TransparencyLicensed Psychologist
Guidelines
Harbor Regional Center is accepting applications for the following:
Service Code / Type: Service Code 056: Interdisciplinary Assessment Service
Rate of Reimbursement: Psychological Testing Services will be reimbursed at an hourly rate, calculated under the Usual and Customary Rate process.
Location: Harbor Regional Center catchment area (See Map) including Catalina Island
Service Description: Harbor Regional Center is seeking qualified licensed Psychologists to become vendored to provide psychological testing and related services for children and adults. The majority of the testing will serve to evaluate for the presence of an Intellectual Disability and/or Autism Spectrum Disorder. There also will be need on occasion to conduct other assessments to evaluate for mental health diagnoses and/or other neuropsychological conditions.
Applicants responding to this LOI who are currently vendored service providers for any other regional center must have services in good standing.
Applicants must disclose any potential conflicts of interest per Title 17, Section 54500. Applicants, including members of governing boards, must be in good standing in regard to all services vendored with any regional center. For partnership submissions, all partners should have full knowledge of the contents of the proposal submitted and must demonstrate commitment to the project during start-up as well as ongoing operations.
General Requirements:
- An applicant shall be, at minimum, validly licensed as a psychologist (Ph.D. or Psy.D.) by the California State Board of Psychology
- Must meet all applicable Title 17 regulations. Regarding eligibility for the Usual and Customary Rate, reference Section 57219(a)(19), Title 17, California Code of Regulations.
- Must meet all applicable Americans with Disabilities Act (ADA) standards
- Must demonstrate understanding and experience working with the developmentally disabled population
- Only upon Harbor Regional Center approval to move forward in the resource development process, service provider must establish a physical business office and a business license located within Harbor’s catchment area; and (P.O. Boxes are only permitted as a mailing address, and do not qualify to meet the office requirement)
- Must have or obtain Commercial General Liability and Professional Liability, Abuse, and Molestation Insurance Policies in the amounts of $1 million per occurrence/$3 million aggregate with Harbor Regional Center listed
Interested applicants shall submit the following documentation
via email to Resource.Development@harborrc.org. Please
indicate ”056 LOI” in the subject line of your email.
Application Deadline: July 31, 2024 5:00 PM
Please include:
- Copy of current Resume/CV;
- Copy of current CA Psychologist License;
- Brief description of experience with and understanding the needs of developmentally disabled population and their families, 3 pages or less;
- Schedule of service operating hours including days and times when the service is available.
Please also attach:
• Service Provider Inquiry Cover Page
• Preliminary Service Provider Inquiry Experience and
Qualifications Form
• DS1891 Applicant/Vendor Disclosure Statement Form
*The purpose of the DS1891 form is to identify prospective vendors that may be ineligible for vendorization because the Service Provider has been convicted of a crime related to the Medicare, Medicaid or Title XX programs or has been convicted of abuse or neglect of an elder, dependent adult, or child. An applicant or vendor entity must provide an original, signed DS1891 Form to the Regional Center for each program that is separately vendored by the Regional Center. All Service Providers are required to comply with vendorization requirements established in the Welfare & Institutions Code, Section 4648.12 and California Code of Regulations (CCR), Title 17, Section 54311, including other requirements established in the regulations regarding the Service Provider’s eligibility to provide services.
Late or incomplete applications will not be accepted for review.
DS1891 Application Vendor Disclosure Statement
Preliminary Service Provider Inquiry Experience and Qualifications Form