Medi-Cal 合格自閉症服務（QAS）提供者註冊清單
This enrollment checklist is only for Board Certified Behavioral Analysts and Educational Psychologists to assist them with Medi-Cal enrollment as a QAS provider. Please note that QAS professionals and QAS paraprofessionals (technicians) do not need to apply for Medi-Cal enrollment.
Prior to enrolling as a QAS provider (individual or organization) in the Medi-Cal provider enrollment system, please have the documents, certificates and licenses in the checklist below available. The checklist includes local or state business requirements in addition to qualifications established by the Department of Health Care Services (DHCS) to enroll as a QAS provider. Please see the Behavioral Health TreatmentFrequently Asked Questions for Providers, Question No. 3, for information about attesting to the qualifications of rendering QAS providers, QAS professionals, and QAS paraprofessionals as part of the application, starting in mid-November, 2025.
The checklist will help you determine what documents you will need to upload as part of your Medi-Cal provider application, depending on how you are enrolling and in which counties you will provide services to Medi-Cal members.
QAS providers who currently have an enrollment pathway, including physicians, 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 again as a QAS provider to bill for BHT services. These providers will not need to report BCBAs, QAS professionals, or QAS paraprofessionals.
Note: Medi-Cal currently requires that QAS providers have an established place of business (EPOB), in compliance with section 51000.60 of Title 22 of the Code of Federal Regulations. DHCS intends to publish a regulatory bulletin later in 2025 to waive this requirement for individual BCBAs who work out of their home and do have an EPOB where they see clients. Individual BCBAs who are contracted with a Medi-Cal managed care plan and do not have an EPOB do not currently need to enroll. DHCS is working to publish a new regulatory bulletin to waive the EPOB requirement for individual BCBAs. Once published, individual BCBAs would then need to enroll.
Section A – Mandatory Documentation
This section includes all documents that you are required to submit as part of your Medi-Cal provider enrollment application as a QAS provider in Medi-Cal.
- 代表實體簽署申請的個人所有擁有 5% 或以上的人士的當前駕照或州發出的身份證明副本。
- Document identifying how you operate your business, which includes asole-proprietorship, corporation, Limited Liability Company (LLC) or partnership (See definitions in Appendix A: Definitions)
- 國家提供者識別號碼 (NPI)
- To apply and receive an NPI online, visit the National Plan & Provider Enumeration System website.
- 如果您已經成立有限責任公司或公司，即使您是唯一所有者，您也必須為有限責任公司或公司獲得並使用類型 2 NPI。
Section B – Potential Additional Documentation
This section includes all documentation that may be required based upon additional city, county and/or state requirements to operate a business in California. Note that all of these additional documents may not apply to your application, so review each item carefully to determine if you need to submit additional documentation.
- 工人賠償保險（來源：州法）
- 某些企業需要工人賠償保險。如果加州州法規要求您的企業擁有工人賠償保險，則您必須在申請中附加保險證明。
- If you are not otherwise required to have Workers’ Compensation insurance, you do not have to obtain insurance to enroll as a Medi-Cal provider.
- For more information on Workers’ Compensation Insurance, visit the Workers’ Compensation Insurance website.
- 營業執照/許可證（來源：城市/縣規例）
- 大多數城市都要求所有企業獲得營業執照。即使業務由一個人經營，也是如此。
- 在某些城市，營業執照可能被稱為營業稅證明或商業登記證明。
- 如果您尚未擁有營業執照，請在提交申請之前查看您城市的網站並獲得營業執照。
- 如果您的城市不需要營業執照，則可以在申請中註明這一點，但請注意，大多數城市對所有業務類型都需要這些。
- 如果您不住在註冊城市的限制內，您的縣可能需要營業執照。查看您所在縣的網站以驗證要求。
Note: The name and address on the business license must match the name and service address reported on the application.
- 虛構企業名稱聲明（FBNS）（資料來源：州法律）
- 獲得 FBNS 的要求在州法律中。但是，獲得 FBNS 的過程是通過縣。如果一個人居住在城市內，並且同時需要營業執照和 FBNS，他們需要從城市獲得營業執照，並從縣取得 FBNS。
- 您必須在以下情況下獲得 FBNS：
- 您是以獨資業主的身份運作，並為您的企業使用一個不包含您的姓氏的名稱。
- 您的身份有限責任公司或公司運作，並使用與向加州國務司長提交的公司章程或組織章程中所述的名稱不完全匹配的公司名稱。
- 您是以合作夥伴身份運作，並使用不包含每個合作夥伴的姓氏的公司名稱。
- 如需獲取 FBNS 的更多信息和說明，請訪問您所在縣的網站。