Program Design Addendum Process Resource Development

Types of Changes Change of Ownership/ Entity Change For Sole Proprietors becoming Limited Liability Corporations, Corporations or a Partnership. Facility Name Change Location Change Type Change Change in Program/Service Design Change in Mailing Address, Email Address or Phone Number (process does not require an addendum and is completed with the Vendorization unit directly)

Addendum Process for Change in Ownership/Entity, Name Change or Type Change Before Contacting IRC to make the change, must be in the process of updating Community Care Licensing, Department of Health, Professional or Business License as applicable. A current updated license reflecting the change, or proof that it is in pending status is required. Before the process is complete a copy of the updated and active license must be submitted. IDT meetings with IRC Consumer Service Coordinator, and the individual to occur to review the changes being made. *Please note: For Change in Ownership/Entity, new prospective provider will be required to attend IRC’s New Residential Provider Orientation.

Letter of Intent Notify the QA Liaison of change in writing. Send the Letter of Intent to NRSPO@inlandrc.org Must contain the following: Vendor Name Current Licensee and Administrator (if applicable) Type of change requested Indicate whether or not the Tax ID will be changing RDTU CSTIII will respond to the email with a checklist to complete the addendum

Addendum Checklist The addendum must then be completed according to the checklist, and with all required supporting documentation included. Once complete, the addendum, supporting documentation and the checklist should be sent to RDTU by email at NRSPO@inlandrc.org. The addendum will then be assigned to a Community Resource Specialist to review. With each submission the Community Resource Specialist has 45 days to review the addendum Once Approved, the Community Resource Specialist will inform the vendor and forward the addendum and supporting documentation to the Vendorization Unit to complete the Vendorization process.

Addendum Process for Location Change Prior to any location change, the new location must first be approved by IRC’s Quality Assurance Liaison. Inform the QA Liaison in writing of the proposed location and moving date, and request to schedule a walkthrough of the new location with QA Liaison. At this point it is advised to begin the process of getting the new location licensed with Community Care Licensing. If QA Liaison approves the new location, RDTU will be informed, and a program design addendum checklist will be emailed. Return the completed addendum, with all necessary attachments and the checklist to RDTU by email at NRSPO@inlandrc.org The location change addendum will be assigned to a Community Resource Specialist for review. (with each submission there is a 45 day timeline to review) Once approved, the Community Resource Specialist will respond in writing.

Change in Program/Service Design IRC must be notified 30 days prior to any change to the program design or service design in accordance to Title 17, Sections 56712(B); 56762(C), 56780(B) Notify QA Liaison, of the requested change in writing A Community Resource Specialist will be assigned to request an addendum With each submission the Community Resource Specialist has 45 days to review the addendum Once approved, the vendor will receive written notification, and The Community Resource Specialist will notify all applicable parties, including, Vendorization, Quality Assurance and the RDTU Program Manager. A copy of the approved addendum will be sent to IRC’s Vendorization and Quality Assurance Units.

Questions???