GENERAL SERVICE PROVIDER INFORMATION
Service Provider Application- What is it?
All service providers who are interested in becoming approved as prospective providers of services through California Regional Centers must complete an application and approval process (also known as vendorization). An approval of a service provider application by a Regional Center certifies that the individual or program meets the minimum standards to provide services to developmentally disabled individuals of any Regional Center in California. Minimum service provider standards are set by the State Department of Developmental Services and described in Title 17 regulations for residential and non-residential services.
Each Regional Center is responsible for a defined geographic area. Regional Centers may approve only those service provider applicants whose business addresses are within that Regional Center's assigned service area. However, once a prospective service provider has completed the application and approval process, their services can be utilized by any Regional Center (referred to as a Courtesy Vendorization).
Prospective service providers whose business address is within the San Andreas Regional Center service area (Santa Clara, San Benito and Monterey Counties), are advised to contact the Resource Department of San Andreas Regional Center before developing services to discuss the need for the proposed service and any local issues and concerns. The Resource Department may have additional information that can assist a prospective applicant.
Once the need for a service has been defined, the prospective service provider will be sent a service provider application packet. This packet will include a variety of forms, all of which must be completed. Depending on what type of service the provider is offering, there may be licensing, certification and program design requirements which must be met before an application is accepted. The requirements for each service category are specified in Title 17, California Code of Regulations, Section 54302.
Once the application packet is submitted with all required licenses or certifications, it will be reviewed for completeness. If the information provided is complete, San Andreas then has 45 days from receipt of the completed application to determine whether the applicant meets the requirements of Title 17, and whether the applicant possesses the skills necessary to provide quality services required by San Andreas. If approved, the Regional Center issues a Service Provider Approval Letter that contains the provider's assigned identification number, approved service code, agreed rate of reimbursement and effective date. If the application is denied, the applicant will receive a letter stating the reasons for the denial and will be informed of the appeal rights, in accordance with Title 17 Regulations.
Completing the service provider application process, does NOT guarantee nor imply that the service provider will receive client referrals. Approval of a service provider application simply means that the service provider is eligible to provide the selected service for individuals served by the Regional Center at the approved/designated rate of reimbursement.
Service provider approval is also not a blanket process applied to all of the services provided by an applicant. Each service must be approved separately. For example, if a service provider offers residential services as well as out of home respite services, each of these services must undergo the application process and obtain approval, separately.
The service provider's rate of reimbursement is determined according to the service category, as specified in Title 17 Regulations. There are several types of rate methodology structures. They include:
- Schedule of Maximum Allowable Rates (SMA) - in which the SMA rate, as established by the Department of Health Services for services reimbursable under the Medi-Cal program, is applied;
- Negotiated Rate - in which the rate is mutually agreed upon by the Regional Center and the service provider for a specific service and time frame, according to the rates for comparable services in the region;
- Cost Statement in which the rate is established by the Department of Developmental Services and is determined by a formula based upon the service provider's program, allowable cost, client attendance and income.
San Andreas Regional Center contracts with service providers. Service providers are not employees of the Regional Center or the Department of Developmental Services. Service providers are responsible for complying with all State and Federal employment and tax laws. Vendorization is non-transferable. Title 17 California Code of Regulations prohibits service providers from transferring vendorization of their service to another person or entity. The service provider must notify the vendoring Regional Center at least 30 days prior to any change in ownership, location or in the required license, certificate, registration, credential or permit.
- When a change of ownership occurs, the new owner must meet the requirements for vendorization, including all licensing/registration/certification requirements for the service being provided. Service providers must notify the vendoring Regional Center and all user Centers in writing at least 60 days before discontinuing service or making modifications to the program design or service curriculum.
In addition to the requirements specified above, all service providers are required to do the following:
- Provide access to Regional Center and/or Department staff, on an announced or unannounced basis, for the purpose of monitoring services and supports purchased by the Regional Center.
- Regional Center staff shall have access to the provider's grounds, buildings and service program, and to all related records, including books, computerized data, accounting records and related documentation.
- Maintain records of services provided to the individuals served by the Regional Center in sufficient detail to verify delivery of the units of service billed.
Such records shall be maintained for a minimum of five years from the date of origination or until audit findings have been resolved, whichever is longer.
Records must be specific to the date, actual service time, location, nature of services provided, units of service provided and name of the individuals served.
Attendance data, as specified above, for the billing period shall be submitted to the Regional Center with the billings/invoices.
- Make available any books and records pertaining to the vendored service, including those of the management organization, if applicable, for audit, inspection or authorized agency representatives. This shall also include only those portions of any personnel records that are necessary to ensure staff qualifications comply with the requirements contained in Title 17, CCR, Sections 56724, and Section 56770 or 56792, as applicable, in order to comply with the monitoring of program standards pursuant to the Welfare and Institutions Code, Section 4691(f).
- Utilize and be bound by Title 17, Sections 50700 through 50767, and the Welfare and Institutions Code, Section 4648.2, should the service provider elect to appeal any audit findings.
- Comply with the provisions contained in the Fair Labor Standards Act.
- Not discriminate in the provision of services to the individuals served by the Regional Center on the basis of race, religion, age, disability, sex, or national origin of the consumer, or his/her parents, guardian, or conservator.
- Provide certification consistent with the Public Contract Code, Sections 10410 and 10411, that the service provider and the agents or employees of the service provider, in the performance of the contracts, are independent contractors and are not officers or employees of the State of California.
- Bill only for services which are actually provided to the individuals served by the Regional Center and which have been authorized by the referring Regional Center.
- Not bill for absences of the individuals served by the Regional Center for nonresidential services.
- Agree to accept the rate established, revised or adjusted by the Department as payment in full for all authorized services provided to the individuals served by the Regional Center and not bill him/her nor the family, conservator, guardian or authorized representative for a supplemental amount regardless of the cost of providing the authorized service. This shall not preclude the service provider from billing the individual served by the Regional Center or his/her family for services provided which were authorized by the individual or family and which were not authorized by the Regional Center.
- Comply with all applicable staffing ratio requirements.
- Be prohibited from being vendored by more than one Regional Center for the same service at the same location.
- Comply with conflict of interest requirements as determined by the criteria established by Title 17, Sections 54500 through 54525 and the Welfare and Institutions Code, Sections 4626 through 4628.
- Sign Form DS 1896, Home and Community Based-Services Provider Agreement.
- Report all Special Incidents as specified in Title 17 Regulations, Section 54327, to the vendoring Regional Center and the Regional Center which provides case management services, as applicable.
- Promote the rights of the individuals served by the Regional Center and only deny rights in accordance with Title 17, Sections 50500 through 50540.
- Adopt written internal policies and procedures to resolve grievances of the individuals served by the Regional Center pursuant to the Welfare and Institutions Code, Section 4705.
- Maintain and keep confidential all information of the individuals served by the Regional Center and utilize such information only as necessary to provide safe and effective services in accordance with the W&I Code, Sections 4515 - 4518 and the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
- The service provider shall maintain a written description of its organizational structure and operations at the service provider's business office in accordance with Title 17, Section 54326(b).
Vendorization may be terminated by the Regional Center if the service provider is in violation of regulations. Termination may occur when:
- The service provider is serving individuals without a current license, credential, registration, certificate, degree or permit that is required for the performance or operation of the service.
- Vendorization has been transferred to another person or entity.
- The service provider has refused to make available any books and records pertaining to the vendored service.
- The service being provided is not the same service that was approved for vendorization.
- The service provider is using planned behavior modification interventions that cause pain or trauma.
- The service provider is transporting the individuals served by the Regional Center using a driver who does not possess a valid California driver's license appropriate for the vehicle being driven.
- The Regional Center has determined that continued utilization of the service provider's services threatens the health and safety of the individuals it serves.
A service provider or an applicant has the right to appeal denial of vendorization, termination of vendorization or failure of the Regional Center to comply with regulations in accordance with Title 17, Sections 54380 - 54390.
You may review Title 17 California Code of Regulations and the Lanterman Act, Welfare & Institutions Code by accessing this internet web address:
Sections 50500 through 50550 . . . . . . . . . . .. Clients Rights
Sections 50605 through 50767 . . . . . . . . . . . Service Provider Accountability
& Audit Standards
Sections 54300 through 54390 . . . . . . . . . . . Vendorization and Service Code Information
Sections 54380 through 54390 . . . . . . . . . . . Vendor Appeal Procedure