California PDHC Requirements Library

01.01 02 · Establish

Entity & Ownership

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.

01.02 02 · Establish

Entity & Ownership

Administrator of Record

Identify 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.

02.01 02 · Establish

Facility & Physical Plant

Site Selection + Zoning

Identify 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.

02.02 02 · Establish

Facility & Physical Plant

Architect Review Against Title 22

Engage 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.

03.01 03 · License & enroll

CDPH Licensing

CDPH PDHC Application Packet

Obtain 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.

03.02 03 · License & enroll

CDPH Licensing

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.

03.03 03 · License & enroll

CDPH Licensing

Adverse-History Review

Review 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.

04.01 03 · License & enroll

Medical Director Readiness

Medical Director — Board-Certified Pediatrician

The 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.

05.01 04 · Build operations

Nursing Operations Readiness

Director of Nursing (DON) Qualifications

California-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.

05.02 04 · Build operations

Nursing Operations Readiness

Title 22 PDHC Staffing Ratios

Census 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.

06.01 05 · Open & improve

Operations / QA Readiness

QA/QI Committee Design

Design 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.

07.01 03 · License & enroll

Medical Records Readiness

Nursing Protocol of Care

Develop 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.

07.02 03 · License & enroll

Medical Records Readiness

Medical Record Content and Retention

Map record-content and retention requirements from Title 22 into your record design before opening. Verify current retention period against the current Title 22 text.

08.01 04 · Build operations

Admissions Readiness

PDHC Admission Requirements

Admission 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.

09.01 03 · License & enroll

Medi-Cal Enrollment

DHCS PAVE Enrollment

Enroll 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.

09.02 03 · License & enroll

Medi-Cal Enrollment

NPI (CMS NPPES) Pre-Requisite

Obtain 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.

10.01 05 · Open & improve

Authorization / Payer Readiness (CCS)

California Children's Services (CCS) Paneling

PDHC 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.

10.02 05 · Open & improve

Authorization / Payer Readiness (CCS)

Authorization Approval ≠ Payment

CCS / 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.

11.01 05 · Open & improve

Billing Evidence Readiness

DHCS PDHC Coverage and Rate Verification

Service 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.

11.02 05 · Open & improve

Billing Evidence Readiness

Daily Documentation → Billing Evidence

Design 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.

12.01 05 · Open & improve

Survey / Inspection Readiness

CDPH Initial and Subsequent Inspections

CDPH 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.

12.02 05 · Open & improve

Survey / Inspection Readiness

Plan of Correction (POC) Workflow

Design 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.

13.01 05 · Open & improve

Systems / Software Readiness

PDHC-Native vs. Generic EHR Choice

California 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.