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STARTERCalifornia · PDHC
Check my readiness
California PDHC / Field guide

Understand the path before you commit capital.

Use the guide for orientation, then open the source-backed requirement when a decision becomes actionable.

Treat each domain as part of one operating system. Licensing, clinical leadership, payer readiness, documentation, billing evidence, and survey posture all depend on one another.

How to use this guide

Orient here, then follow the requirement links to the current source-backed binder items. The guide is planning awareness, not a substitute for official authority or professional advice.

01
Chapter 01

Entity & Ownership

Form a California entity, register with the Secretary of State, and identify the Administrator of record for CDPH.

What this domain covers

Form a California entity, register with the Secretary of State, and identify the Administrator of record for CDPH.

What to assemble

  • California Entity Formation (Secretary of State)Form a California LLC or corporation and register with the California Secretary of State (bizfileOnline.sos.ca.gov). The PDHC license is issued to the entity; ownership and authorized signatory must match. Verify current filing requirements at sos.ca.gov.
  • Administrator of RecordIdentify the individual who will serve as the Administrator of record on the CDPH PDHC application. This role owns day-to-day program management and is the principal point of contact with CDPH Licensing & Certification.
Open source-backed requirements →
02
Chapter 02

Facility & Physical Plant

California PDHC facilities must meet Title 22 physical-plant requirements. Engage a California-licensed architect early to design against the regulation set rather than retrofitting after the fact.

What this domain covers

California PDHC facilities must meet Title 22 physical-plant requirements. Engage a California-licensed architect early to design against the regulation set rather than retrofitting after the fact.

What to assemble

  • Site Selection + ZoningIdentify a site that meets PDHC use requirements under local zoning and confirm allowable use with the local planning department before signing a lease or purchase agreement. PDHC is a specialized licensed-care use; not every commercial site is eligible.
  • Architect Review Against Title 22Engage a California-licensed architect with experience in licensed-care facilities to review your floor plan against Title 22 PDHC physical-plant requirements. Catching gaps at the design stage is materially cheaper than at the CDPH plan-check stage.
Open source-backed requirements →
03
Chapter 03

CDPH Licensing

The California PDHC license is issued by CDPH Licensing & Certification. License-first, Medi-Cal-enrollment-second — the sequence cannot be reversed.

What this domain covers

The California PDHC license is issued by CDPH Licensing & Certification. License-first, Medi-Cal-enrollment-second — the sequence cannot be reversed.

What to assemble

  • CDPH PDHC Application PacketObtain the current PDHC application packet from CDPH Licensing & Certification. The packet specifies forms, fees, ownership disclosure, financial-capacity evidence, policies & procedures, organizational documents, and supporting attachments. Verify current packet contents and fees at cdph.ca.gov before assembly.
  • Personnel Background Screening (LiveScan + TB)All PDHC personnel with patient contact must complete California LiveScan fingerprinting (Department of Justice + FBI) and TB clearance before patient contact. Build the LiveScan + TB workflow into hiring before opening so first-day-of-service is fully cleared.
  • Adverse-History ReviewReview whether any owner, manager, or affiliated entity has prior adverse licensing actions, investigations, settlements, or ownership history that would affect the CDPH PDHC application. Disclose proactively; CDPH discovery of undisclosed history is a far worse outcome than disclosure.
Open source-backed requirements →
04
Chapter 04

Medical Director Readiness

California PDHC requires a Medical Director with clinical oversight of every attending child. Plan the role's authority, cadence, and policy-setting responsibilities before opening.

What this domain covers

California PDHC requires a Medical Director with clinical oversight of every attending child. Plan the role's authority, cadence, and policy-setting responsibilities before opening.

What to assemble

  • Medical Director — Board-Certified PediatricianThe California PDHC Medical Director must be a board-certified pediatrician. The role covers medical oversight of every attending child, supervision of nursing on clinical matters, medical-policy authorship, and participation in the QA program. Verify current qualification details against Title 22 before commitment.
Open source-backed requirements →
05
Chapter 05

Nursing Operations Readiness

Title 22 sets DON qualifications and PDHC staffing-ratio requirements. Plan staffing around the ratio table before opening.

What this domain covers

Title 22 sets DON qualifications and PDHC staffing-ratio requirements. Plan staffing around the ratio table before opening.

What to assemble

  • Director of Nursing (DON) QualificationsCalifornia-licensed RN with documented pediatric nursing experience. The DON owns nursing supervision, individual nursing protocols, and staffing-ratio compliance. Hire before the CDPH initial survey. Verify current qualification specifics against Title 22 at the time of hire.
  • Title 22 PDHC Staffing RatiosCensus planning and scheduling must be coordinated against the Title 22 staffing-ratio schedule for PDHC. Verify the complete current ratio schedule at govt.westlaw.com / oal.ca.gov before publishing staffing plans, then design scheduling logic around the table.
Open source-backed requirements →
06
Chapter 06

Operations / QA Readiness

California PDHC requires a structured Quality Assurance / Quality Improvement program. Design committee composition, cadence, and record-review scope before opening.

What this domain covers

California PDHC requires a structured Quality Assurance / Quality Improvement program. Design committee composition, cadence, and record-review scope before opening.

What to assemble

  • QA/QI Committee DesignDesign the QA/QI committee (composition, meeting cadence, scope of medical-record review, corrective-action tracking, reporting up to Medical Director and Administrator) before opening. CDPH surveyors will look for evidence the program is in place — not promised.
Open source-backed requirements →
07
Chapter 07

Medical Records Readiness

Title 22 sets PDHC medical-record content and retention requirements. Record design must satisfy both CDPH licensing standards and DHCS Medi-Cal billing-documentation requirements layered on top.

What this domain covers

Title 22 sets PDHC medical-record content and retention requirements. Record design must satisfy both CDPH licensing standards and DHCS Medi-Cal billing-documentation requirements layered on top.

What to assemble

  • Nursing Protocol of CareDevelop an individualized nursing protocol of care for each child per Title 22 PDHC requirements. The protocol must be reviewed at the regulatory cadence. Records must reflect all care provided and any changes to the child's condition or care plan. Verify the current authoring + review cadence against Title 22 directly.
  • Medical Record Content and RetentionMap record-content and retention requirements from Title 22 into your record design before opening. Verify current retention period against the current Title 22 text.
Open source-backed requirements →
08
Chapter 08

Admissions Readiness

Admissions to a California PDHC require physician prescription, ongoing physician care, written parent/guardian consent, and pre-admission planning by Medical Director and DON.

What this domain covers

Admissions to a California PDHC require physician prescription, ongoing physician care, written parent/guardian consent, and pre-admission planning by Medical Director and DON.

What to assemble

  • PDHC Admission RequirementsAdmission requires: (1) physician prescription authorizing PDHC attendance; (2) ongoing active physician care; (3) pre-admission planning by Medical Director and DON; (4) written parent/guardian consent covering purpose, responsibilities, authorized treatments, liability, and emergency plans. Bake these into the intake workflow from day one.
Open source-backed requirements →
09
Chapter 09

Medi-Cal Enrollment

Medi-Cal PDHC enrollment runs through DHCS via the Provider Application and Validation for Enrollment (PAVE) system. CDPH PDHC license must be issued before enrollment can complete.

What this domain covers

Medi-Cal PDHC enrollment runs through DHCS via the Provider Application and Validation for Enrollment (PAVE) system. CDPH PDHC license must be issued before enrollment can complete.

What to assemble

  • DHCS PAVE EnrollmentEnroll as a Medi-Cal PDHC provider through the DHCS PAVE portal. License first, enrollment second — the order cannot be reversed. Verify current PAVE requirements and supporting-document list at dhcs.ca.gov before starting the application.
  • NPI (CMS NPPES) Pre-RequisiteObtain your NPI through the CMS NPPES system before completing Medi-Cal PAVE enrollment. The NPI is the canonical provider identifier linking your billing to your CDPH license.
Open source-backed requirements →
10
Chapter 10

Authorization / Payer Readiness (CCS)

California PDHC services are typically authorized through the California Children's Services (CCS) program. CCS paneling and treatment authorization requests (TARs) are part of the operating model.

What this domain covers

California PDHC services are typically authorized through the California Children's Services (CCS) program. CCS paneling and treatment authorization requests (TARs) are part of the operating model.

What to assemble

  • California Children's Services (CCS) PanelingPDHC services for medically eligible children are typically authorized through CCS. Understand CCS clinical eligibility, county-program intake, paneling requirements, and authorization (TAR) workflow before opening. Authorization must be in place before services begin.
  • Authorization Approval ≠ PaymentCCS / DHCS authorization approves the service; payment still depends on the claim meeting all Medi-Cal coverage criteria. Build cash-flow plans around this distinction — TAR in hand is not money in the bank.
Open source-backed requirements →
11
Chapter 11

Billing Evidence Readiness

California PDHC bills Medi-Cal under DHCS coverage policy. Service codes and rates come from the DHCS Medi-Cal Provider Manual — verify current rates directly with DHCS before pro-forma planning.

What this domain covers

California PDHC bills Medi-Cal under DHCS coverage policy. Service codes and rates come from the DHCS Medi-Cal Provider Manual — verify current rates directly with DHCS before pro-forma planning.

What to assemble

  • DHCS PDHC Coverage and Rate VerificationService codes and reimbursement for California PDHC are governed by the DHCS Medi-Cal Provider Manual. Verify the current PDHC code set, modifier rules, and rate schedule directly at dhcs.ca.gov before publishing pro-forma rates. Manual updates ship periodically — last-reviewed timestamps matter.
  • Daily Documentation → Billing EvidenceDesign daily attendance and service documentation so it produces clean billing evidence in real time, aligned to the active CCS / DHCS authorization period. Reconciling attendance against authorization windows after-the-fact creates avoidable denials.
Open source-backed requirements →
12
Chapter 12

Survey / Inspection Readiness

CDPH conducts initial and subsequent PDHC inspections. Survey readiness requires engagement with qualified PDHC consultants, legal counsel, and clinical leadership.

What this domain covers

CDPH conducts initial and subsequent PDHC inspections. Survey readiness requires engagement with qualified PDHC consultants, legal counsel, and clinical leadership.

What to assemble

  • CDPH Initial and Subsequent InspectionsCDPH Licensing & Certification conducts initial and ongoing inspections of California PDHCs. Operations must be continuously survey-ready: staffing ratios, documentation, QA program, and physical plant must meet Title 22 standards at all times.
  • Plan of Correction (POC) WorkflowDesign a corrective-action / plan-of-correction template and escalation model before opening. Deficiency citations require timely documented responses — do not wait until you receive a finding to design the workflow.
Open source-backed requirements →
13
Chapter 13

Systems / Software Readiness

No specific software system is required to obtain a California PDHC license. Founders should evaluate systems against their specific operating model and Title 22 + DHCS documentation requirements.

What this domain covers

No specific software system is required to obtain a California PDHC license. Founders should evaluate systems against their specific operating model and Title 22 + DHCS documentation requirements.

What to assemble

  • PDHC-Native vs. Generic EHR ChoiceCalifornia PDHC documentation (nursing protocol-of-care, QA records, attendance, CCS / DHCS authorization evidence) is materially different from outpatient EHR documentation. A PDHC-native system reduces the integration burden; a generic EHR can work but needs explicit adaptation.
Open source-backed requirements →
Planning awareness only.

This guide is not legal, clinical, billing, reimbursement, architectural, or licensing advice. Verify current requirements with official sources and qualified professionals.