If you need assistance with Long-Term Care or Intermediate Care Facility – Developmentally Disabled or additional resources, go to our Skilled Nursing Resources web page.
To request authorization that is needed for LTC or ICF/DD, complete and fax a Prior Authorization form.
- Fax: 213-438-4877
- Required Documents for ICF/DD:
- L.A. Care Authorization Request Form
- Certification for Special Treatment Program Services form (HS 231) signed by Regional Center
- Medical Review/Prolonged Care Assessment (PCA) form (DHCS 6013A)
Please note: Initial ICF/DD placement needs to be coordinated with Regional Center