Multipurpose Senior Services Program

The California Department of Aging (CDA) administers programs that serve older adults, adults with disabilities, family caregivers, and residents in long-term care facilities throughout the State. These services are provided locally by contracted agencies. This webpage is intended for those who provide, or seek to provide, Multipurpose Senior Services Program (MSSP) services.

For Providers & Partners - Program Narrative and Fact Sheets

For Consumers - Multipurpose Senior Services Program

The California Department of Aging is updating our website. Please contact your assigned program analyst should you require any contract-related documents.

MAGL NumberSubjectRevision Date
17-01Final Rule Implementing Section 1557 of the Affordable Care Act6/24/2019
21-01Google Home Smart Speakers Guidance Memo1/20/2021
Manual Section Subject
Philosophy Philosophy Statement
Table of Contents Table of Contents
Summary of Changes Summary of Changes
Chapter 1 Introduction
Chapter 2 Site Staffing
Chapter 3 Program Components
Chapter 4 Quality Assurance and Program Review
Chapter 5 Participant Records and Information
Chapter 6 Participant Rights
Chapter 7 Information System Components
Chapter 8 Service Vendors
Chapter 9 Site Budget and Claims Reimbursement
Chapter 10 Equipment
Appendix 01 Right to State Medi-Cal Fair Hearing
Appendix 02 Termination of Services NOA (Available in other languages)
Appendix 02 - Arabic Termination of Services NOA
Appendix 02 - Chinese Simple Termination of Services NOA
Appendix 02 - Chinese Traditional Termination of Services NOA
Appendix 02 - Korean Termination of Services NOA
Appendix 02 - Russian Termination of Services NOA
Appendix 02 - Spanish Termination of Services NOA
Appendix 03 Change in Services NOA (Available in other languages)
Appendix 03 - Arabic Change in Services NOA
Appendix 03 - Chinese Simple Change in Services NOA
Appendix 03 - Chinese Traditional Change in Services NOA
Appendix 03 - Korean Change in Services NOA
Appendix 03 - Russian Change in Services NOA
Appendix 03 - Spanish Change in Services NOA
Appendix 04 Your Right to Appeal (Available in other languages)
Appendix 04 - Arabic Your Right to Appeal
Appendix 04 - Chinese Simple Your Right to Appeal
Appendix 04 - Chinese Traditional Your Right to Appeal
Appendix 04 - Korean Your Right to Appeal
Appendix 04 - Russian Your Right to Appeal
Appendix 04 - Spanish Your Right to Appeal
Appendix 05 Request for State Fair Hearing Form (Available in other languages)
Appendix 05 - Arabic Request for State Fair Hearing Form
Appendix 05 - Chinese Simple Request for State Fair Hearing Form
Appendix 05 - Chinese Traditional Request for State Fair Hearing Form
Appendix 05 - Korean Request for State Fair Hearing Form
Appendix 05 - Russian Request for State Fair Hearing Form
Appendix 05 - Spanish Request for State Fair Hearing Form
Appendix 06 Hearing Withdrawal Form
Appendix 07 Participant Non-Discrimination Notice
Appendix 08 Language Assistance Taglines
Appendix 09 Medi-Cal Aid Codes
Appendix 10 Institutional Deeming Waiver Aid Codes
Appendix 11 CDA Waiver Referral
Appendix 12 Application (Available in other languages)
Appendix 12 - Arabic Application
Appendix 12 - Chinese Simple Application
Appendix 12 - Chinese Traditional Application
Appendix 12 - Korean Application
Appendix 12 - Russian Application
Appendix 12 - Spanish Application
Appendix 13 Application for MSSP-Institutional Deeming (Available in other languages)
Appendix 13 - Spanish Application for MSSP-Institutional Deeming
Appendix 14 Deinstitutional Services Request (Available in other languages)
Appendix 14 - Spanish Deinstitutional Services Request
Appendix 15 Deinstitutional Services Data Tracking Form
Appendix 16 Participant Rights (Available in other languages)
Appendix 16 - Arabic Participant Rights
Appendix 16 - Chinese Simple Participant Rights
Appendix 16 - Chinese Traditional Participant Rights
Appendix 16 - Korean Participant Rights
Appendix 16 - Russian Participant Rights
Appendix 16 - Spanish Participant Rights
Appendix 17 Your Rights Under California Public Benefits Programs
Appendix 18 Authorization for Use and Disclosure of Personal Health Information (Available in other languages)
Appendix 18 - Arabic Authorization for Use and Disclosure of Personal Health Information
Appendix 18 - Chinese Simple Authorization for Use and Disclosure of Personal Health Information
Appendix 18 - Chinese Traditional Authorization for Use and Disclosure of Personal Health Information
Appendix 18 - Korean Authorization for Use and Disclosure of Personal Health Information
Appendix 18 - Russian Authorization for Use and Disclosure of Personal Health Information
Appendix 18 - Spanish Authorization for Use and Disclosure of Personal Health Information
Appendix 19 Title 22 LOC Criteria
Appendix 20 LOC Certification
Appendix 21 Participant Enrollment Termination Form
Appendix 22 Cover - ALL Assessments (Optional)
Appendix 23 Deinstitutional Assessment
Appendix 24 Initial Health Assessment
Appendix 24A Initial Health Assessment Summary (Optional)
Appendix 25 Initial Psychosocial Assessment
Appendix 25A Initial Psychosocial Assessment Summary (Optional)
Appendix 26 Psychological Functioning
Appendix 26A Psychological Functioning Instructions
Appendix 27 Reassessment Summary
Appendix 28 Functional Needs Assessment Grid
Appendix 28A Functional Needs Assessment Grid Instructions
Appendix 29 Participant's Medications
Appendix 30 Approved Cognitive Screening Tools
Appendix 31 Determine Your Nutritional Health
Appendix 32 Participant's Physicians and Other Health Professionals (Optional)
Appendix 33 Institutionalization Form (Optional)
Appendix 34 Care Plan (Available in other languages)
Appendix 34 - Arabic Care Plan
Appendix 34 - Chinese Simple Care Plan
Appendix 34 - Chinese Traditional Care Plan
Appendix 34 - Korean Care Plan
Appendix 34 - Russian Care Plan
Appendix 34 - Spanish Care Plan
Appendix 34A Care Plan Instructions
Appendix 35 Negotiated Risk Agreement Form
Appendix 35A Negotiated Risk Agreement Form- Example A
Appendix 35B Negotiated Risk Agreement Form- Example B
Appendix 36 Service Planning and Utilization Summary (SPUS)
Appendix 37 Licensure & Certification - Provider Qualifications
Appendix 38 MSSP Service Vendor Application
Appendix 39 Vendor Licensing Form
Appendix 40 File Specifications
Appendix 41 Rate Sheet Sorted by EDS Procedure Code
Appendix 42 HCPCS Billing Codes (Placeholder)
Appendix 43 Property/Equipment Instructions
Appendix 44 Title III Services
Appendix 45 MOU DSS-CDA
Appendix 46 PACE Policy Letter 17-01
Appendix 47 SCAN Policy Letter 17-01
Appendix 48 HCBS Settings Requirements 42 CFR 441.301(c)(4)
Appendix 49 Requesting an Exemption to Minimum Qualifications for CM Staff
Appendix 50 NCM TD Pathway
Appendix 51 NCM-SWCM TD Plan
Appendix 52 SWCM-NCM Checklist
Appendix 53 SWCM TD Pathway
Appendix 54 SCM TD Plan
Appendix 55 SCM Orientation Checklist
Appendix 56 SCM Pathway
Appendix 57 Electronic Utilization Review Tool (Available on FIFO)

MSSP Waiver Amendment Submitted

The Department of Health Care Services (DHCS) and the California Department of Aging (CDA) have submitted an amendment of the Multipurpose Senior Services Program (MSSP) Waiver to the Centers for Medicare & Medicaid Services (CMS) for approval. The amendment application includes revised content based on input received from stakeholders during the 30-day Public Comment Period held October 1 – October 30, 2021. All changes to the MSSP Waiver program must be approved by CMS before they can be implemented.

• Application for a 1915(c) HCBS Waiver
• MSSP Waiver Amendment Public Comment Summary

MSSP Waiver Appendix K Applications and Approvals

In response to the COVID-19 emergency, the Centers for Medicare & Medicaid Services (CMS) has approved several 1915(c) Home and Community-Based Services (HCBS) Waiver modifications under Appendix K authority, for the Multipurpose Senior Services Program (MSSP). These modifications allow temporary flexibilities, such as telephonic or video visits in lieu of home visits, for MSSP.

MSSP Waiver Renewal Announcement

The Department of Health Care Services (DHCS) and the California Department of Aging (CDA) are pleased to announce the approval of the 1915(c) Multipurpose Senior Services Program (MSSP), Home and Community-Based Services Waiver, Control Number 0141.R06.00. On Friday, November 1, 2019, DHCS received official notice from the Centers for Medicare & Medicaid Services (CMS) that the MSSP Waiver was approved for the period July 1, 2019 through June 30, 2024. MSSP will continue to provide social and health care management services and purchased waiver services for frail older adults as a cost-effective alternative to institutionalization.

CA 0141 MSSP 2019 Approval Letter

§1915(c) Home and Community-Based Waiver Application

Statewide Transition Plan for Home and Community-Based Settings

The California Department of Health Care Services (DHCS) has released a draft Statewide Transition Plan (STP) as required by new Federal regulations. These new regulations, effective March 17, 2014, establish requirements for settings eligible for Medicaid Home and Community-Based Services funding. The draft Statewide Transition Plan, and information on providing input required to finalize the plan, is available on the DHCS website.

Program Resources

Click here to access program resources.

For past and current program data visit the CDA COVID-19 Response Data Dashboard and the Data and Reports sections of the website.