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Innovations at Work
Partners in Action
About Us
Support Us
Events
- Tribute Dinner
Workforce Development
Training Center
Community Care Hub

Innovations at Work
Partners in Action
About Us
Support Us
Events
- Tribute Dinner
Workforce Development
Training Center
Community Care Hub

Innovations at Work
Partners in Action
About Us
Support Us
Events
- Tribute Dinner
Workforce Development
Training Center
Community Care Hub

Community Care Hub Provider Application

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Application Date(Required)

Main Contact Name(Required)

First Last

Phone(Required)

Email(Required)

Agency Name(Required)

Website(Required)

Tax ID(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

How did you hear about us?(Required)

If colleague/organization, please specify

If health plan, please specify

If other, please specify

Provide a brief description of your organization's background, experience and qualifications(Required)

Days and Hours of Operation(Required)

Populations Served/Focus(Required)

Individuals experiencing homelessness

Individuals who are at risk for avoidable hospital or emergency department (ED) care

Individuals with serious mental health and/or substance use disorder (SUD) needs

Adults living in the community and at risk for long-term care institutionalization

Adult nursing facility residents transitioning to the community

Children and youth enrolled in California Children’s Services (CCS) or CCS Whole Child Model with additional needs beyond their CCS condition(s)

Children and youth involved in child welfare (foster care)

Individuals with intellectual or developmental disabilities (I/DD)

Adults and youth who are transitioning from incarceration

Pregnant and postpartum individuals

Birth equity population of focus

Other

If other, please specify populations served/focus

Ages Served(Required)

Individuals served per year(Required)

List current services offered(Required)

Check off all counties served(Required)

Alameda

Alpine

Amador

Butte

Calaveras

Colusa

Contra Costa

Del Norte*

El Dorado

Fresno

Glenn

Humboldt*

Imperial

Inyo*

Kern*

Kings

Lake

Lassen*

Los Angeles

Madera

Marin

Mariposa

Mendocino *

Merced

Modoc*

Mono*

Monterey

Napa

Nevada

Orange

Placer

Plumas*

Riverside

Sacramento

San Benito

San Bernardino

San Diego

San Francisco

San Joaquin

San Luis Obispo

San Mateo

Santa Barbara

Santa Clara

Santa Cruz

Shasta

Sierra

Siskiyou

Solano

Sonoma

Stanislaus

Sutter

Tehama

Trinity

Tulare

Tuolumne

Ventura

Yolo

Yuba

*=Primary area of coverage needed

NPI#

# of Staff(Required)

Number of years providing service(Required)

For Enhanced Care Management (ECM), are your staff trained in person-centered care planning?(Required)

Yes

No

For Private Duty (personal care, homemaker and respite) services, are you a licensed Home Care Organization?(Required)

Yes

No

N/A

If yes, what is your HCO license number?

Bilingual Staff(Required)

Yes

No

Languages Served(Required)

List current Health Plan Contracts if applicable

Please select Community Care Hub Contracted Services interested in providing(Required)

Enhanced Care Management (ECM)

HomeMeds/Med Reconciliation

Evidence Based Self-Management Workshops

Private Duty

Care Transition

Meals

Service Coordination/Care Coordination

Hub Business Services*

Other services not listed here

*Hub Business services only as defined (Leadership and governance, Strategic business development, Network recruitment, Engagement and support, Contract administration and compliance, Operations, Information technology and security)

If other services not listed here, please specify

Partners in Care Foundation

732 Mott Street, Suite 150, San Fernando CA 91340

P: 818.837.3775

F: 818.837.3799

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You may be eligible to earn up to $2,750 for participating in the training.

Please answer a few questions to see if you qualify.

Are you 18 years of age or older?(Required)

Yes

No

Are you a resident of California?(Required)

Yes

No

Are you licensed (such as an RNs or LVNs) or certified as an HHA?(Required)

Yes

No

Have you worked as a paid direct care worker (home care aides, care coordinators or care managers, dementia care specialists, non-IHSS affiliated personal care assistants, activities coordinators, transportation providers, community health workers) for the last 60 days?(Required)

Yes

No

Unfortunately, you are not currently eligible for these incentive programs. You can still take this free course by registering here.

You may qualify for the CalGrows incentive payments. Click here to complete registration.

You may qualify for the Caring4Cal incentive payments. Click here to complete registration.

Community Wellness Workshop Sign-Up Form

Name(Required)

First Last

Email(Required)

Phone(Required)

Please select which workshop you are interested in participating in:(Required)

Arthritis Foundation Exercise Program - La Mirada Activity Center (3/26/2024-5/2/2024)

Arthritis Foundation Exercise Program - Hawthorne Senior Center (3/26/2024-5/2/2024)

Arthritis Foundation Exercise Program - SBSS Mid-City Senior Center (4/2/2024-5/9/2024)

Arthritis Foundation Exercise Program - Long Beach Senior Housing (4/8/2024-5/16/2024)

Arthritis Foundation Exercise Program - Canyon Country Community Center (4/8/2024-5/17/2024)

Arthritis Foundation Exercise Program - Lawndale Community Center (4/9/2024-5/16/2024)

Arthritis Foundation Exercise Program - Independent Square (4/9/2024-5/17/2024)

Arthritis Foundation Exercise Program - Beverly Hills Carmel South (4/10/2024-5/17/2024)

Arthritis Foundation Exercise Program - Beverly Hills Carmel North (4/10/2024-5/17/2024)

Arthritis Foundation Exercise Program - Independent Square (4/23/2024-5/31/2024)

Arthritis Foundation Exercise Program - White Memorial (Spanish) (4/24/2024-5/31/2024)

Arthritis Foundation Exercise Program - Online Group E (5/6/2024-6/17/2024)

Arthritis Foundation Exercise Program - Pasadena Senior Center (5/13/2024-6/24/2024)

Bingocize - Online Group T (3/25/2024-6/3/2024)

Bingocize - Westchester Senior Center (4/16/2024-6/20/2024)

Chronic Disease Self-Management Program - Parks Chapel AME Church (4/29/2024-6/10/2024)

Chronic Disease Self-Management Program Online Group H (5/10/2024-6/14/2024)

Chronic Pain Self Management Program - Legacy Commons for Active Seniors (4/2/2024-5/7/2024)

Chronic Pain Self Management Program - Imperial Beach Library (San Diego) (4/4/2024-5/9/2024)

Chronic Pain Self Management Program - Telephonic Toolkit (Ventura) (5/7/2024-6/11/2024)

Chronic Pain Self Management Program - Telephonic Toolkit (Ventura) (5/7/2024-6/11/2024)

Diabetes Self Management - Vistas Apartments (RHF) (4/3/2024-5/8/2024)

Diabetes Self Management - Venice Japanese Community Center (4/11/2024-5/15/2024)

Diabetes Self Management - Ahmanson Senior Citizen Center (4/16/2024-5/21/2024)

Diabetes Self Management - Weingart Senior Center (4/23/2024-6/4/2024)

Diabetes Self Management - Legacy Commons for Active Seniors (5/14/2024-6/18/2024)

Diabetes Self Management - Imperial Beach Community Clinic (San Diego) (3/20/2024-4/24/2024)

Diabetes Self Management - Telephonic Toolkit (Ventura) (5/16/2024-6/30/2024)

EnhanceFitness - Ladera Park (4/8/2024-5/22/2024)

Matter of Balance - Lawndale Community Center (6/5/2024-6/28/2024)

Tai Chi - DD (4/9/2024-6/13/2024)

Tai Chi - CC (4/22/2024-6/26/2024)

Walk With Ease - Miramar Towers (4/23/2024-5/30/2024)

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