Continuation of Assisted Living Waiver Billing on Facility License Transfer

By kylie


CiminoCare takes great pride in being subject matter experts for California’s Assisted Living Waiver (ALW) program, and to that end, it is our desire to share any new learnings that we come across during our own journey with the program.

As those in the ALW program know, we must obtain a Medi-Cal provider number in our own entity’s name, for a particular property. When purchasing a new community that is already in the ALW, it is a little tricky because you cannot apply for your provider number until the license is approved into your name. But when the licensee has been transferred, one would suspect, the seller’s provider status would disappear. But thank goodness, there is a solution. When an operator in the ALW program transfers the business ownership—and thus a new license is applied for by another party, there is a mechanism in place to ensure that the Medi-Cal billing is not interrupted.

As one might imagine, especially in AL communities that have a heavy reliance on ALW clients, having interruptions or delays in billing could be catastrophic. Thus, under certain conditions (see bullets below), the law allows for what is called “successor liability” which is, in simple terms, allowing a new owner to use a previous owner’s existing provider number to bill and receive payments for services.

Per CCR, Section 51000.32:  Successor liability may occur when there is, amongst other things:

  • A change of ownership.
  • 50 percent or more of the assets owned by a corporation at the location for which a provider number has been issued has been sold or transferred.
  • A cumulative change of 50 percent or more in the person(s) with an ownership or controlling interest since the information provided in the last complete application package that was approved for enrollment.

To answer any more detailed questions, please review the link below that explains this process and will most likely answer specific question for your situation:

http://files.medi-cal.ca.gov/pubsdoco/Publications/masters-other/provappsenroll/PEB_Dec2005_7183_2.pdf

Please continue to share this pertinent information so that we can spread awareness about this important program.

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