護理協調機構提供者註冊
輔助生活豁免計劃
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 基本要求
報名機構：
- 必須成立並運營至少 12 個月。
- 必須在過去 12 個月內完成 8-10 次過渡。
- 必須僱用具有社會工作，心理學，諮詢，康復，老年學或社會學碩士學位的社會工作者，以及一年相關工作經驗。
- 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:
- 在急性護理環境中，為具有類似護理需求的患者提供護理服務的至少 1,000 小時經驗。
- 至少 2,000 小時在家庭環境中為具有類似需求的患者提供護理服務的經驗。
- 必須為其員工提供強制性的在職培訓計劃。
- 需要有一個程序來徵求客戶和/或獲得客戶對服務滿意度的反饋。
- 必須有質量保證計劃來跟踪客戶的投訴和事件報告。
- 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.
- 必須證明與 4-6 個熟練護理設施和 4-6 個輔助生活設施的現有關係，其中一個必須是成人住宿照顧設施（ARF）。
家庭健康局申請人不符合資格在 Medi-Cal ALW 計劃下註冊成為 CCA 提供者。 Medi-Cal ALW 計劃下的 CCA 提供者不符合資格提供家庭健康局直接服務（公共資助住房 HHA 除外），因為這將被視為利益衝突。 作為 CCA 提供商案例管理 ALW 參與者，請參閱以下內容：
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:
- 註冊用戶端
- Conducting assessments and reassessments using the ALW Assessment Tool
- 確定每個客戶的照顧程度
- Developing ISP
- 根據個人評估確定有必要的安排服務
- 每月參觀參加者
請參閱 衞生防護中心豁免 滿足完整的 ALW 要求。
CCA 提供者註冊步驟：
衛生護理服務部（DHCS）已收到了大量申請來自有興趣成為認可的 ALW 計劃提供商作為護理協調機構（CCA）的提供者。 DHCS 處理申請時間比正常更長，並根據地理覆蓋範圍和受益人護理協調需求，將申請優先順序排列。
DHCS 對此發展可能造成的任何不便感到抱歉，並期待將來與您的組織合作。
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:
- CCA 名稱
- CCA 的位置（城市和縣）
- CCA 打算服務的覆蓋區域（城市和縣）
- 聯絡人
一旦查詢進行審查並確定特定地理區域需要 CCA，DHCS 團隊將通知您提交申請包。
為了參加 ALW 計劃，需要以下應用程序包：
- The Initial Program Application – This portion of the application must be emailed directly to the Provider and Facility Site Review Unit (PFSRU). There is no need to mail this in. Applications and questions regarding this portion can be sent to ProFacWAIVER@dhcs.ca.gov.
- 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.
將您完整的 Medi-Cal 註冊申請套件郵寄到下面列出的地址。 忽略 Medi-Cal 表格上所指示的地址。 重要注意事項：請勿將申請發送給提供者註冊部門。
郵寄至:
Department of Health Care Services
綜合護理系統科
提供者註冊單位
國會大道 1501 號，密西西比州大廈 4502
郵政編碼 箱子 997437
加利福尼亞州薩克拉門托 99-7437
For a Change of Ownership or Change of Location, contact: ProFacWAIVER@dhcs.ca.gov.
For Revalidations, contact: WaiveProEnroll@dhcs.ca.gov.
提交申請
準備郵寄申請包時，請按以下方式發送所有紙質文件：
- 請勿使用夾具。
- 請勿使用夾具、分隔器或檔案整理器。
- 請勿使用貼紙、便條或標籤。
- 請勿使用大於 Letter 尺寸（8.5 x 11 英寸）的紙張。
- 請勿使用校正膠帶、白光筆或類似類型的螢光筆或墨水。 如果您必須進行更正，請用墨水排列，日期和首字母。
- 可以使用夾子，粘合夾和橡皮帶。
- 確保所有 Medi-Cal 表單頁面都按正確的順序。