California - Respite Care Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

The California Department of Developmental Services (DDS) funds Respite Care Services under the HCBS Waiver for Californians with Developmental Disabilities (Control Number CA.0336.R05.13) through a localized vendorization process. Providers deliver short-term relief to unpaid caregivers, either in the consumer's home or in an approved out-of-home facility, governed by Title 17 of the California Code of Regulations.

Approval requires securing a vendor agreement with one of California's 21 independent Regional Centers before any Medi-Cal enrollment can occur. Applicants must first obtain either a Home Care Organization (HCO) license from the Department of Social Services for in-home care or a Community Care Licensing Division (CCLD) facility license for out-of-home care prior to submitting a vendor application to their local Regional Center.

1. Service Definition and Scope

In California, Respite Care Services provide short-term, non-medical care for members who need temporary supervision, giving unpaid caregivers time for rest or relief. The service is distinct from medical respite and is solely intended to support the caregiver to avoid institutional placement of the consumer.

Services are categorized by delivery setting and model. They include in-home respite provided by an agency, out-of-home respite provided in a licensed facility, and participant-directed respite where the consumer or family member acts as the employer of record.

• Service Code 862: In-Home Respite Services Agency
• Service Code 864: Out-of-Home Respite Services
• Service Code 465: Participant-Directed Respite Service
• Service Code 420: Voucher Respite
• Annual Limit: Up to 336 hours per calendar year for certain managed care populations, though Regional Center IPP authorizations dictate specific waiver limits
• Setting Restriction: Combined in-home and direct care services cannot exceed 24 hours per day

2. Regulatory and Oversight Agencies

The Department of Developmental Services (DDS) operates the HCBS waiver and oversees the Regional Center system. The Department of Health Care Services (DHCS) acts as the single state Medicaid agency responsible for federal compliance and final provider enrollment.

The California Department of Social Services (CDSS) handles the physical licensure of agencies and facilities through its Community Care Licensing Division (CCLD) and Home Care Services Bureau (HCSB).

• Operating Agency: California Department of Developmental Services (DDS) (https://www.dds.ca.gov/)
• Medicaid Agency: California Department of Health Care Services (DHCS) (https://www.dhcs.ca.gov/)
• Licensing Agency: CDSS Community Care Licensing Division (CCLD) (https://www.cdss.ca.gov/inforesources/community-care-licensing)
• Local Designating Entities: 21 California Regional Centers (https://www.dds.ca.gov/rc/)

3. Gatekeeping Prerequisites: Who Can Even Apply

California utilizes a closed-network vendorization model managed by 21 independent Regional Centers. A provider cannot simply enroll in Medi-Cal to provide HCBS respite; they must be vendored by the specific Regional Center covering their geographic catchment area.

Regional Centers act as the absolute gatekeepers and may refuse to accept new vendor applications if they determine they have adequate network capacity for respite services. Furthermore, providers must hold the appropriate CDSS license before a Regional Center will even review a vendor application.

• Designation Prerequisite: Regional Center Vendorization required under Title 17 CCR Section 54310
• Network Access: Subject to local Regional Center network adequacy and need assessments
• Licensure Prerequisite: Must hold an active CDSS HCO or CCLD facility license prior to vendor application
• Geographic Restriction: Vendorization is tied to the specific Regional Center's catchment area

4. Licensure and Certification Requirements

Licensure depends entirely on the setting. Agencies providing staff to a consumer's home must be licensed as a Home Care Organization (HCO) by the CDSS Home Care Services Bureau.

Providers offering out-of-home respite must hold a facility license from CDSS CCLD, such as an Adult Residential Facility (ARF) or Group Home. Relatives providing out-of-home respite in their own house are exempt from licensure pursuant to Title 22 CCR Section 80007.

• In-Home License: Home Care Organization (HCO) license from CDSS
• Out-of-Home License: CCLD Facility License (e.g., ARF, Group Home) meeting Title 17 Section 54342(a)(58) standards
• Licensure Exemption: Relatives providing out-of-home respite in their own home (Title 22 CCR Section 80007)
• Regulatory Citation: Title 17, California Code of Regulations, Section 54342

5. Medicaid Provider Enrollment

Once vendored by a Regional Center, the provider is assigned a unique vendor number. This vendor number is required to finalize enrollment as a Medi-Cal waiver provider.

Providers must submit their enrollment applications through the DHCS Provider Application and Validation for Enrollment (PAVE) portal to receive reimbursement for waiver services.

• Enrollment Portal: DHCS PAVE Portal (https://pave.dhcs.ca.gov/)
• Primary Form: DS 1890 (Vendor Application)
• Requirement: Must possess a Regional Center Vendor Number before DHCS enrollment
• Agreement: Must sign the Medi-Cal Provider Agreement (DHCS 6208)

6. Staffing, Training and Background Checks

Direct care staff must clear rigorous background checks through the California Department of Justice (DOJ) and the FBI. In-home respite workers must be registered on the CDSS Home Care Aide (HCA) Registry.

Staff must possess current CPR and First Aid certifications. Specific consumer needs identified in the Individual Program Plan (IPP) may dictate additional specialized training requirements.

• Background Check: DOJ Live Scan via the Caregiver Background Check Bureau
• Registry Requirement: Active clearance on the CDSS Home Care Aide (HCA) Registry
• Basic Training: First Aid and Cardiopulmonary Resuscitation (CPR) certification
• Specialized Training: Dictated by the consumer's Individual Program Plan (IPP) or Individualized Family Service Plan (IFSP)

7. Documentation, Policies and Records

Providers must maintain comprehensive records to support all billed services. Title 17 CCR Section 50604 mandates that all service providers' records shall be supported by source documentation and retained for a minimum of five years.

For voucher-based respite, families and providers must utilize specific DDS forms to certify hours worked and ensure compliance with labor laws.

• Record Retention: Minimum of 5 years pursuant to Title 17 CCR Section 50604(d)(3)
• Billing Documentation: Form DS 1811 (Respite Services Billing Form)
• Source Documentation: Timesheets must include start/end times, dates, and worker signatures
• Policy Requirement: Must maintain written policies on consumer abuse reporting and incident management

8. Billing, Rates and Claims

Claims for Regional Center vendored services are submitted through the DDS eBilling system. Providers bill the Regional Center directly, which then draws down Medi-Cal federal financial participation.

Rates are established by DDS based on rate studies and are published on the DDS website. Voucher respite allows families to procure their own services up to the authorized rate limit.

• Billing System: DDS eBilling Portal
• Voucher Form: DS 1811 required for participant-directed/voucher billing
• Rate Setting: Established by DDS rate models and published in the DDS rate schedule
• Claim Cycle: Typically billed monthly in arrears based on authorized IPP hours

9. Approval Sequence and Timeline

The approval sequence is strictly linear: obtain CDSS licensure, apply for Regional Center vendorization, and finally enroll in DHCS PAVE. Attempting to bypass the Regional Center will result in immediate rejection.

CDSS licensure can take 3 to 6 months. Once licensed, Regional Centers have 45 days to review a complete vendor application, though backlogs can extend this timeframe.

• Step 1: Obtain CDSS HCO or Facility License (3-6 months)
• Step 2: Submit Vendor Application (DS 1890) to local Regional Center
• Step 3: Regional Center Review (Statutory 45-day review period for complete packets)
• Step 4: DHCS PAVE Enrollment for Medi-Cal billing (30-60 days)

10. Common Denials and Survey Findings

The most frequent barrier to entry is a Regional Center denying a vendor application due to a lack of local need, as they are not obligated to vendor providers if their network is adequate.

During audits, providers are commonly cited for failing to maintain continuous Home Care Aide Registry clearances for all staff or lacking original signatures on timesheets (Form DS 1811).

• Gatekeeping Denial: Regional Center rejection due to adequate existing network capacity
• Application Denial: Submitting a vendor packet before CDSS licensure is finalized
• Audit Finding: Missing or expired CPR/First Aid certificates in personnel files
• Audit Finding: Failure to retain source documentation for the required 5-year period

11. Key Contacts and Resources

Prospective providers must coordinate with their local Regional Center for vendorization and the Department of Social Services for licensure. The DDS website hosts all required DS forms and Title 17 regulations.

For Medi-Cal enrollment technical assistance, providers utilize the DHCS PAVE help desk.

• DDS Respite Information: https://www.dds.ca.gov/services/crisis-safety-net-services/respite
• Title 17 Regulations: https://www.dds.ca.gov/wp-content/uploads/2023/01/07.-Text-of-Regulations.pdf
• Regional Center Directory: https://www.dds.ca.gov/rc/
• DHCS PAVE Portal: https://pave.dhcs.ca.gov/

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