Sources
Sources behind this course
Each lesson lists the sources it uses. Open the original for the exact rule, form or instruction that applies to your work. The source library describes each one in more detail.
Assisted Living Waiver program page
Room and board paid by the participant, the ALW program-integrity note on claiming, the 2026 table of assisted living service codes by tier, and the list of current policy letters, including Policy Letter 26-002 on claiming.
Where to look: The Eligibility, ALW Program Integrity, HCBS Provider Minimum Wage Increase and Current Policy Letters and Memorandums sections.
Open the DHCS ALW pageApplication for a 1915(c) HCBS Waiver, CA.0431.R04.00 (the Assisted Living Waiver, from March 1, 2024)
The approved ALW waiver, including how the ISP is developed, reviewed, monitored and kept, risk and back-up planning, informed choice of providers, and the safeguards on restraints.
Where to look: Appendix D-1 (service plan development) and D-2 (implementation and monitoring); the Care Coordination service definition in Appendix C; Appendix G-2.
Open the ALW waiver application (PDF)Assisted Living Waiver Individual Service Plan Desk Guide (August 2024)
How a care coordinator completes each section of the ALW ISP workbook: strengths, personal goals, preferences, assessed needs and services, risk management, the back-up plan, care coordination monitoring, rights modifications and the Patient's Rights Form.
Where to look: The section for the part of the ISP you are writing; Rights Modifications (pages 29 to 32) and the Patient's Rights Form (pages 33 to 38).
Open the DHCS ISP Desk Guide (PDF)DHCS 0062, Assisted Living Waiver Freedom of Choice Form (Revised 12/2019)
The person's written choice to accept or decline ALW services as an alternative to nursing facility care, the right to choose a waiver provider, and when an authorized representative signs.
Where to look: Page 1 (the letter and the two numbered statements) and page 2 (the Accept and Decline sections).
Open the DHCS 0062 Freedom of Choice form (PDF)DHCS 0060, Assisted Living Waiver Amenity Form (Revised 09/2023)
The room and kitchenette benefits offered at enrollment, and the person's signed choice to waive a private room, a refrigerator or a microwave.
Where to look: Page 1: the two numbered benefits and the three waiver choices.
Open the DHCS 0060 Amenity Form (PDF)DHCS 0063, Assisted Living Waiver Informing Notice (Revised 12/2019)
The notice of ALW enrollment and its effective date, what DHCS needs from the care coordinator to authorize services, the roles of the person, the waiver providers and DHCS, and the reasons services may end.
Where to look: Page 1 (the effective date), page 2 (the four items DHCS needs), page 3 (provider duties, including the provider agreement and change-in-condition notices) and pages 3 to 4 (when DHCS may end services).
Open the DHCS 0063 Informing Notice (PDF)Title 22, section 87457: Pre-admission appraisal
The RCFE interview, consent and determination of suitability before admission.
Where to look: Subdivisions (a) to (c).
Open section 87457 on Cornell LIITitle 22, section 87458: Medical assessment
The medical assessment a home obtains before accepting a resident: who signs it, the one-year window, and what it includes (TB, medications, mobility, cognition).
Where to look: Subdivisions (a), (b) and (c)(1) to (8).
Open section 87458 on Cornell LIILIC 602A, Medical Assessment for Residential Care Facilities for the Elderly (4/26)
The state's medical assessment form for RCFEs: diagnoses, self-management, physical and mental health, medication management, ambulatory status and hospice care.
Where to look: The note to the medical professional (page 1), the diagnosis blocks (pages 2 and 3), medication management and ambulatory status (page 8), and hospice care (page 9).
Open LIC 602A (PDF)Title 22, section 87507: Admission agreements
Who signs the RCFE admission agreement and by when, the copies, the payment provisions, and the written notice before a rate change.
Where to look: Subdivisions (c) to (e) and (g)(3) to (g)(4).
Open section 87507 on Cornell LIITitle 22, section 87463: Reappraisals
Updating the pre-admission appraisal, significant changes in condition, and who the home tells about them and how it records it.
Where to look: Subdivisions (a), (b) and (d) to (f).
Open section 87463 on Cornell LII