Cal. Code Regs. tit. 17 § 54310

Current through Register 2024 Notice Reg. No. 43, October 25, 2024

Section 54310 - Vendor Application Requirements

(a) An applicant who desires to be vendored shall submit Form DS 1890 (7/2011), entitled Vendor Application, and the information specified in (1) through (10) below, to the vendoring regional center.

(1) Applicant's name, including the name of any governing body or management organization;

(2) Applicant's Social Security Number, Federal Tax ID number, or a copy of any document accepted by the federal government which establishes identity of applicant;

(3) Applicant's mailing address;

(4) Address of service, if applicable;

(5) Name of family member, owner or executive director, as applicable;

(6) Types of service to be provided;

(7) Telephone number;

(8) Facility capacity, if applicable;

(9) Identification of the type of consultants, subcontractors and community resources to be used by the vendor as part of its service.

(10) Copies of:

(A) Any license, credential, registration, certificate or permit required for the performance or operation of the service, or proof of application for such document;

(B) Any academic degree required for performance or operation of the service;

(C) Any waiver from licensure, registration, certification, credential, or permit from the responsible controlling agency;

(D) The proposed or existing program design as required in Sections 56712 and 56762 of these regulations, if applicable, for applicants seeking vendorization as community-based day programs;

(E) The proposed or existing staff qualifications and duty statements as required in Sections 56722 and 56724 of these regulations for applicants seeking vendorization as community-based day programs;

(F) The proposed or existing service design as required in Section 56780 of these regulations for applicants seeking vendorization as in-home respite service agencies;

(G) The proposed or existing program design as required in Section 58811 of these regulations for applicants seeking vendorization as habilitation service providers;

(H) The proposed or existing staff qualifications and duty statements as required in Sections 56790 and 56792 of these regulations for applicants seeking vendorization as in-home respite services agencies;

(I) The proposed service design as required in Sections 58630 and 58631 of these regulations for applicants seeking vendorization to provide supported living service;

(J) The signed Home and Community-Based Services Provider Agreement (6/99) with the Department of Health Services, obtainable from the regional centers as part of the vendorization packet, for those applicants whose proposed service is eligible for Medi-Cal reimbursement; and

(K) The proposed program design as required by Subchapter 4.1, Section 56084 for those applicants seeking vendorization as a family home agency (FHA).

(b) The applicant shall sign and date Form DS 1890 (7/2011), which includes a certification that the information is true, correct and complies with Title 17, Section 54310(a).

(c) In addition to subsection (a), a Family Home Agency (FHA) shall specify the following information:

(1) The name, title, business address and telephone number of each officer and member of the governing board;

(A) The application packet shall include copies of the corporation's articles of incorporation; by-laws, which shall include provisions for control by a responsible governing board; annual statement filed with the Secretary of State; corporate charter, if applicable; and evidence certifying the corporation's nonprofit status.

(B) The application packet shall contain a written resolution from the governing board stating that the board shall operate the FHA in full conformity with all applicable statutes and regulations.

(2) Name, address and telephone number of the owner of the facility premises if the applicant is leasing or renting;

(3) Disclosure of:

(A) Any board member's or officer's prior or present service as an administrator, general partner, corporate officer or director of any health facility certified by the Department of Health Services or community care facility licensed by the Department of Social Services' Community Care Licensing Division; and

(B) Any revocation or other action taken, or in the process of being taken, against any community care facility license or health facility certification held or previously held by the applicant or any officer or member of the governing board.

(4) A financial statement and budget which demonstrate the applicant's ability to cover the costs of operating the FHA to provide the level of services and supports necessary to maintain consumers for whom the regional center is responsible in family homes;

(5) A written statement that no FHA employee, Board of Directors member or officer shall be a family home provider of the FHA;

(6) A written statement that no family home shall be approved by the FHA as a residence for a consumer who is a relative of the family home provider except when:

(1) the residence is consistent with the services and supports referenced in the consumer's IPP; and

(2) the relative has no legal obligation to support the consumer;

(7) Any other information required by the regional center which is pertinent to vendorization of the FHA.

(d) Habilitation services providers who, on July 1, 2004, are providing services to consumers shall be deemed to be an approved vendor. Each approved vendor shall submit to the vendoring regional center, and a copy to the Department, a completed Vendor Application, DS 1890 (12/03) and a completed Annual Habilitation Services Provider Profile, DS 1970 (4/04) by July 31, 2004.

(e) Habilitation Services providers not deemed approved vendors pursuant to (d), and approved vendors seeking vendorization as Habilitation Services providers in a new location, shall, in addition to meeting the general requirements of this section and of Title 17, Sections 58800 through 58882, meet the following requirements as a condition of vendorization:

(1) The applicant shall:

(A) If currently accredited, supply a copy of its last accreditation report and indicate the date its next accreditation review is due.

(B) If not currently accredited, supply a copy of certification by the Department of Rehabilitation and shall become accredited within 3 years of the date of their certification.

(f) The following applicants shall be required to submit only Form DS 1890 (7/2011) and, if applicable, a copy of any license, credential, registration, certificate, permit, or academic degree required for the performance or operation of the service, or any waiver from licensure, registration, certification, credential, or permit from the responsible controlling agency. If the proposed service is eligible for Medi-Cal reimbursement, the applicant shall also sign the Home and Community Based Services Provider Agreement (6/99), and submit the original of the signed agreement to the vendoring regional center.

(1) Public transit authorities, dial-a-ride, rental car agencies, or taxis;

(2) Out-of-state manufacturers or distributors who are eligible for vendorization pursuant to Section 54318 of these regulations;

(3) Retail/wholesale stores; and

(4) Generic agencies specified in Section 54316(a)(2) of these regulations.

(g) Family members or consumers who desire to be vendored in the following categories shall be required to submit to the vendoring regional center Form DS 1890 (7/2011), and, if the vouchered family member or consumer is also the provider of the vouchered service, a copy of any license, credential, registration, certificate, permit, or academic degree required for the performance or operation of the service, or any waiver from licensure, registration, certification, credential, or permit from the responsible controlling agency, if applicable. If a proposed service is eligible for Medi-Cal reimbursement, the applicant shall also sign the Home and Community-Based Services Provider Agreement (6/99) and submit it to the vendoring regional center.

(1) Respite service--family member;

(2) Nursing service--family member;

(3) Transportation--family member;

(4) Day care--family member; and

(5) Diaper and nutritional supplements--family member.

(h) For the purposes of subsections (a) and (b) of this section, the documentation provided to the dentist by the Department of Health Care Services (DHCS) approving the dentist's enrollment in the Denti-Cal program, including the dentist in the Provider Master File and providing the dentist with a Medi-Cal provider number, constitutes vendorization for the purposes of providing services to consumers under Dentistry -- Service Code 715. The dentist's status as a Denti-Cal provider is under the oversight of DHCS.

Cal. Code Regs. Tit. 17, § 54310

1. New section filed 6-26-90 as an emergency; operative 7-1-90 (Register 90, No. 36). A Certificate of Compliance must be transmitted to OAL by 10-29-90 or emergency language will be repealed by operation of law on the following day.
2. Certificate of Compliance as to 6-26-90 order transmitted to OAL 9-28-90 and filed 10-29-90 (Register 90, No. 46).
3. Editorial correction of printing error in article 2 heading (Register 91, No. 30).
4. Amendment of section heading, subsections (a), (a)(5)(b) and NOTE filed 11-5-91 as an emergency; operative 11-5-91 (Register 92, No. 21). A Certificate of Compliance must be transmitted to OAL 3-4-92 or emergency language will be repealed by operation of law on the following day.
5. Amendment of section heading, subsections (a), (a)(5)(b) and NOTE refiled 3-4-92 as an emergency; operative 3-4-92 (Register 92, No. 25). A Certificate of Compliance must be transmitted to OAL 7-2-92 or emergency language will be repealed by operation of law on the following day.
6. Certificate of Compliance as to 3-4-92 order including amendment of section heading and text transmitted to OAL 6-25-92 and filed 8-6-92 (Register 92, No. 33).
7. Amendment of section filed as an emergency 6-17-93; operative 6-17-93. Submitted to OAL for printing only pursuant to SB485 (Chapter 722, Statutes of 1992) Section 147(a) (Register 93, No. 26).
8. Amendment of subsections (a)(10)(H), (c) and (d) filed 4-22-94; operative 4-22-94. Submitted to OAL for printing only (Register 94, No. 16).
9. Amendment of subsections (d)(1)-(5) and new subsections (e)-(e)(8) filed 6-20-94 as an emergency; operative 6-20-94. Submitted to OAL for printing only pursuant to Chapter 722, Statutes of 1992, Section 147 (Register 94, No. 25).
10. Certificate of Compliance as to 6-17-93 order transmitted to OAL 6-20-94 and filed 8-2-94 (Register 94, No. 31).
11. New subsections (a)(10)(I) and (c)-(c)(7), subsection relettering and amendment of NOTE filed 7-24-95 as an emergency; operative 7-24-95 (Register 95, No. 30). A Certificate of Compliance must be transmitted to OAL by 11-21-95 or emergency language will be repealed by operation of law on the following day.
12. New subsection (a)(10)(H), subsection relettering and amendment of NOTE filed 8-14-95 as an emergency; operative 8-14-95 (Register 95, No. 33). A Certificate of Compliance must be transmitted to OAL by 12-12-95 or emergency language will be repealed by operation of law on the following day.
13. New subsections (a)(10)(I) and (c)-(c)(7), subsection relettering and amendment of NOTE refiled 11-14-95 as an emergency; operative 11-14-95 (Register 95, No. 46). A Certificate of Compliance must be transmitted to OAL by 3-13-96 or emergency language will be repealed by operation of law on the following day.
14. New subsection (a)(10)(H), subsection relettering and amendment of NOTE refiled 12-4-95 as an emergency; operative 12-12-95 (Register 95, No. 49). A Certificate of Compliance must be transmitted to OAL by 4-10-96 or emergency language will be repealed by operation of law on the following day.
15. Certificate of Compliance as to 7-24-95 order including new subsection (a)(10)(H) and subsection relettering transmitted to OAL 1-8-96 and filed 2-22-96 (Register 96, No. 8).
16. Certificate of Compliance as to 6-20-94 order, including amendment of subsections (a)(10)(I), (d) and (e) and repealer of subsections (f)-(f)(8), transmitted to OAL 2-20-96 and filed 3-29-96 (Register 96, No. 13).
17. Editorial correction of HISTORY 12 and HISTORY 14 (Register 96, No. 15).
18. New subsection (a)(10)(H), subsection relettering and amendment of NOTE refiled 4-8-96 as an emergency; operative 4-10-96 (Register 96, No. 15). A Certificate of Compliance must be transmitted to OAL by 8-6-96 or emergency language will be repealed by operation of law on the following day.
19. Certificate of Compliance as to 8-14-95 order transmitted to OAL 8-8-96 and filed 9-20-96 (Register 96, No. 38).
20. Change without regulatory effect amending subsection (e) filed 1-17-97 pursuant to section 100, title 1, California Code of Regulations (Register 97, No. 3).
21. New subsections (a)(10)(G) and (d)-(f), subsection relettering and amendment of NOTE filed 7-22-2004 as an emergency; operative 7-22-2004 (Register 2004, No. 30). A Certificate of Compliance must be transmitted to OAL by 11-19-2004 or emergency language will be repealed by operation of law on the following day.
22. Amendment of subsections (a), (a)(5), (a)(10)(J), (b), (g) and (i) and amendment of NOTE filed 8-27-2004 as an emergency; operative 8-27-2004 (Register 2004, No. 35). A Certificate of Compliance must be transmitted to OAL by 12-27-2004 or emergency language will be repealed by operation of law on the following day.
23. Reinstatement of section as it existed prior to 7-22-2004 emergency amendment by operation of Government Code section 11346.1(f) (Register 2004, No. 49).
24. New subsections (a)(10)(G) and (d)-(f), subsection relettering and amendment of NOTE refiled 11-29-2004 as an emergency; operative 11-29-2004 (Register 2004, No. 49). A Certificate of Compliance must be transmitted to OAL by 3-29-2005 or emergency language will be repealed by operation of law on the following day.
25. Refiling of 8-27-2004 order, including relettering of subsection (i) to subsection (h), 12-22-2004 as an emergency; operative 12-22-2004 (Register 2004, No. 52). A Certificate of Compliance must be transmitted to OAL by 4-21-2005 or emergency language will be repealed by operation of law on the following day.
26. New subsections (a)(10)(G) and (d)-(f), subsection relettering and amendment of NOTE refiled 3-30-2005 as an emergency; operative 3-30-2005 (Register 2005, No. 13). A Certificate of Compliance must be transmitted to OAL by 7-28-2005 or emergency language will be repealed by operation of law on the following day.
27. Certificate of Compliance as to 12-22-2004 order, including further amendment of subsections (a)(2) and (h), transmitted to OAL 4-19-2005 and filed 5-18-2005 (Register 2005, No. 20).
28. Certificate of Compliance as to 3-30-2005 order, including redesignation of former subsections (f)-(f)(2) as new (e)(1)-(e)(1)(B) and subsection relettering, transmitted to OAL 6-21-2005 and filed 8-1-2005; amendments operative 8-31-2005 (Register 2005, No. 31).
29. Amendment of subsections (a), (b), (c)(1)(A)-(B), (f) and (g), new subsection (h) and amendment of NOTE filed 12-27-2011 as a deemed emergency pursuant to Welfare and Institutions Code section 4648.12; operative 12-27-2011 (Register 2011, No. 52). A Certificate of Compliance must be transmitted to OAL within 18 months or emergency language will be repealed by operation of law on the following day.
30. Certificate of Compliance as to 12-27-2011 order transmitted to OAL 2-15-2013 and filed 4-2-2013 (Register 2013, No. 14).

Note: Authority cited: Chapter 157, Statutes of 2003; Sections 4405, 4648(a), 4648.12(c)(1)(A) and 4689.1, Welfare and Institutions Code; Section 11152, Government Code; and Chapter 1095, Statutes of 1994, Section 14. Reference: Sections 4502, 4631, 4648(a), 4648.12, 4690, 4691 and 12305.81(a)(2), Welfare and Institutions Code; and Title 42, Code of Federal Regulations, Sections 455.104, 455.105 and 455.106.

1. New section filed 6-26-90 as an emergency; operative 7-1-90 (Register 90, No. 36). A Certificate of Compliance must be transmitted to OAL by 10-29-90 or emergency language will be repealed by operation of law on the following day.
2. Certificate of Compliance as to 6-26-90 order transmitted to OAL 9-28-90 and filed 10-29-90 (Register 90, No. 46).
3. Editorial correction of printing error in article 2 heading (Register 91, No. 30).
4. Amendment of section heading, subsections (a), (a)(5)(b) and Note filed 11-5-91 as an emergency; operative 11-5-91 (Register 92, No. 21). A Certificate of Compliance must be transmitted to OAL 3-4-92 or emergency language will be repealed by operation of law on the following day.
5. Amendment of section heading, subsections (a), (a)(5)(b) and NOTE refiled 3-4-92 as an emergency; operative 3-4-92 (Register 92, No. 25). A Certificate of Compliance must be transmitted to OAL 7-2-92 or emergency language will be repealed by operation of law on the following day.
6. Certificate of Compliance as to 3-4-92 order including amendment of section heading and text transmitted to OAL 6-25-92 and filed 8-6-92 (Register 92, No. 33).
7. Amendment of section filed as an emergency 6-17-93; operative 6-17-93. Submitted to OAL for printing only pursuant to SB485 (Chapter 722, Statutes of 1992) Section 147(a) (Register 93, No. 26).
8. Amendment of subsections (a)(10)(H), (c) and (d) filed 4-22-94; operative 4-22-94. Submitted to OAL for printing only (Register 94, No. 16).
9. Amendment of subsections (d)(1)-(5) and new subsections (e)-(e)(8) filed 6-20-94 as an emergency; operative 6-20-94. Submitted to OAL for printing only pursuant to Chapter 722, Statutes of 1992, Section 147 (Register 94, No. 25).
10. Certificate of Compliance as to 6-17-93 order transmitted to OAL 6-20-94 and filed 8-2-94 (Register 94, No. 31).
11. New subsections (a)(10)(I) and (c)-(c)(7), subsection relettering and amendment of Note filed 7-24-95 as an emergency; operative 7-24-95 (Register 95, No. 30). A Certificate of Compliance must be transmitted to OAL by 11-21-95 or emergency language will be repealed by operation of law on the following day.
12. New subsection (a)(10)(H), subsection relettering and amendment of Note filed 8-14-95 as an emergency; operative 8-14-95 (Register 95, No. 33). A Certificate of Compliance must be transmitted to OAL by 12-12-95 or emergency language will be repealed by operation of law on the following day.
13. New subsections (a)(10)(I) and (c)-(c)(7), subsection relettering and amendment of Note refiled 11-14-95 as an emergency; operative 11-14-95 (Register 95, No. 46). A Certificate of Compliance must be transmitted to OAL by 3-13-96 or emergency language will be repealed by operation of law on the following day.
14. New subsection (a)(10)(H), subsection relettering and amendment of Note refiled 12-4-95 as an emergency; operative 12-12-95 (Register 95, No. 49). A Certificate of Compliance must be transmitted to OAL by 4-10-96 or emergency language will be repealed by operation of law on the following day.
15. Certificate of Compliance as to 7-24-95 order including new subsection (a)(10)(H) and subsection relettering transmitted to OAL 1-8-96 and filed 2-22-96 (Register 96, No. 8).
16. Certificate of Compliance as to 6-20-94 order, including amendment of subsections (a)(10)(I), (d) and (e) and repealer of subsections (f)-(f)(8), transmitted to OAL 2-20-96 and filed 3-29-96 (Register 96, No. 13).
17. Editorial correction of History 12 and History 14 (Register 96, No. 15).
18. New subsection (a)(10)(H), subsection relettering and amendment of Note refiled 4-8-96 as an emergency; operative 4-10-96 (Register 96, No. 15). A Certificate of Compliance must be transmitted to OAL by 8-6-96 or emergency language will be repealed by operation of law on the following day.
19. Certificate of Compliance as to 8-14-95 order transmitted to OAL 8-8-96 and filed 9-20-96 (Register 96, No. 38).
20. Change without regulatory effect amending subsection (e) filed 1-17-97 pursuant to section 100, title 1, California Code of Regulations (Register 97, No. 3).
21. New subsections (a)(10)(G) and (d)-(f), subsection relettering and amendment of Note filed 7-22-2004 as an emergency; operative 7-22-2004 (Register 2004, No. 30). A Certificate of Compliance must be transmitted to OAL by 11-19-2004 or emergency language will be repealed by operation of law on the following day.
22. Amendment of subsections (a), (a)(5), (a)(10)(J), (b), (g) and (i) and amendment of Note filed 8-27-2004 as an emergency; operative 8-27-2004 (Register 2004, No. 35). A Certificate of Compliance must be transmitted to OAL by 12-27-2004 or emergency language will be repealed by operation of law on the following day.
23. Reinstatement of section as it existed prior to 7-22-2004 emergency amendment by operation of Government Code section 11346.1(f) (Register 2004, No. 49).
24. New subsections (a)(10)(G) and (d)-(f), subsection relettering and amendment of Note refiled 11-29-2004 as an emergency; operative 11-29-2004 (Register 2004, No. 49). A Certificate of Compliance must be transmitted to OAL by 3-29-2005 or emergency language will be repealed by operation of law on the following day.
25. Refiling of 8-27-2004 order, including relettering of subsection (i) to subsection (h), 12-22-2004 as an emergency; operative 12-22-2004 (Register 2004, No. 52). A Certificate of Compliance must be transmitted to OAL by 4-21-2005 or emergency language will be repealed by operation of law on the following day.
26. New subsections (a)(10)(G) and (d)-(f), subsection relettering and amendment of Note refiled 3-30-2005 as an emergency; operative 3-30-2005 (Register 2005, No. 13). A Certificate of Compliance must be transmitted to OAL by 7-28-2005 or emergency language will be repealed by operation of law on the following day.
27. Certificate of Compliance as to 12-22-2004 order, including further amendment of subsections (a)(2) and (h), transmitted to OAL 4-19-2005 and filed 5-18-2005 (Register 2005, No. 20).
28. Certificate of Compliance as to 3-30-2005 order, including redesignation of former subsections (f)-(f)(2) as new (e)(1)-(e)(1)(B) and subsection relettering, transmitted to OAL 6-21-2005 and filed 8-1-2005; amendments operative 8-31-2005 (Register 2005, No. 31).
29. Amendment of subsections (a), (b), (c)(1)(A)-(B), (f) and (g), new subsection (h) and amendment of Note filed 12-27-2011 as a deemed emergency pursuant to Welfare and Institutions Code section 4648.12; operative 12-27-2011 (Register 2011, No. 52). A Certificate of Compliance must be transmitted to OAL within 18 months or emergency language will be repealed by operation of law on the following day.
30. Certificate of Compliance as to 12-27-2011 order transmitted to OAL 2-15-2013 and filed 4-2-2013 (Register 2013, No. 14).