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How to become a service provider

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The San Gabriel/Pomona Regional Center relies on our community service providers to meet the needs of our community. The Community Services Department is the division to identify, recruit, and maintain qualified services providers.  Our expectation is that our service provider community share our vision and commitment to providing quality services to our diverse population.  When becoming a vendor, you will primarily work with our resource development staff and vendor coordinators.

Resource Development

Our Resource Developers provide outreach to prospective individuals and entities interested in providing services to our community. Resource Developer’s provide technical assistance throughout the vendorization process and help to ensure the services both meet the current needs and are in compliance with applicable laws, regulations, and/or ordinances. 

  • The Resource Developers are available to assist with finding a generic resource or identifying and vendoring a resource that is needed.
  • Special resources developed through grant funding include a mental health resource website “Project Hope” & an employment website “WorkNow”


Vendorization

The Vendor Coordinators are responsible for the process for identification, selection, and utilization of service providers based on the qualifications and other requirements necessary in order to provide the services. The vendorization process allows regional centers to verify, prior to the provision of services to clients, that an applicant meets all of the requirements and standards specified in regulations. Applicants who meet the specified requirements and standards are assigned a service code and a unique vendor identification number.

  • Vendor Coordinators duties include entering new vendors into the system, including requesting out-of-area vendor information from other regional centers.
  • Vendor Coordinators maintain the rate table to ensure that all rates are supported by contracts, payment agreements, DDS rate letters or fee schedules.
  • Vendor Coordinators can assist new vendors, including parent vendors, in completing vendor applications and documents.
  • The New Vendor Request form is utilized when there is a need to add a new vendor to the system

Vendorization Application Process

The prospective vendor completes the vendor application and packet of documents that must be completed. The documents that must be included are:

  • DS1890

  • W-9 including Articles of Incorporation or Fictitious Statement if applicable

  • IRS letter-to verify the EIN # on W-9

  • HOME AND COMMUNITY BASED-SERVICES PROVIDER AGREEMENT (HAS TO BE ON BLUE PAPER)

  • CONFLICT OF INTEREST

  • PROVIDER VENDOR DEVELOPMENT QUESTIONNAIRE

  • APPLICANT’S TITLE 17 AND SPECIAL INCIDENT CERTIFICATION

  • HIPPA

  • AB1402- CHANGE IN WIC STATUTE –NOTIFICATION OF APPEALS PROCEDURE

  • INSURANCE REQUIREMENTS- including SGPRC as Certificate Name Holder

  • E-MAIL NOTIFICATION FORM

  • ENROLLMENT PROCESS – E-BILLING

  • EFT - OPTIONAL

  • DS1891- VERIFY ALL NAMES LISTED ON THE EXCLUSIONS DATABASE (https://exclusions.oig.hhs.gov/) AND DHS –SUSPENDED AND INELIGIBLE PROVIDER LIST (http://files.medi-cal.ca.gov/pubsdoco/SandILanding.asp)

  • Print results for each database and attached to the DS1891 form

  • DS1891 verification must be completed before vendorization is finalized

  • ZERO TOLERANCE POLICY

  • COPY OF BUSINESS/FACILITY LICENSE

  • COPY OF DRIVERS LICENSE AND SOCIAL SECURITY CARD IF APPLICABLE

  • CALIFORNIA SECRETARY OF STATE RESULTS TO VERIFY SUSPENDED LICENSES

If you are interested in pursuing vendorization with the San Gabriel/Pomona Regional Center, please feel free to contact, resources@sgprc.org for additional information.  Thank you for your interest in providing services to individuals with developmental disabilities.