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Licensure/Certification & Navigating the Agencies
An understanding of the difference between the licensure and certification process is important for prospective providers. A license is granted when the facility meets the State requirements to open its doors and admit clients. Certification is the review process that is conducted to ensure that the facility meets the federal standards of participation in the Medi-Cal Program.
It is the certification portion of the process that qualifies the facility for the daily reimbursement from Medi-Cal. It is imperative that the licensee and facility staff involved understand that the facility must remain in continuous compliance with all federal and state regulations. Failure to do so jeopardizes the facility's certification and Medi-Cal reimbursements.
Applicants interact with the following regulatory and state governmental entities responsible for program plan approval, licensing, certification, referral, and reimbursement:
- Department of Developmental Services (DDS), Health Facilities Program Section (HFPS): Review and approves program plans.
- California Department of Public Health (CDPH) Licensing and Certification: Grants licenses, conducts the life and safety surveys, and conducts Medi-Cal certification surveys
- Regional Center: Determines the need for services and referral of clients.
- Department of Health Care Services (DHCS), Medi-Cal Field Office: Reviews and approves initial and continued client eligibility for level of care.
- Med-Cal Billing: DHCS has the responsibility for the Medi-Cal billing. DHCS sub-contracts the billing process to a billing provider. For information on the current billing provider, please contact DHCS.
It is essential that applicants become familiar with the state and federal regulations and the process for initial licensure and certification.