(1-833-422-4255). Access the Guardian Applicant Portal at https://guardian.dss.ca.gov/Applicant. California Department of Public Health. V1JN'u_W]`FWA~kQFUqD/|T2|{9 CE +.d*& Ojw3fUGi.EH.;8&qfTC3 T^GqE_Vv?* mq;d3 Home Care Services Bureau How to Apply Application for Home Health Agency License State Disclosure of Ownership and Control Interest Statement 197.400 - 197.478 RSMo Home Health Agencies 2CB]i;sBTQVHa:' # :"u82xM.emMnHfF1K. Make Your Voice Heard click for more. California law established the Home Care Services Consumer Protection Act which, as of January 2016, requires Home Care Organizations to be licensed and creates a public online registry for Home Care Aides who have been background checked. After you submit your application, you will receive a notice stating that your There are three primary types of caregiver roles: companions/homemakers, home care aides/assistants, and medical caregivers such as CNA's and registered nurses. Phone: (916) 552-8632Email: CAB@cdph.ca.gov. An account will need to be created to submit and update your Home Care Aide details. to Default, Registered Environmental Health Specialist, California Health Facilities Information Database, Chronic Disease Surveillance and Research, Medical Marijuana Identification Card Program, Office of State Public Health Laboratory Director, Centers for Disease Control and Prevention, License or Facility/Agency # (if applicable). Are license approvals guaranteed? The Health Homes Program (HHP) is desi gned to serve eligible Medi-Cal beneficiaries with complex medical needs and chronic conditions who may benefit from enhanced care managem ent and coordination. Licensure & Certification Application Form (HS 200) Applicant Individual Information (HS 215A) Application for Medi-Cal Certification as a Primary Care Clinic Provider (HS 269) Administrative Organization Form (HS 309) Affidavit Regarding Patient Money Form (HS 400) Surety Bond Verification (HS 402) Transfer Agreement Form (HS 602) 846 0 obj <>/Filter/FlateDecode/ID[<7F2B1F9801260E4E9809715681229720>]/Index[817 53]/Info 816 0 R/Length 125/Prev 243845/Root 818 0 R/Size 870/Type/XRef/W[1 3 1]>>stream 2250 0 obj <> endobj The provider checklist identifies the required forms and supporting documents needed to apply for licensing and certification. 744 P Street MS 9-14-90 Check all that apply: Initial License Change of Ownership (CHOW) Medicare Medi-Cal California Department of Public Health Licensing and Certification Program Centralized Applications Branch P.O. (1-833-422-4255). To apply for an Initial license, you must complete the required application packet. This law is intended to promote consumer protection for elderly and disabled individuals who hire private aides to come into their homes and provide assistance with activities of daily living. ADPH = Daily Eligibility Program Operations For more information, call 1-800-225-9770 or see our Home Health Services Information Card. An entity operating as a licensed home health agency must offer two skilled services on an intermittent basis, one of which must be skilled nursing. Click on the links in the Section A chart below to access the appropriate application forms. The Home Care Services Bureau (HCSB) is responsible for licensing Home Care Organizations including processing applications, receiving and responding to complaints and conducting unannounced visits to ensure compliance. Application Fees Below you will find the application fees associated with the Home Care Services Consumer Protection Act (HCSCPA): More Information For more information on the fingerprinting and LiveScan fees please contact the Care Provider Management Bureau at 1 (888) 422-5669. TheHome Medical Device RetailProgram's mission isto promote and improve the health and well-beingof all California residents and to facilitate the growth and vitality of California home medical device retail product industries, while ensuring that products are not adulterated, misbranded or falsely advertised. Healthcare Professional Certification and Training Section (HPCTS)P.O. A CNA who was permitted to work during the pandemic with expired certification must obtain certification by March 1, 2023. New customers, please register with your email address as your username; Existing customers, please login with your email address.County: Wake Dear Ms. Cummer: The Healthcare Planning and Certificate of Need Section, Division of Health Service Regulation (Agency), determined that the above referenced project is exempt from certificate of need . 0 Have successfully completed a training program approved by the department in California, which includes an examination to test the applicant's knowledge and skills related to basic patient care services. %PDF-1.6 % APPLICATION FOR LICENSE TO OPERATE A HOME HEALTH AGENCY State Form 4008 (R10 / 9-18) Indiana State Department of Health - Division of Acute Care (Pursuant to IC 16-27-1-7 and 410 IAC 17-10-1) . Complete the application forms and compile all the supplemental documents listed in the Section B chart. Rural Health Clinic Application Packet. HHAs must be in compliance with the regulatory requirements for HHA renewal by March 1, 2023. 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