Starting May 5, 2025, California ABA Therapy Providers can enroll in California's Medi-Cal Fee-for-Service (FFS) program through the PAVE system. This new process helps create a smoother experience for both providers and patients. Here’s a simple guide to help you understand the changes.
Why should California ABA Therapy Providers enroll in the Fee-for-Service Medi-Cal Program?
- Your Managed Care Organization (MCO) in California (examples: CalOptima, IEHP, Partnership HealthPlan, etc.) may require you to enroll through PAVE.
- You may want to enroll in the Fee-For-Service Medi-Cal program, even if your MCO does not currently require it.
- Enrolling now ensures you're prepared for any future changes your MCO may implement.
How to Enroll with PAVE
- Enroll through the PAVE portal starting May 5, 2025.
- Organizations must register as a Healthcare Business, not as a Group.
- You’ll need to include:
- First and last names of all providers.
- National Provider Identifier (NPI).
- License, certification, or registration numbers for applicable staff.
Attestation & Roster
- Organizations must confirm that all staff, including BCBAs, RBTs, and paraprofessionals:
- Meet the rules in SPA 14-026 and SPA 18-011.
- Are properly supervised as required by the State Plan.
- BCBAs, RBTs, and paraprofessionals don’t enroll individually but must be listed on their organization’s roster (this process is done manually).
- Each individual must have a Type 1 NPI and be included in the application.
Reporting Changes
- Any updates, like new hires or staff leaving, must be reported through a PAVE Supplemental Application within 35 days.
- Only updates submitted through PAVE will be accepted.
Timeline & Effective Dates
- The sooner you apply, the sooner you can start.
- Applications from May 5 – June 30, 2025: Enrollment starts July 1, 2025.
- Applications after June 30: Enrollment starts once your application is reviewed and approved.
Administrative Location Requirements
- You must list one physical location for your business.
- This cannot be a P.O. box, home address, or virtual office.
- If you work from multiple locations, you’ll need to submit separate applications.
Managed Care Plan (MCOs) Contracting
- While FFS enrollment is optional, many MCOs (i.e., CalOptima, IEHP, Anthem..etc) may require it to stay in their network.
- MCOs may give you up to 120 days of provisional participation while your enrollment is processed.
Approval and Listing
- Once approved, you’ll receive a PAVE approval letter and be added to the Medi-Cal Open Data Portal.
Key Points to Remember
- BCBAs working for a QAS organization (ABA therapy group) don’t need to enroll individually unless they are billing independently.
- Services are available for all Medi-Cal children under 21 if a doctor or psychologist deems them medically necessary.
Application Process Timeline
- DHCS has 180 days to process your application.
- If corrections are needed, you’ll have 60 days to resubmit, and DHCS will have another 60 days to review.
Credentialing
- Enrolling in PAVE doesn’t replace credentialing with Managed Care Organizations (MCOs). You’ll still need to work directly with MCOss for contracts.
How Theralytics Can Help
Managing Medi-Cal compliance can feel overwhelming, especially for large teams or multi-location practices. Theralytics simplifies the process by helping you organize staff data, track updates, and stay compliant with PAVE’s rules. Whether it’s data migration or meeting the 35-day update deadline, we’ve got you covered.
Theralytics was also built with California-specific needs in mind, including automations for drive time, mileage tracking, and paid 10-minute breaks—designed to handle the complexities of running a business in California.
Let us help you focus on patient care while staying audit-ready. Interested? Contact Theralytics today to get started.
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