Assessment and development of behavioral treatment plans. In addition, behavioral health treatment intervention services are identified in the Behavioral Health Treatment Services Chart in the State Plan. Behavioral health treatment services must be provided by a QAS provider, QAS professionals, or QAS paraprofessionals as defined in the State Plan.​​  

A QAS provider organization or individual is defined as the applicant that submits the Medi-Cal application for enrollment to provide behavioral health treatment services. Note, QAS providers who currently have an enrollment pathway, including physician and surgeons, psychologists, physical therapists, occupational therapists, licensed marriage and family therapists, licensed clinical social workers, licensed professional clinical counselors, speech-language pathologists, and audiologists, do not need to enroll as a QAS provider to provide and bill for behavioral health treatment services. Individual Board Certified Behavior Analysts (BCBAs) and educational psychologists may enroll using the QAS application. The QAS applicant may be an individual or an entity such as a corporation and must meet all of the Medi-Cal enrollment requirements as specified in the Medi-Cal Enrollment Requirements and Procedures section of the aforementioned provider bulletin. Additionally, the enrolling QAS individual or organization must attest that all individuals providing services are reported to the DHCS and that all individuals meet the qualifications and follow supervision requirements listed in accordance with the State Plan for behavioral health treatment services. Please refer to the Attestation Requirement section of the aforementioned provider bulletin for more information.​​ 

所需文件​​  

收集下面列出的所需文件（如适用），以便在完成 PAVE 申请时将它们上传到 PAVE。请确保上传的文件清晰易读。​​ 

• 联邦雇主识别号 (FEIN) 或个人纳税人识别号 (ITIN) 验证（如果未使用社会安全号码），请提交当前美国国税局 (IRS) 生成的文件。唯一可接受的文件包括 IRS 生成的信函 147-C、IRS 生成的表格 941（雇主季度联邦纳税申报表）、IRS 生成的表格 8109-C（存款券）或 IRS 生成的表格 SS-4（仅限 FEIN/ITIN 分配的官方确认通知）。注意：申请表上的申请人或提供者的法定名称必须与 IRS 生成的文件上的名称完全一致；并且申请人/提供者必须是 IRS 文件中列出的实体的所有者或官员。如需更多信息，请访问 IRS 或致电 (800) 829-4933。​​ 
• 提供商或签署申请且有权对申请人或提供商具有法律约束力的人员的驾驶执照或州政府颁发的身份证（在美国 50 个州或哥伦比亚特区内颁发）。 签名必须是提供商的签名，除非提供商是公司。 如果提供商是公司，并且申请将由提供商以外的人员签署，请提交公司章程中指明签署人对公司具有法律约束力的权力的部分的副本。​​ 
• Local Business License, Tax Certificate, and Permit for any city and/or county where business activities are conducted. Note: The name and business address of the applicant or provider on the application must exactly match the business name and business address on all local licenses and permits. If a business license/permit is not required, please submit a written statement from your local city/county indicating that your business does not require any license or permit. For further information, please contact your city business license office and/or visit the California State Association of Counties and click on the “California’s Counties” link, and select “County Web Sites.”​​ 
• Recorded/stamped Fictitious Business Name Statement (FBNS), issued by the county where the principal place of business is located, if using a fictitious business name AND the business name is different from the legal name on your application. For example, in the case of a corporation, any name other than the corporation name on record with the Secretary of State requires a FBNS. Note: The business name and business address of the applicant or provider on the application, all local business licenses/permits, and the FBNS must exactly match. To determine the applicable county agency where fictitious business names are filed, please visit the California State Association of Counties and  click on the “California’s Counties” link, and select “County Web Sites.”​​ 
• If your business is a corporation, processing delays may be avoided by attaching a copy of the filed Articles of Incorporation from the California Secretary of State (or a Statement of Domestic Stock Corporation if your corporation is based outside of California), and a list of directors’ and officers’ names and titles, with percent of ownership and control interest for each. To verify or change the name and/or status of your corporation or for further information, please visit the Secretary of State California Business Portal and click on the “California Business Search” link or other appropriate link.​​ 
• 商业责任保险证明（商业、一般或综合责任或办公场所保险），每次索赔的金额不少于 100,000 美元，每年最低累计金额为 300,000 美元。 可接受的证明是自保证据，或保险公司出具的保险证明或声明表，其中包含保险公司的名称、被保险人的姓名和营业地址、生效日期和承保限额。 注意：申请表上的申请人或提供商的姓名和营业地址（包括套房号码（如适用））必须与保险证书或申报单上的被保险人的姓名和地址完全一致。​​ 
• 如果您的企业有一名或多名员工，则加州法律要求您的企业提供工伤赔偿保险证明。 可接受的证明是自保证据，或者保险公司出具的保险证明或声明表，其中包含保险公司名称、投保人姓名和生效日期。 如果不需要工伤赔偿保险，则必须提供解释。 注：申请人或提供者的姓名必须与保险凭证上的被保险人姓名完全一致。​​ 
• 如果营业场所不属于申请人或提供商所有，则需签署租赁协议。注意：申请人或提供商的名称和营业地址必须与租赁协议上的承租人的名称和地址完全一致。​​ 
• 承担连带责任协议的继任责任（ DHCS 6217 ）（如适用）。​​ 

资源​​ 

• 使用 PAVE 注册 QAS 提供商组织/个人​​ 
• Medi-Cal Provider Enrollment for QAS Provider Organizations, QAS Individuals, and CBOs Offering Behavioral Health Treatment Services – Frequently Asked Questions​​ 

PAVE 门户​​ 

前往PAVE门户。
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