MHP Provider Documents

This page is utilized by BHS Provider Staff to obtain forms, manuals and reports for the electronic health record, Cerner Community Behavioral Health.

A new Cerner Community Behavior Health (CCBH) EHR Training Tips and Resources page is now available for providers and Program Managers.

For Behavioral Health Services Provider Communications and Local information on COVID-19 Please visit the County OF San Diego Webpage.Coronavirus Disease 2019 COVID-19

NOABD

NOABD Webinar available online.


NOABD_Grievance_and_Appeal_Timely_Resolution_Notice_-_SPANISH.doc	-	2018-08-07
NOABD_Modification_Notice_-_SPANISH.doc	-	2018-08-07
NOABD_Authorization_Delay_Notice_-_ENGLISH.doc	-	2018-08-07
NOABD_Your_Rights_Notice_-_VIETNAMESE.doc	-	2018-08-07
NOABD_Delivery_System_Notice_-_ENGLISH.doc	-	2018-08-07
NOABD_Authorization_Delay_Notice_-_SPANISH.doc	-	2018-08-07
NOABD_Financial_Liability_Notice_-_ENGLISH.doc	-	2018-08-07
NOABD_Language_Assistance_Notice_-_ENGLISH.doc	-	2018-08-07
NOABD_Payment_Denial_Notice_-_ENGLISH.docx	-	2018-08-07
NOABD_Timely_Access_Notice_-_ARABIC.doc	-	2018-08-07
NOABD_Grievance_and_Appeal_Timely_Resolution_Notice_-_TAGALOG.docx	-	2018-08-07
NOABD_Timely_Access_Notice_-_SPANISH.doc	-	2018-08-07
NOABD_Your_Rights_Notice_-_TAGALOG.docx	-	2018-08-07
NOABD_Your_Rights_Notice_-_SPANISH.doc	-	2018-08-07
NOABD_Timely_Access_Notice_-_TAGALOG.docx	-	2018-08-07
NOABD_Grievance_and_Appeal_Timely_Resolution_Notice_-_ENGLISH.doc	-	2018-08-07
NOABD_Modification_Notice_-_ENGLISH.doc	-	2018-08-07
NOABD_Grievance_and_Appeal_Timely_Resolution_Notice_-_ARABIC.doc	-	2018-08-07
NOABD_Authorization_Delay_Notice_-_TAGALOG.docx	-	2018-08-07
NOABD_Termination_Notice_-_ARABIC.doc	-	2018-08-07
NOABD_Modification_Notice_-_ARABIC.doc	-	2018-08-07
NOABD_Payment_Denial_Notice_-_ARABIC.docx	-	2018-08-07
NOABD_Modification_Notice_-_FARSI.doc	-	2018-08-07
NOABD_Financial_Liability_Notice_-_VIETNAMESE.doc	-	2018-08-07
NOABD_Your_Rights_Notice_-_ARABIC.doc	-	2018-08-07
NOABD_Your_Rights_Notice_-_VIETNAMESE.pdf	-	2018-08-07
NOABD_Your_Rights_Notice_-_FARSI.pdf	-	2018-08-07
NOABD_Grievance_and_Appeal_Timely_Resolution_Notice_-_VIETNAMESE.doc	-	2018-08-07
NOABD_Language_Assistance_Notice_-_ENGLISH.pdf	-	2018-08-07
NOABD_Your_Rights_Notice_-_ENGLISH.doc	-	2018-08-07
NOABD_Your_Rights_Notice_-_SPANISH.pdf	-	2018-08-07
NOABD_Financial_Liability_Notice_-_FARSI.doc	-	2018-08-07
NOABD_Timely_Access_Notice_-_ENGLISH.doc	-	2018-08-07
NOABD_Delivery_System_Notice_-_VIETNAMESE.doc	-	2018-08-07
NOABD_Termination_Notice_-_VIETNAMESE.doc	-	2018-08-07
NOABD_Termination_Notice_-_ENGLISH.doc	-	2018-08-07
NOABD_Termination_Notice_-_TAGALOG.docx	-	2018-08-07
NOABD_Payment_Denial_Notice_-_VIETNAMESE.docx	-	2018-08-07
NOABD_Modification_Notice_-_VIETNAMESE.doc	-	2018-08-07
NOABD_Modification_Notice_-_TAGALOG.docx	-	2018-08-07
NOABD_Payment_Denial_Notice_-_TAGALOG.docx	-	2018-08-07
NOABD_Financial_Liability_Notice_-_SPANISH.doc	-	2018-08-07
NOABD_Timely_Access_Notice_-_VIETNAMESE.doc	-	2018-08-07
NOABD_Your_Rights_Notice_-_ENGLISH.pdf	-	2018-08-07
NOABD_Timely_Access_Notice_-_FARSI.doc	-	2018-08-07
NOABD_Authorization_Delay_Notice_-_FARSI.doc	-	2018-08-07
NOABD_Grievance_and_Appeal_Timely_Resolution_Notice_-_FARSI.doc	-	2018-08-07
NOABD_Your_Rights_Notice_-_TAGALOG.pdf	-	2018-08-07
NOABD_Your_Rights_Notice_-_ARABIC.pdf	-	2018-08-07
NOABD_Delivery_System_Notice_-_SPANISH.doc	-	2018-08-07
NOABD_Authorization_Delay_Notice_-_ARABIC.doc	-	2018-08-07
NOABD_Payment_Denial_Notice_-_FARSI.docx	-	2018-08-07
NOABD_Authorization_Delay_Notice_-_VIETNAMESE.doc	-	2018-08-07
NOABD_Delivery_System_Notice_-_ARABIC.doc	-	2018-08-07
NOABD_Delivery_System_Notice_-_TAGALOG.docx	-	2018-08-07
NOABD_Financial_Liability_Notice_-_TAGALOG.docx	-	2018-08-07
NOABD_Your_Rights_Notice_-_FARSI.doc	-	2018-08-07
NOABD_Financial_Liability_Notice_-_ARABIC.doc	-	2018-08-07
NOABD_Delivery_System_Notice_-_FARSI.doc	-	2018-08-07
NOABD_Termination_Notice_-_FARSI.doc	-	2018-08-07
NOABD Denial of Authorization Notice – ARABIC (doc)	-	2018-08-07
NOABD Denial of Authorization Notice – CHINESE (doc)		2023-12-01
NOABD Denial of Authorization Notice – ENGLISH (doc)		2020-06-16
NOABD Denial of Authorization Notice – FARSI (doc)	-	2018-08-07
NOABD Denial of Authorization Notice – KOREAN (doc)		2023-12-01
NOABD Denial of Authorization Notice – SOMALI (doc)		2023-12-01
NOABD Denial of Authorization Notice – SPANISH (doc)	-	2018-08-07
NOABD Denial of Authorization Notice – TAGALOG (docx)	-	2018-08-07
NOABD Denial of Authorization Notice – VIETNAMESE (doc)	-	2018-08-07
NOABD Payment Denial Notice SPANISH (docx)		2020-06-16
NOABD Table	Revised April 2024	2024-05-23
NOABD Termination Notice - SPANISH (doc)		2020-05-08
NOABD_Authorization_Delay_Notice_-_CHINESE.doc		2023-12-01
NOABD_Authorization_Delay_Notice_-_KOREAN.doc		2023-12-01
NOABD_Authorization_Delay_Notice_-_SOMALI.doc		2023-12-01
NOABD_Delivery_System_Notice_-_CHINESE.doc		2023-12-04
NOABD_Delivery_System_Notice_-_CHINESE.pdf		2023-12-04
NOABD_Delivery_System_Notice_-_KOREAN.doc		2023-12-04
NOABD_Delivery_System_Notice_-_KOREAN.pdf		2023-12-04
NOABD_Delivery_System_Notice_-_SOMALI.doc		2023-12-04
NOABD_Delivery_System_Notice_-_SOMALI.pdf		2023-12-04
NOABD_Financial_Liability_Notice_-_CHINESE.doc		2023-12-01
NOABD_Financial_Liability_Notice_-_KOREAN.doc		2023-12-01
NOABD_Financial_Liability_Notice_-_SOMALI.doc		2023-12-01
NOABD_Grievance_and_Appeal_Timely_Resolution_Notice_-_CHINESE.doc		2023-12-01
NOABD_Grievance_and_Appeal_Timely_Resolution_Notice_-_KOREAN.doc		2023-12-01
NOABD_Grievance_and_Appeal_Timely_Resolution_Notice_-_SOMALI.doc		2023-12-04
NOABD_Modification_Notice_-_CHINESE.doc		2023-12-04
NOABD_Modification_Notice_-_KOREAN.doc		2023-12-04
NOABD_Modification_Notice_-_SOMALI.doc		2023-12-04
NOABD_Payment_Denial_Notice_-_CHINESE.docx		2023-12-04
NOABD_Payment_Denial_Notice_-_KOREAN.docx		2023-12-04
NOABD_Payment_Denial_Notice_-_SOMALI.docx		2023-12-04
NOABD_Termination_Notice_-_CHINESE.doc		2023-12-04
NOABD_Termination_Notice_-_KOREAN.doc		2023-12-04
NOABD_Termination_Notice_-_SOMALI.doc		2023-12-04
NOABD_Timely_Access_Notice_-_CHINESE.doc		2023-12-04
NOABD_Timely_Access_Notice_-_KOREAN.doc		2023-12-04
NOABD_Timely_Access_Notice_-_SOMALI.doc		2023-12-04
NOABD_Your_Rights_Notice_-_CHINESE.doc		2023-12-04
NOABD_Your_Rights_Notice_-_CHINESE.pdf		2023-12-04
NOABD_Your_Rights_Notice_-_KOREAN.doc		2023-12-04
NOABD_Your_Rights_Notice_-_KOREAN.pdf		2023-12-04
NOABD_Your_Rights_Notice_-_SOMALI.doc		2023-12-04
NOABD_Your_Rights_Notice_-_SOMALI.pdf		2023-12-04
SanWITS NOABD		2019-10-25
SanWITS NOABD		2019-10-25

Beneficiary

The order form to request hard copies of Beneficiary Materials is available online


MHP Beneficiary Handbook_January 2024_English_Large Font.pdf		2024-10-10
MHP Beneficiary Handbook_January 2024_English.pdf		2024-10-10


MHP Beneficiary Handbook Summary of Changes 12-1-23 (pdf)	Updated December 2023	2023-11-28


MHP Beneficiary Handbook_January 2024_Tagalog_Large Font.pdf		2024-10-10
MHP Beneficiary Handbook_January 2024_Spanish_Large Font.pdf		2024-10-10
MHP Beneficiary Handbook_January 2024_Vietnamese_Large Font.pdf		2024-10-10
MHP Beneficiary Handbook_January 2024_Somali.pdf		2024-10-10
MHP Beneficiary Handbook_January 2024_Persian (Dari_Farsi)_Large Font.pdf		2024-10-10
MHP Beneficiary Handbook_January 2024_Chinese (Trad).pdf		2024-10-10
MHP Beneficiary Handbook_January 2024_Spanish.pdf		2024-10-10
MHP Beneficiary Handbook_January 2024_Somali_Large Font.pdf		2024-10-10
MHP Beneficiary Handbook_January 2024_Persian (Dari_Farsi).pdf		2024-10-10
MHP Beneficiary Handbook_January 2024_Tagalog.pdf		2024-10-10
MHP Beneficiary Handbook_January 2024_Chinese (Trad)_Large Font.pdf		2024-10-10
MHP Beneficiary Handbook_January 2024_Korean.pdf		2024-10-10
MHP Beneficiary Handbook_January 2024_Vietnamese.pdf		2024-10-10
MHP Beneficiary Handbook_January 2024_Arabic.pdf		2024-10-10
MHP Beneficiary Handbook_January 2024_Arabic_Large Font.pdf		2024-10-10
MHP Beneficiary Handbook_January 2024_Korean_Large Font.pdf		2024-10-10


San Diego Provider List Translation Instructions (pdf)	Revised 12/13/2024	2024-12-13
BBS Required Notice to Consumers SC1024 (pdf)		2024-12-10
BBS Required Notice to Consumers 2022 (pdf)		2024-12-10
MHP Beneficiary Handbook Cover in Threshold Languages (pdf)	Revised 11/18/2024	2024-11-20
Quick Guide To MH Services-Arabic (pdf)		2024-09-05
Quick Guide To MH Services-Chinese (pdf)		2024-09-05
Quick Guide To MH Services-English (pdf)		2024-09-05
Quick Guide To MH Services-Korean (pdf)		2024-09-05
Quick Guide To MH Services-Persian (Dari_Farsi) (pdf)		2024-09-05
Quick Guide To MH Services-Somali (pdf)		2024-09-05
Quick Guide To MH Services-Spanish (pdf)		2024-09-05
Quick Guide To MH Services-Tagalog (pdf)		2024-09-05
Quick Guide To MH Services-Vietnamese (pdf)		2024-09-05
Physician Notice To Patients CA Regulation_English.pdf		2024-08-26
Physician Notice To Patients CA Regulation_Somali.pdf		2024-08-26
Physician Notice to Patients California Regulation_Arabic.pdf		2024-08-26
Physician Notice To Patients CA Regulation_Persian_(Dari_Farsi).pdf		2024-08-26
Physician Notice to Patients California Regulation_Vietnamese.pdf		2024-08-26
Physician Notice to Patients California Regulation_Chinese.pdf		2024-08-26
Physician Notice to Patients California Regulation_Korean.pdf		2024-08-26
Physician Notice to Patients California Regulation_Tagalog.pdf		2024-08-26
Physician Notice to Patients California Regulation_Spanish.pdf		2024-08-26
Limited_English_Proficiency_Poster_04-2023_Vietnamese.pdf		2024-08-26
Limited_English_Proficiency_Poster_04-2023_Arabic.pdf		2024-08-26
Limited_English_Proficiency_Poster_04-2023_Persian (Dari_Farsi).pdf		2024-08-26
Limited_English_Proficiency_Poster_04-2023_English.pdf		2024-08-26
Limited_English_Proficiency_Poster_04-2023_Korean.pdf		2024-08-26
Limited_English_Proficiency_Poster_04-2023_Chinese (Traditional).pdf		2024-08-26
Limited_English_Proficiency_Poster_04-2023_Somali.pdf		2024-08-26
Limited_English_Proficiency_Poster_04-2023_Tagalog.pdf		2024-08-26
Limited_English_Proficiency_Poster_04-2023_Spanish.pdf		2024-08-26
Advance Directive - PUB325_Arabic_12.2016.pdf		2024-08-26
Advance Directive - PUB325_Vietnamese_12.2016.pdf		2024-08-26
Advance Directive - PUB325_Chinese_12.2016.pdf		2024-08-26
Advance Directive - PUB325_Persian (Dari_Farsi)_12.2016.pdf		2024-08-26
Advance Directive - PUB325_Korean_12.2016.pdf		2024-08-26
Advance Directive - PUB325_English_12.2016.pdf		2024-08-26
Advance Directive - PUB325_Somali_12.2016.pdf		2024-08-26
Advance Directive - PUB325_Spanish_12.2016.pdf		2024-08-26
Advance Directive - PUB325_Tagalog_12.2016.pdf		2024-08-26
Human Trafficking Notice – Arabic (pdf)		2024-08-08
Human Trafficking Notice – English (pdf)		2024-08-08
Human Trafficking Notice – Dual English - Spanish (pdf)		2024-08-08
Human Trafficking Notice – Farsi (pdf)		2024-08-08
Human Trafficking Notice – Korean (pdf)		2024-08-08
Human Trafficking Notice – Spanish (pdf)		2024-08-08
Human Trafficking Notice – Tagalog (pdf)		2024-08-08
Human Trafficking Notice – Chinese (Traditional) (pdf)		2024-08-08
Human Trafficking Notice – Vietnamese (pdf)		2024-08-08
ACL Poster - Dari (pdf)		2024-07-17
Beneficiary_Non-Discrimination_Notice_-_SOMALI.pdf		2023-11-30
NAR_Your_Rights_State_Hearing_-_KOREAN.pdf		2023-11-30
NAR_Your_Rights_State_Hearing_-_SOMALI.pdf		2023-11-30
Beneficiary_Non-Discrimination_Notice_-_KOREAN.pdf		2023-11-30
Beneficiary_Non-Discrimination_Notice_-_CHINESE.pdf		2023-11-30
NAR_Your_Rights_State_Hearing_-_CHINESE.pdf		2023-11-30
Beneficiary_Non-Discrimination_Notice_-_SOMALI.doc		2023-11-30
NAR_Your_Rights_State_Hearing_-_CHINESE.doc		2023-11-30
Beneficiary_Non-Discrimination_Notice_-_CHINESE.doc		2023-11-30
Notice_of_Grievance_Resolution_-_SOMALI.doc		2023-11-30
Beneficiary_Non-Discrimination_Notice_-_KOREAN.doc		2023-11-30
NAR_Adverse_Benefit_Determination_Upheld_Notice_-_CHINESE.doc		2023-11-30
Notice_of_Grievance_Resolution_-_KOREAN.doc		2023-11-30
NAR_Adverse_Benefit_Determination_Upheld_Notice_-_SOMALI.doc		2023-11-30
Notice_of_Grievance_Resolution_-_CHINESE.doc		2023-11-30
NAR_Your_Rights_State_Hearing_-_KOREAN.doc		2023-11-30
NAR_Your_Rights_State_Hearing_-_SOMALI.doc		2023-11-30
NAR_Adverse_Benefit_Determination_Overturned_Notice_-_KOREAN.doc		2023-11-30
NAR_Adverse_Benefit_Determination_Overturned_Notice_-_SOMALI.doc		2023-11-30
NAR_Adverse_Benefit_Determination_Overturned_Notice_-_CHINESE.doc		2023-11-30
NAR_Adverse_Benefit_Determination_Upheld_Notice_-_KOREAN.doc		2023-11-30
SD Grievance-Appeal POSTER Somali (pdf)	Revised 03/05/2019	2023-11-15
Grievance and Appeal Form – JFS Advocacy 08-20-21 - Somali (docx)		2023-11-15
SD Grievance-Appeal POSTER Korean (pdf)	Revised 03/05/2019	2023-11-15
SD Grievance-Appeal POSTER Chinese (pdf)	Revised 03/05/2019	2023-11-15
SD Grievance - Appeal Brochure - Somali (pdf)	Revised 08/27/2021	2023-11-15
SD Grievance - Appeal Brochure - Korean (pdf)	Revised 08/27/2021	2023-11-15
Grievance and Appeal Form – JFS Advocacy 08-20-21 - Chinese (docx)		2023-11-15
SD Grievance - Appeal Brochure - Chinese (pdf)	Revised 08/27/2021	2023-11-15
Grievance and Appeal Form – CCHEA OP Advocacy 6-28-18 Somali (docx)		2023-11-15
Grievance and Appeal Form – CCHEA OP Advocacy 6-28-18 Korean (docx)		2023-11-15
Grievance and Appeal Form – JFS Advocacy 08-20-21 - Korean (docx)		2023-11-15
Grievance and Appeal Form – CCHEA OP Advocacy 6-28-18 Chinese (docx)		2023-11-15
NPP Acknowledgement Somali (pdf)		2023-10-17
Notice of Privacy Practices – Somali (pdf)		2023-09-15
NPP Acknowledgement Chinese (pdf)		2023-10-17
Notice of Privacy Practices - Korean (pdf)		2023-09-15
Notice of Privacy Practices – Chinese (pdf)		2023-09-15
NPP Acknowledgement Korean (pdf)		2023-10-17
NPP Acknowledgement Dari (pdf)		2023-10-17
Notice of Privacy Practice - Dari (pdf)		2023-09-15
ACL Poster - Vietnamese (pdf)		2023-11-06
ACL Poster - Traditional Chinese (pdf)		2023-11-06
ACL Poster - Tagalog (pdf)		2023-11-06
ACL Poster - Spanish (pdf)		2023-11-06
ACL Poster - Somali (pdf)		2023-11-06
ACL Poster - Korean (pdf)		2023-11-06
ACL Poster - Farsi (pdf)		2023-11-06
ACL Poster - English (pdf)		2023-11-06
ACL Poster - Dari (pdf)		2023-11-06
ACL Poster - Arabic (pdf)		2023-11-06
Open Payments Database Notice to Clients Display (docx)	Link	2023-05-01
Open Payments Database Physician Notice to Clients (docx)	Revised 01/19/2023	2023-05-01
CA Board of Psychology Consumer Statement - Korean (pdf)		2023-05-01
CA Board of Psychology Consumer Statement - Chinese (pdf)		2023-05-01
SD Grievance - Appeal Brochure - Vietnamese (pdf)	Revised 08/27/2021	2022-03-30
SD Grievance - Appeal Brochure - Arabic (pdf)	Revised 08/27/2021	2022-03-30
SD Grievance - Appeal Brochure - English (pdf)	Revised 08/27/2021	2022-03-30
SD Grievance - Appeal Brochure - Farsi (pdf)	Revised 08/27/2021	2022-03-30
SD Grievance - Appeal Brochure - Spanish (pdf)	Revised 08/27/2021	2022-03-30
SD Grievance - Appeal Brochure - Tagalog (pdf)	Revised 08/27/2021	2022-03-30
Grievance and Appeal Form – CCHEA OP Advocacy 6-28-18 English (docx)	Revised 06/28/2018	2021-11-04
Grievance and Appeal Form – CCHEA OP Advocacy 7-1-18 Persian (Dari/Farsi) (docx)		2021-09-14
Grievance and Appeal Form – CCHEA OP Advocacy 6-28-18 Arabic (docx)		2021-09-14
Grievance and Appeal Form – CCHEA OP Advocacy 6-28-18 Tagalog (docx)		2021-08-24
Grievance and Appeal Form – CCHEA OP Advocacy 6-28-18 Spanish (docx)		2021-08-24
Grievance and Appeal Form – CCHEA OP Advocacy 6-28-18 Vietnamese (docx)		2021-08-24
Grievance and Appeal Form – JFS Advocacy 08-20-21 – Persian (Dari/Farsi)		2021-08-24
Grievance and Appeal Form – JFS Advocacy 08-20-21 - Arabic (docx)		2021-08-24
Grievance and Appeal Form – JFS Advocacy 08-20-21 - Vietnamese (docx)		2021-08-23
Grievance and Appeal Form – JFS Advocacy 08-20-21 - Tagalog (docx)		2021-08-23
Grievance and Appeal Form – JFS Advocacy 08-20-21 - Spanish (docx)		2021-08-23
Grievance and Appeal Form – JFS Advocacy 08-20-21 - English (docx)		2021-08-23
NPP Acknowledgement Arabic (pdf)	Revised August 2021	2021-08-20
NPP Acknowledgement English (pdf)	Revised August 2021	2021-08-20
NPP Acknowledgement Farsi (pdf)	Revised August 2021	2021-08-20
NPP Acknowledgement Spanish (pdf)	Revised August 2021	2021-08-20
NPP Acknowledgement Tagalog (pdf)	Revised August 2021	2021-08-20
NPP Acknowledgement Vietnamese (pdf)	Revised August 2021	2021-08-20
CA Board of Psychology Consumer Statement-English (pdf)		2021-07-27
CA Board of Psychology Consumer Statement-Spanish (pdf)		2021-07-27
CA Board of Psychology Consumer Statement-Tagalog (pdf)		2021-07-27
CA Board of Psychology Consumer Statement-Vietnamese (pdf)		2021-07-27
SD Grievance-Appeal POSTER English LARGE FONT (pdf)	Revised 03/05/2019	2021-07-15
SD Grievance-Appeal POSTER Spanish (pdf)	Revised 03/06/2019	2021-07-15
SD Grievance-Appeal POSTER Arabic (pdf)	Revised 03/06/2019	2021-07-14
SD Grievance-Appeal POSTER English (pdf)	Revised 03/06/2019	2021-07-14
SD Grievance-Appeal POSTER Farsi (pdf)	Revised 03/06/2019	2021-07-14
SD Grievance-Appeal POSTER Tagalog (pdf)	Revised 03/06/2019	2021-07-14
SD Grievance-Appeal POSTER Vietnamese (pdf)	Revised 03/06/2019	2021-07-14
Beneficiary Non-Discrimination Notice - ENGLISH (pdf)		2018-08-07
NAR_Adverse_Benefit_Determination_Overturned_Notice_-_ARABIC.doc	-	2018-08-07
NAR_Adverse_Benefit_Determination_Overturned_Notice_-_FARSI.doc	-	2018-08-07
NAR_Adverse_Benefit_Determination_Overturned_Notice_-_SPANISH.doc	-	2018-08-07
NAR_Adverse_Benefit_Determination_Overturned_Notice_-_TAGALOG.docx	-	2018-08-07
NAR_Adverse_Benefit_Determination_Upheld_Notice_-_FARSI.doc	-	2018-08-07
NAR_Adverse_Benefit_Determination_Upheld_Notice_-_SPANISH.doc	-	2018-08-07
NAR_Adverse_Benefit_Determination_Upheld_Notice_-_TAGALOG.docx	-	2018-08-07
NAR_Adverse_Benefit_Determination_Overturned_Notice_-_VIETNAMESE.doc	-	2018-08-07
Notice_of_Grievance_Resolution_-_TAGALOG.docx	-	2018-08-07
Notice_of_Grievance_Resolution_-_SPANISH.doc	-	2018-08-07
Notice_of_Grievance_Resolution_-_FARSI.doc	-	2018-08-07
Notice_of_Grievance_Resolution_-_ENGLISH.doc	-	2018-08-07
Notice_of_Grievance_Resolution_-_ARABIC.doc	-	2018-08-07
Beneficiary Non-Discrimination Notice - ENGLISH (doc)		2018-08-07
NAR_Your_Rights_State_Hearing_-_VIETNAMESE.doc	-	2018-08-07
NAR_Your_Rights_State_Hearing_-_TAGALOG.docx	-	2018-08-07
NAR_Your_Rights_State_Hearing_-_SPANISH.doc	-	2018-08-07
NAR_Your_Rights_State_Hearing_-_FARSI.doc	-	2018-08-07
NAR_Your_Rights_State_Hearing_-_ENGLISH.doc	-	2018-08-07
NAR_Your_Rights_State_Hearing_-_ARABIC.doc	-	2018-08-07
NAR_Adverse_Benefit_Determination_Upheld_Notice_-_VIETNAMESE.doc	-	2018-08-07
NAR_Adverse_Benefit_Determination_Upheld_Notice_-_ENGLISH.doc	-	2018-08-07
NAR_Adverse_Benefit_Determination_Upheld_Notice_-_ARABIC.doc	-	2018-08-07
NAR_Adverse_Benefit_Determination_Overturned_Notice_-_ENGLISH.doc	-	2018-08-07
Notice_of_Grievance_Resolution_-_VIETNAMESE.doc	-	2018-08-07
NAR_Your_Rights_State_Hearing_-_VIETNAMESE.pdf	-	2018-08-07
NAR_Your_Rights_State_Hearing_-_TAGALOG.pdf	-	2018-08-07
NAR_Your_Rights_State_Hearing_-_SPANISH.pdf	-	2018-08-07
NAR_Your_Rights_State_Hearing_-_FARSI.pdf	-	2018-08-07
NAR_Your_Rights_State_Hearing_-_ENGLISH.pdf	-	2018-08-07
NAR_Your_Rights_State_Hearing_-_ARABIC.pdf	-	2018-08-07
Beneficiary_Non-Discrimination_Notice_-_VIETNAMESE.pdf		2018-08-06
Beneficiary_Non-Discrimination_Notice_-_VIETNAMESE.doc		2018-08-06
Beneficiary_Non-Discrimination_Notice_-_TAGALOG.pdf		2018-08-06
Beneficiary_Non-Discrimination_Notice_-_TAGALOG.docx		2018-08-06
Beneficiary_Non-Discrimination_Notice_-_SPANISH.pdf		2018-08-06
Beneficiary_Non-Discrimination_Notice_-_SPANISH.doc		2018-08-06
Beneficiary_Non-Discrimination_Notice_-_FARSI.pdf		2018-08-06
Beneficiary_Non-Discrimination_Notice_-_FARSI.doc		2018-08-06
Beneficiary_Non-Discrimination_Notice_-_ARABIC.pdf		2018-08-06
Beneficiary_Non-Discrimination_Notice_-_ARABIC.doc		2018-08-06
Beneficiary Problem Resolution Process (doc)		2018-06-28
Notice of Privacy Practices - Farsi (pdf)		2018-02-13
NoticeofPrivacyPractices_Vietnamese_12-16-14.pdf		2017-02-06
NoticeofPrivacyPractices_Tagalog_12-16-14.pdf		2017-02-06
NoticeofPrivacyPractices_Spanish_12-16-14.pdf		2017-02-06
NoticeofPrivacyPractices_English_12-16-14.pdf		2017-02-06
NoticeofPrivacyPractices_Arabic_12-16-14.pdf		2017-02-06

Communications


2024-09-03 BHS Info Notice - Outcome Measures for Children & Youth (pdf)		2024-09-04
2024-09-03 – BHS Info Notice – Utilization Management (UM) Updates (pdf)		2024-09-04
County Logo for Provider Use – HHSA/Live Well San Diego (Grey text)	4/24/2024	2024-04-24
County Logo for Provider Use – HHSA/Live Well San Diego (White text)	4/24/2024	2024-04-24
2024-02-06- BHS Info Notice - Prior Authorization Request Form Alignment with CalAIM Update (pdf)		2024-02-09
2023-12-28 BHS Info Notice - SMHS Documentation Reform (pdf)		2024-01-04
2023-09-12 - BHS Contractor Memo #2 TAY CANS (docx)		2023-09-14
2023-09-12 - BHS Contractor Memo Changes to Informed Consent Requirements for Psychotropic Medication (pdf)		2023-09-14
2023-06-29-BHS Contractor Memo-Single Point of Access for ACT and SBCM (pdf)		2023-08-02
MH Access Times FAQ and Tip Sheet (pdf)	06/30/2023	2023-07-11
CANS Sharing Confirmation Form Retirement (pdf)	Effective July 1, 2023	2023-06-27
2023-05-20-BHS Provider Memo-Payment Reform CPT for SMHS (pdf)		2023-06-06
2023-05-04 - BHS Contractor Memo-Open Payments Database (pdf)		2023-05-19
2023-04-20 – BHS Contractor Memo-TAY CANS (pdf)		2023-05-04
2023-05-01- BHS Contractor Memo- Open Payments Database (pdf)	Memo	2023-05-01
2023-02-22 – BHS Provider Memo – Screening and Transition Tool (docx)		2023-02-23
Revised 2023-2-8-BHS and Probation Care Coordination Directive_.pdf		2023-02-16
Day Treatment CalAIM and Contract Requirement Updates Memo 11.17.22 (docx)		2022-12-02
BHS Contractor Memo – CalAIM Documentation Reform (docx)	08/15/2022	2022-08-25
2022-06-21 – BHS Info Notice – Utilization Management (UM) Update (pdf)		2022-06-24
BHS Contractor Memo-CalAIM Documentation Reform	05/22/2022	2022-05-24
2022-02-11-BHS Contractor Memo-Medi-Cal RX Update dbc (docx)		2022-03-15
2021-11-10-BHS Contractor Memo-Medi-Cal RX 2021 (pdf)		2021-11-15
2021-06-29-BHS Information Notice-CYF Utilization Management Reinstated Effective 7.1.21 (pdf)	Effective July 1, 2021	2021-06-30
System of Care (SOC) Application - (BHS) – Contractor Information Notice (pdf)	11/23/2020	2020-11-30
Medication Assisted Treatment (MAT) Referrals (pdf)		2020-08-27
QM Memo ICD-10 7-16-20 (pdf)		2020-07-17
3/19/20 BHS Provider Notice #3- COVID 1- Quality Improvement Updates and Best Practices (pdf)		2020-03-20
QM Memo - EBP Indicator Removal for Homework & Child Family Team Meetings (docx)	Issued 02/06/2020	2020-02-07
QM MEMO - Medication Monitoring (pdf)	Issued 01/31/2020	2020-01-31
QIP Texting Presentation (pptx)		2020-01-21
CYF MEMO - Updated Ancillary SMHS Request Form (pdf)	Effective 1/1/2020	2020-01-10
CYF Memo Prior Auth for Day Services (pdf)	Effective 1-1-2020	2020-01-10
QM MEMO - CSI Diagnosis errors (pdf)	Issued 12/26/2019	2019-12-30
CYF MEMO - Utilization Management Outpatient Cycle Expansion (pdf)	Issued 12/20/2019	2019-12-30
QM Memo - DHCS Revised Telehealth Policies (docx)	Issued 12/06/2019	2019-12-09
QI - PIT MEMO - SOC Application (pdf)		2019-11-04
Optum San Diego Website MH Provider Registration Instructions (pdf)		2019-11-04
CYF MEMO – Revised UM Request Form (pdf)	Issued 09/03/2019	2019-09-06
CYF MEMO – IHBS Prior Authorization 08/16/19 (pdf)		2019-08-20
CYF Memo – TBS Prior Authorization Process (pdf)	Issued 7/29/19	2019-08-14
QM MEMO - New BHS 025 Forms (docx)		2019-04-24
QM MEMO - New Updated Discharge Form - 4.4.19 (pdf)		2019-04-12
CYF MEMO - Revised CANS Sharing Confirmation 3.26.19 (pdf)		2019-04-09
QM MEMO – PROSPECTIVE RISK ANALYSIS – 02.07.19 (docx)		2019-02-08
QM MEMO – PROSPECTIVE RISK ANALYSIS – 02.14.19 (doc)		2019-02-08
QM MEMO - Prospective Risk Analysis (docx)		2019-01-09
QM MEMO_-_New_Non-Bill_Other_Support_Service_Code_01_29_18.pdf		2018-11-29
QM MEMO - Patient_Advocacy Services for BHS - Record Requests 11 01 18 (pdf)		2018-10-31
QM MEMO - Privacy - Confidentiality Legislative Updates 10.23.18 (docx)		2018-10-24
QM MEMO_-_Specialty_Mental_Health_Service_Claiming_for_ES-HS_9_7_18.pdf		2018-10-08
Intensive_Service_Request_ISR_CYF_Memo_04-1617.pdf		2017-06-30
QM MEMO - Specialty Mental Health Service Claiming for ES-HS (pdf)		2018-09-10
QM MEMO – Billing for C-practitioners 07 02 18 (docx)		2018-07-13
QM MEMO – AOA Outpatient Utilization Management 06 29 18 (pdf)		2018-07-13
QI_PIT_MEMO_2018 6-1-18 AOA Substance Use Tracking Reporting Changes (pdf)		2018-06-14
QM MEMO - Controlled Substance - CURES Mandate (pdf)		2018-06-08
QM_MEMO_-_New_Auth_to_Use-Disclose_Multiple_Form_051513.pdf		2017-05-12
QM_MEMO_-_Client_Plan_Redesign_6-20-17.pdf		2017-06-27
QM_MEMO_-_Utilization_of_BHA_Adult_Walk_In_for_OP_Walk_In_Services_6_21_17.pdf		2017-06-27
QM_MEMO_-_New_Evidence_Based_Practice_Indicators_06_23_17.pdf		2017-06-27
QM_MEMO_-_Allowed_Services_Prior_to_Client_Plan_Completion_-_DHCS_Guidelines_6_20_17.pdf		2017-06-21
QM Memo - New Billing Indicators - Intrepreter and Language 06-08-17 (pdf)		2017-06-14
QM_MEMO_-_Day_Treatment_Interim_Folder_03_29_17.pdf		2017-03-31
QM_MEMO_-_Place_of_Service_Update_03_30_17.pdf		2017-03-31
QM_MEMO_- 42_CFR_Final_Rule_1-26-17.pdf		2017-02-02
QI_MIS_MEMO_2016_12_01_CCBH_Client_Attachments.pdf		2018-05-25
QI_MIS_MEMO_2016_10_31_CCBH_Demographic_Form_Table_Change.docx		2016-11-03
QI_MIS_MEMO_2016_05_09_CCBH_Outside_of_the_Office_Update.pdf		2016-05-11
QM_MEMO_-_Day_Tx_Program_-_Updated_Standards.5.1.16.docx		2016-05-11
QI_MIS_MEMO_2015_11_20_Saving_Reports_to_a_SpreadsheetProcess_and Policy.pdf		2015-11-30
QM_MEMO_DHP_4_14.pdf		2015-10-09
QM_MEMO_-_Reaffirming_DHCS_Day_Treatment_Standards_08_26_14.docx		2015-10-09
QM_MEMO_-_New_Interactive_Add_On_Service_Code_785_9_22_14.docx		2015-10-09
QM_MEMO_-_Documentation_Guidelines_when_EHR_Unavailable_9_04_14.docx		2015-10-09
QM_Memo_-_90_Day_Lockout_Process_Update_11_06_13.pdf		2015-10-09
QI_MIS_MEMO_2014_1_09_Notifications_in_Anasazi.pdf		2016-05-16
QM Memo - CPT Coding Changes 2013 (pdf)		2016-07-15
QM Memo - LPCC Credential Under MHP 07 24 13 (doc)		2015-10-09
QM Memo - Holder of Records 01 03 13 (pdf)		2016-07-15
CSI Requirement for MH Programs 08 27 12 (pdf)		2016-07-15

Forms


5150 Form (pdf)	Revised 09/2023	2023-11-09
72 Hour Post Discharge Log (pdf)		2017-03-23
AOB - Arabic Version (docx)		2021-11-09
AOB - Arabic Version (pdf)		2021-11-05
AOB - English Version (docx)		2023-09-06
AOB - Spanish Version (docx)		2021-11-09
AOB - Spanish Version (pdf)		2021-11-05
AOB - Tagalog Version (docx)		2021-11-09
AOB - Tagalog Version (pdf)		2021-11-05
AOB - Vietnamese Version (docx)		2021-11-09
AOB - Vietnamese Version (pdf)		2021-11-05
Access to Services Log (xlsx)		2018-06-20
BHS 025 Form and Instructions (pdf)		2024-09-16
CAPS Administrative Days Weekly Contacts Log (docx)		2024-07-22
CCBH Void and Replace Form (xlsm)	Revised 10/04/2021	2021-10-07
Case Management Six Month Review Progress Note (pdf)		2017-03-23
Case Management UR Record (pdf)		2017-03-23
Case Management URC Minutes Form (pdf)		2017-03-23
DHCS 1739 Mental Health Professional Licensing Waiver Request (pdf)		2021-03-12
DPC 203 and 204 Forms (docx)		2023-02-07
Group Service Record (rtf)	Revised 08/2020	2020-08-07
HSD Medi-Cal Quick Guide Screening Tool (docx)		2021-12-13
Individual Service Record (doc)	Revised 07/10/2024	2024-07-11
JV220(A) - Physician's Statement - Attachment (pdf)		2018-03-01
JV220(B) - Physican's Request to Continue Medication - Attachment (pdf)		2018-03-01
MAA Service Record (pdf)		2017-08-24
Med Mon McFloop Form (docx)	Revised 01/17/2020	2020-01-31
Med Monitoring Submission Form - Adult (xlsx)	Revised 12/08/2023	2023-12-19
Med Monitoring Submission Form - Childrens (xlsx)	Revised 12/08/2023	2023-12-19
Med Monitoring Tool AOA (docx)	Revised 04/10/2024	2024-04-11
Med Monitoring Tool CYF (docx)	Revised 04/10/2024	2024-04-11
Medi-Cal Administrative Activities (MAA) Procedures		2017-08-24
Medication Disposal Log (pdf)		2021-06-03
Mental Health Professional Licensing Waiver Request (pdf)	DHCS 1739 Revised 11/2021	2022-01-10
NVRA Voter Preferences Form-Arabic (pdf)		2021-03-12
NVRA Voter Preferences Form-English (pdf)		2021-03-12
NVRA Voter Preferences Form-Spanish (pdf)		2021-03-12
NVRA Voter Preferences Form-Tagalog (pdf)		2021-03-12
NVRA Voter Preferences Form-Vietnamese (pdf)		2021-03-12
NVRA_Voter_Preference_Form_Farsi.pdf		2017-09-14
New MRR Hybrid Chart and Program Compliance CHECKLIST (docx)	Revised 02/12/2021	2021-02-18
QIP Follow up Form FY 20-21 (docx)		2020-08-07
Reestablishment Recommendation Form (doc)		2021-03-12
Request for Verification of Veterans Eligibility (pdf)		2017-03-23
START TCC and URC Record (pdf)		2017-03-23
START URC Minutes Form (pdf)		2017-03-23
Service Authorization Request (pdf)		2021-03-12
Transition of Care Tool for Medi-Cal Mental Health Services (pdf)		2023-02-28
Transition of Care Tool for Medi-Cal Mental Health Services - Explanation Form (docx)	Revised 01/01/2024	2024-01-16
Written Translation Service Authorization Form (pdf)		2021-03-12

Manuals

Please go to the new MH & DMC-ODS page’s Manuals tab to access files. This tab is in the process of being sunset.

OPOH

Please go to the new MH & DMC-ODS page’s OPOH/SUDPOH tab to access files. This tab is in the process of being sunset.

References


EPSDT_TBS_Brochure_English.pdf		2016-07-15
EPSDT_TBS_Brochure_Spanish.pdf		2016-07-15
State_Plan_Amendment_SPA_12-025.pdf		2015-10-09
ICD_10_and_DAS_Tip_Sheet_09.2015.docx		2016-07-15
037_-_OPOH_-_Appendix_D_-_A.D.03_-_California_State_Penal_Institutions_List_.pdf		2017-03-23
QI_UPDATES_-_Annual_7_11_17 FINAL.pdf		2017-07-13
State_Health_Information_Guidance_-_December_2017.pdf		2017-12-18
Program_Provider_Numbers_List.pdf		2018-02-15
Travel_Time_Guidelines_Final_2-01-18.pdf		2018-02-15
Setting the Face Sheet to Display Instructions (doc)		2016-07-15
CCBH_-_CP_Folder_and_PN_TIP_SHEET-updated_6_16_17.pdf		2017-06-27
CCBH_-_Quick_Click_Guide_REVIEW_-_REVISE-updated_6_16_17.pdf		2017-06-27
CCBH_CP_Quick_Click_Guide-updated_6_16_17.pdf		2017-06-27
Client_Management_Payment_Report_V3.pdf		2016-07-15
PWB Report Template Instructions (pdf)		2016-05-16
Payment Appilication Claims Report Instructions (pdf)		2016-05-16
Service_Date_Verification_Report.pdf		2016-05-16
BHS Quality Improvement 8th Annual Mental Health Providers Knowledge Forum - Presentation handout.pdf		2021-09-07
BHS Quality Improvement 8th Annual Mental Health Providers Knowledge Forum - Question-Answer Sheet.pdf		2021-09-07
3rd Party Suspense Report Instructions (ppt)		2019-04-10
7th Annual Mental Health Forum 9.22.20 - QA (docx)		2020-10-08
Active Parolee Clients Report Instructions (docx)		2020-10-01
BHS Information Notice-Utilizing CANS Strengths in Therapy	03/09/2021	2021-03-10
Billing Lockout Settings and Non-Reimbursable/Reimbursable Activities (pdf)	Revised 06/26/2023	2023-06-27
Billing SMHS for Sibling Sets Guidelines (docx)		2024-05-09
Billing for Medication Services (docx)	11/29/2023	2023-12-04
CCBH Report Uses for Program Integrity (pdf)		2019-10-07
CSI Correction Guide – Full Version (pdf)		2021-01-29
CSI Correction Guide – Most Frequent Errors (pdf)		2021-01-29
Case Management versus Collateral (docx)		2021-03-15
Client Categories Maintenance (pdf)		2018-06-29
Client Categories – Parolee Tip Sheet (docx)		2020-07-31
Clinical Standard for Assessments (doc)		2018-06-15
Clinical Standards For Client Plans (pdf)	Updated 6/28/2019	2019-07-01
Crisis Intervention SC 70 Guideline (pdf)		2020-09-09
Denial Report Instructions (ppt)		2019-09-16
Diagnosis Practice Guidelines (pdf)	Updated 01/24/2022	2022-01-25
FY 24-25 FWA Reference Document (pdf)		2024-10-15
FY 24-25 Reason for Recoupment SMHS Final (pdf)	Revised 09/27/2024	2024-10-15
HOW Service Model Data Collection Flow (pdf)		2021-03-12
Housing Quality Checklist (docx)		2023-07-11
Interactive Add-On for Admin Staff (pdf)		2023-07-11
Interactive Add-On for Clinical Staff (pdf)		2023-07-11
Interpreter Add-On for Admin Staff (pdf)		2023-07-11
Interpreter Add-On for Clinical Staff (pdf)		2023-07-11
List of Controlled Substance 08.20.20 (pdf)		2020-09-01
MAA Procedures (pdf)		2021-03-12
MAA Service Record (pdf)		2021-03-12
MIS-25 Program Listing Report (xlsx)		2024-11-07
Medi-Cal Certification-Recertification Tool (xls)	FY 22-23	2022-04-07
Medi-Cal Rx Provider Registration and Training FAQs (pdf)		2021-12-16
Medi-Cal Rx Provider Training Checklist (pdf)	Revised 11/04/2021	2021-12-16
Medi-Cal Rx UAC Registration Quick Start Guide (pdf)		2021-12-16
Medical Necessity CalAIM Updates (docx)	Active 01/01/2022	2021-12-15
Medication Monitoring Process Flow Chart for Org Providers (pdf)		2021-04-27
Mental Health Professional Licensure Waiver (pdf)		2021-01-06
Mobile Crisis Billing Tip Sheet (docx)		2024-08-07
Mobile Crisis Response Documentation Requirements (docx)		2024-08-07
New Contractor Orientation Resources (pdf)	Revised 04/02/2024	2024-07-10
Progress Note Checklist Table (pdf)	Checklist	2020-03-10
QAPR Program Compliance Attestation - FY 24-25 (docx)	Revised 09/23/2024	2024-09-26
QAPR Tool – FY 24-25 (xlsx)	Revised 09/23/2024	2024-09-26
QI UPDATES MHP 7th ANNUAL 09.22.20 (pdf)		2020-10-08
QUALITY IMPROVEMENT KNOWLEDGE FORUM Presentation (pdf)	presented July 12, 2019	2019-07-18
Quality Improvement Annual Forum 2018 - Powerpoint (pptx)	07-25-2018 Presentation	2018-07-26
SOC Application - QIP Presentation (pdf)	Presented 10/22/19	2019-10-23
San Diego County BHS Abbreviations List (pdf)	Revised 03/23/2022	2023-07-31
Short-Doyle Medi-Cal (SDMC) Aid Code Master Chart (pdf)	Updated Aid Code Master Chart	2021-01-28
Telehealth Reminder Slides_QIP-July 2020 (pdf)	PowerPoint Presentation 10/22/2018	2020-07-29
Tip Sheet for Billable Services (docx)	Revised 08/22/2023	2023-09-01
Transferring Clients Between Different Program Sites rev. 12.28.23 (docx)		2024-01-04
Trauma-Informed Care Code of Conduct (pdf)		2019-06-17
Treatment Team Documentation Standards (pdf)		2018-09-11
Utilizing CANS Strengths in Therapy (pdf)	March 2021	2021-03-10
Who to Contact List (pdf)		2021-04-20

UCRM


A/OA Outpatient Utilization Management Form		2019-02-08
A/OA Outpatient Utilization Management Form Explanation Sheet	Revised 01/31/2019	2019-02-08
A/OA Patient Medication Agreement Explanation Sheet		2018-07-26
Advanced Directive Explanation Sheet		2018-05-25
Advanced Directive Advisement		2018-05-25
Ancillary SMHS Request Form		2020-01-10
Ancillary SMHS Request Form Explanation Sheet		2020-01-10
Authorization for the Disclosure of Protected Health Information (pdf)		2024-10-01
CSI Standalone Collection		2024-09-11
CSSRS- Adult LT		2024-09-11
CSSRS- Child LT		2024-09-11
CalAIM ASSESSMENT EXPLANATION SHEET INSTRUCTIONS (docx)	Revised 12/05/2024	2024-12-12
Care Plan Explanation Sheet (docx)	Revised 11/01/2024	2024-11-01
Child/ Youth Utilization Management Request Form	Revised 09/03/24	2024-09-04
Child/ Youth Utilization Management Request Form Explanation Sheet	Revised 09/03/24	2024-09-04
Client Clinical Problems		2024-09-11
Client Face Sheet	09/2024	2024-09-11
Coordinated Care Consent (docx)	Revised 12/09/2024	2024-12-11
Coordinated Care Consent Explanation Sheet (pdf)		2024-12-13
Coordination with PCP & BHS Explanation Sheet		2024-09-05
Coordination with Primary Care Physician & Behavioral Health Services		2024-09-05
Day Treatment Service Note (Shift Summary)		2024-09-11
Diagnosis Document		2024-09-11
Discharge Summary		2024-09-11
Eyberg Child Behavior Inventory (ECBI) Explanation Sheet		2018-05-25
Full Service Partnership (FSP) Agreement	07/30/24	2024-09-11
IOP & PHP Prior Authorization - Day Services Request Form (DSR)	Revised 01/02/2024	2024-01-04
IOP & PHP Prior Authorization - Day Services Request Form (DSR) Explanation Sheet		2024-01-04
Illness Management & Recovery (IMR) Adult Explanation Sheet		2018-02-13
Illness Management & Recovery (IMR) Assessment		2021-02-02
Informed Consent for Taking Psychotropic Medications Explanation Sheet		2023-05-23
Informed Consent for Taking Psychotropic Medications Form		2021-03-05
Intensive Home-Based Services (IHBS) Prior Authorization Explanation Sheet	Revised 02/01/2024	2024-02-19
Intensive Home-Based Services (IHBS) Prior Authorization Request Electronic Form Instructions	Revised 02/07/2024	2024-02-12
Intensive Home-Based Services (IHBS) Prior Authorization Request Form	Revised 02/01/2024	2024-02-12
Level of Care Utilization (LOCUS) Adult	Adult Version 20, December 2016	2019-06-28
Level of Care Utilization (LOCUS) Adult Explanation Sheet		2018-02-13
Milestones of Recovery Score (MORS) Adult		2018-05-25
Milestones of Recovery Score (MORS) Explanation Sheet		2018-02-13
PSC-35 Explanation Sheet Rev 11.15.24 (docx)	Revised 11/15/2024	2024-11-16
Prior Authorization Day Services Request - IOP/PHP (C/Y)	Revised 04/01/2022	2022-03-25
Prior Authorization Day Services Request - IOP/PHP (C/Y) Explanation Sheet		2022-06-13
Psych Medical Service Note		2024-10-17
Psychiatric Assessment		2018-02-13
Psychiatric Assessment Explanation Sheet		2019-12-12
Recovery Markers Questionnaire Form 093009 (pdf)		2020-07-14
Release of Information		2023-08-21
Release of Information - Child/Youth		2017-02-17
Release of Information Explanation Sheet		2018-02-09
Risk Assessment		2024-09-11
Risk Assessment Explanation Sheet		2024-09-11
Safety Plan		2024-09-11
Safety Plan Explanation Sheet		2024-09-11
Service Note (pdf)	Revised 10/17/2024	2024-10-24
Substance Abuse Treatment Scale (SATS-R)		2017-03-02
Substance Abuse Treatment Scale (SATS-R) Explanation Sheet		2018-02-13
TADT (Timely Data Access Tool)		2024-09-11
Youth Transition Self-Evaluation (YTSE)		2020-06-18
Youth Transition Self-Evaluation (YTSE) Explanation Sheet		2021-08-20

Arabic


AUTHORIZATION TO USE OR DISCLOSE PHI – ARABIC (pdf)		2023-10-18
FINAL Coordination of Care Form-Arabic (pdf)		2016-07-13
MY SAFETY PLAN FORM FILL – ARABIC (docx)	Revised 01/30/2024	2024-02-01
PSC-Parent (Arabic)_6_2018_interactive (pdf)		2020-03-25
PSC-Youth (Arabic)_6_2018_interactive (pdf)		2020-03-25
YOUTH TRANSITION SELF EVALUATION ARABIC (doc)		2023-05-09

Chinese


AUTHORIZATION TO USE OR DISCLOSE PHI – CHINESE (pdf)		2023-10-18
MY SAFETY PLAN FORM FILL – CHINESE (docx)	Revised 01/30/2024	2024-02-01

Dari


AUTHORIZATION TO USE OR DISCLOSE PHI – DARI (pdf)		2023-10-18

Farsi


AUTHORIZATION TO USE OR DISCLOSE PHI – FARSI (pdf)		2023-10-18
MY SAFETY PLAN FORM FILL – FARSI (docx)	Revised 01/30/2024	2024-02-01
PSC-Parent (Farsi)_6_2018_interactive (pdf)		2020-03-25
PSC-Youth (Farsi)_6_2018_interactive (pdf)		2020-03-25
YOUTH TRANSITION SELF EVALUATION FARSI (doc)		2023-05-09

Korean


AUTHORIZATION TO USE OR DISCLOSE PHI – KOREAN (pdf)		2023-10-18
MY SAFETY PLAN FORM FILL – KOREAN (docx)	Revised 01/30/2024	2024-02-01

Somali


AUTHORIZATION TO USE OR DISCLOSE PHI – SOMALI (pdf)		2023-10-18
MY SAFETY PLAN FORM FILL – SOMALI (docx)	Revised 01/30/2024	2024-02-01

Spanish


AUTHORIZATION TO USE OR DISCLOSE PHI - SPANISH (docx)	Spanish	2023-08-21
FINAL Coordination of Care Form-Spanish (pdf)		2016-07-13
MY SAFETY PLAN FORM FILL - SPANISH (docx)	Revised 01/30/2024	2024-02-01
PSC-Parent (Spanish) 6 2018 Interactive (pdf)		2024-10-08
YOUTH TRANSITION SELF EVALUATION SPANISH (doc)		2018-05-25

Tagalog


MY SAFETY PLAN FORM FILL - TAGALOG (docx)	Revised 01/30/2024	2024-02-01
AUTHORIZATION TO USE OR DISCLOSE PHI – TAGALOG (pdf)		2023-10-18
FINAL Coordination of Care Form-Tagalog (pdf)		2016-07-13
PSC-Parent (TG)_6_2018_interactive (pdf)		2020-03-25
PSC-Youth (TG)_6_2018_interactive (pdf)		2020-03-25

Vietnamese


YOUTH_TRANSITION_SELF_EVALUATION_VIETNAMESE.doc		2018-05-25
AUTHORIZATION TO USE OR DISCLOSE PHI – VIETNAMESE (pdf)		2023-10-18
FINAL Coordination of Care Form-Viet (pdf)		2016-07-13
MY SAFETY PLAN FORM FILL – VIETNAMESE (docx)	Revised 1/30/2024	2024-02-01
PSC-Parent (VI)_6_2018_interactive (pdf)		2020-03-25
PSC-Youth (VI)_6_2018_interactive (pdf)		2020-03-25

UTTM

Please go to the new MH & DMC-ODS page’s UTTM tab to access files. This tab is in the process of being sunset.

Training

Please go to the new MH & DMC-ODS page’s Training tab to access files. This tab is in the process of being sunset.

PWB

Please go to the new MH & DMC-ODS page’s MH Resources tab to access files. This tab is in the process of being sunset.

STRTP


AB1299 STRTP Admission Report (docx)	Revised 03/24/2022	2022-06-03
AB1299 STRTP Admission Report Explanation Form (pdf)	Revised 03/24/2022	2022-06-03
BHS Contractor Memo – Tracking Out of County Medi-Cal Beneficiaries in CCBH – Revised AB1299 STRTP Admission Report (pdf)	Memo Date 03/04/2022	2022-06-03
BHS Contractor Memo-Revised AB1299 STRTP Admission Report (pdf)	Memo Date : 03/02/20121	2021-03-02
BHS Contractor Memo-Revised STRTP Forms - Effective November 2020 (pdf)	Memo - 11/20/2020	2020-11-25
CYF MEMO – STRTP Release of Forms 08/16/19 (pdf)		2019-08-20
Daily Progress Note (docx)		2023-01-05
Daily Progress Note Explanation Sheet (docx)		2023-01-05
Optional AB1299 STRTP Tracking Tool (xlsx)	Revised 03/02/2021	2021-03-02
STRTP ADMISSION STATEMENT FORM FILL (docx)		2020-11-25
STRTP ADMISSION STATEMENT – EXPLANATION (pdf)	Revised 06/24/2019	2020-11-25
STRTP DISCHARGE SUMMARY FORM FILL (docm)		2023-11-08
STRTP DISCHARGE SUMMARY FORM FILL (docx)		2023-11-17
STRTP DISCHARGE SUMMARY – EXPLANATION (pdf)	Revised 07/12/2019	2020-11-25
STRTP Hybrid Matrix (docx)	Revised 12/10/2020	2020-12-11
STRTP MEDICATION NOT PRESCRIBED PROGRESS NOTE SC11 (docx)		2020-11-25
STRTP Medication Flow Chart (pdf)	Uploaded 07-05-2019	2019-07-05
STRTP PRIOR AUTHORIZATION DAY SERVICES REQUEST (docx)	Revised 04/01/2022	2022-03-25
STRTP PRIOR AUTHORIZATION DAY SERVICES REQUEST - EXPLANATION (docx)		2022-06-10
STRTP TRANSITION DETERMINATION PLAN FORMFILL (docx)	Revised 09/02/2021	2021-09-07
STRTP Transition Determination Plan Explanation Form (docx)	Revised 09/02/2021	2021-09-07
STRTP UM Request Form (docx)	Revised 11/01/2022	2022-11-17
STRTP Utilization Management Request Explanation Form (pdf)	Revised 11/01/2022	2022-11-17
Transition Determination Plan Signature Page (docx)	Revised 09/02/2021	2021-09-07

TFC


ANNUAL TFC PARENT EVALUATION FORM FILL (docx)		2020-11-25
ANNUAL TFC PARENT EVALUATION – EXPLANATION (pdf)		2020-11-25
ANNUAL TFC PARENT SELF -EVALUATION FORM FILL (docx)		2020-11-25
ANNUAL TFC PARENT SELF-EVALUATION FORM – EXPLANATION (pdf)		2020-11-25
BHS Contractor Memo-TFC Forms Effective December 2020 (pdf)	Memo - 11/23/2020	2020-11-25
TFC ANNUAL PARENT AGREEMENT AND CERTIFICATION FORM FILL (docx)		2020-11-25
TFC CLINICAL DOCUMENTATION TIP SHEET (pdf)	09/2024	2024-09-16
TFC DAILY PROGRESS NOTE - EXPLANATION (pdf)	Revised 03/01/2023	2023-03-03
TFC DAILY PROGRESS NOTE FORMFILL (doc)	Revised 03/01/2023	2023-03-03
TFC PARENT DOCUMENTATION TIP SHEET (pdf)		2020-11-25
TFC PRIOR AUTH OPTUM WEB BASED ELECTRONIC FORM SUBMISSION INSTRUCTIONS (docx)		2024-09-27
TFC PRIOR AUTHORIZATION REQUEST (docx)	Revised 02/01/2024	2024-02-19
TFC PRIOR AUTHORIZATION REQUEST - EXPLANATION (docx)	Revised 02/01/2024	2024-02-12

TBS

Please go to the new MH & DMC-ODS page’s MH Resources tab to access files. This tab is in the process of being sunset.

Billing Unit/Finance

Billing Unit Manuals

Financial Eligibility and Billing Manual (pdf)

Billing Unit Resources

Billing Unit Forms

SmartCare

System of Care (SOC) Information and Resources

SOC Resources | Training


CCBH Training Documentation Guide June 2024 (pdf)	Guidance for navigating use of CCBH after training ceases and before SmarCare go-live, including downtime forms	2024-07-01
CalMHSA Required Training by Role Grid (pdf)	SmartCare Trainings by Staff Role – Updated 7/27/2024	2024-07-29
Guide – Admin Service Entry		2024-11-18
Guide – CSU v3 (pdf)		2024-09-03
Guide – Data and Bill Only v1		2024-08-30
Guide – Group Documentation Tips- Mixed Programs (docx)		2024-10-14
Guide – INTERIM- SmartCare CSU with Concurrent Program Enrollment Supplementary Guide (pdf)		2024-11-09
Guide – LTC.SNF Data and Bill With Res Board (pdf)		2024-09-03
Guide – Residential Workflow Change (pdf)		2024-09-04
Guide – Residential v2 (pdf)		2024-09-03
SmartCare ARF for BHS and Optum Staff (pdf)	SmartCare Access Request Form for new users, modifications, reactivations, terminations, or name changes (Updated 11/01/24)	2024-11-05
SmartCare ARF for Treatment Programs (pdf)	SmartCare Access Request Form for new users, modifications, reactivations, terminations, or name changes (Updated 11/01/24)	2024-11-05
SmartCare EHR Training summary (July 2024) (pdf)	Summary of SmartCare required and optional training details	2024-07-15
SmartCare LMS Log In Tip Sheet FINAL 7.11 (pdf)	SmartCare LMS Training Log In Tip Sheet	2024-07-15
SmartCare Training Registration Tip Sheet (pdf)	SmartCare Training Registration Tip Sheet for Supplementary Training Enrollment	2024-07-30

SOC Resources | Requirements and Functionality


ASAM Reporting Tool (xlsx)	Excel-based ASAM reporting tool. See also ASAM Reporting - Youth and Providers not in SmartCare (pdf)	2024-10-01
ASAM Reporting – Youth and Providers not in SmartCare (pdf)	Instructions for all SUD programs who do not use SmartCare as their primary EHR, and all programs who serve youth, regardless of their EHR to provide ASAM data to MIS monthly. See also ASAM Reporting Tool (xlsx)	2024-10-01
Administrative Service Entry (pdf)	This workflow shows the steps for service entry where a progress note will be completed outside of the SmartCare EHR. This process also works through the steps for billing for Add-On procedure codes.	2024-08-30
Authorizations for Services Process (pdf)	This resource is to provide direction on the process for submitting Authorization requests to Optum	2024-08-30
BHS 025 Form and Instructions (pdf)	Client information change, addition, or merge request form	2024-09-17
CCBH to SC Preliminary Reports Crosswalk 2024-08-23 (pdf)	An incomplete crosswalk of CCBH reports to potential SmartCare reports. Additional work is underway to provide more detailed information on report availability (Updated 8/23/2024)	2024-08-30
EPCS Invite Guide 082124 update (pdf)	High level information to support prescriber setup for electronic processing of controlled substances (EPCS) using the soft token app VIP Access by Symantec (Updated 8/21/24)	2024-08-21
EPCS Onboarding Guide (pdf)	High level information to support prescriber setup for electronic prescribing of controlled substances (EPCS) using the soft token app VIP Access by Symantec.	2024-08-16
Guidelines on Completing the SmartCare Client Plan Request Form (pdf)	Instructions for completing the SmartCare client insurance plan request form.	2024-09-17
NOARD Log - FY24-25 (xlsx)	Updated tracking log for completion by programs and submission to QA.	2024-10-17
Quick Start FAQs SmartCare CalMHSA Rx (pdf)	Quick Start instructions and FAQs for launching and using CalMHSA Rx (e-prescribing)	2024-08-30
SmartCare ARF for BHS and Optum Staff (pdf)	SmartCare Access Request Form for new users, modifications, reactivations, terminations, or name changes (Updated 11/01/24)	2024-11-05
SmartCare ARF for Treatment Programs (pdf)	SmartCare Access Request Form for new users, modifications, reactivations, terminations, or name changes (Updated 11/01/24)	2024-11-05
SmartCare CANS PSC July 2024 (pdf)	Summarizes entry of CANS and PSC into SmartCare instead of mHOMS	2024-07-17
SmartCare Client Insurance Entry July2024 (pdf)	Guidance for providers who currently enter insurance information into CCBH or SanWITS – insurance entry will cease at go-live. See the accompanying form: SmartCare Client Insurance Plan Request	2024-07-17
SmartCare Client Insurance Plan Request_updated 08.30.2024 (docx)	SmartCare Client Insurance Plan Request Form for clients with healthcare coverage besides Medi-Cal. See accompanying guidance: SmartCare Client Insurance Entry July2024	2024-09-12
SmartCare Data Migration Resource (pdf)	Updated timelines and guidance to providers about the planned data migration from SanWITS and CCBH to SmartCare. (Updated 8/26/24)	2024-08-27
SmartCare Document Scanning (pdf)	An additional driver is needed for efficient document scanning in SmartCare. This resource provides instructions for document scanning with or without this driver.	2024-09-10
SmartCare DrFirst (CalMHSA Rx) Guidance 2024-08-29 (pdf)	Includes important updates and information related to E-prescribing, including instructions for tokens, identity verification, medication migration, and training. (Updated 8/29/24)	2024-08-30
SmartCare Hardware_Software and Network Requirements - March 2024 update (pdf)	SmartCare hardware, software, and network requirements for customer workstations	2024-03-18
SmartCare MFA 2024-11-19 (pdf)		2024-11-20
SmartCare MFA Relaunch Dec. 2024 (pptx)		2024-12-17
SmartCare NOABD Procedure for MH and SUD (pdf)	An update for SUD providers on the NOABD process, with no change to process for MH providers.	2024-08-27
SmartCare Non Billable Codes 7-29-24 (pdf)	A table highlighting all nonbillable actions that can be entered into the SmartCare system.	2024-08-15
SmartCare Program Crosswalk (xlsx)	Excel-based crosswalk of programs from CCBH or SanWITS to SmartCare.	2024-08-27
SmartCare Reception View Tip Sheet (pdf)	A tip sheet for users to permanently set a filter to remove extraneous information and show program administration, front desk, and reception staff a curated view of the clients at the program.	2024-09-25
SmartCare Scanning Documents Job Aid – Oct. 2024 (pdf)	The SmartCare Scanning Screen lists incomplete scanning jobs by individual users. This job aid describes the correct steps for scanning and how to address the incomplete scans.	2024-10-30
SmartCare Service Code Crosswalk (xlsx)	Revised 11/19/2024	2024-11-21
SmartCare Then and Now EHR Transition Guidance 8-12-24 (pdf)	Guidance informing users how to navigate new options in SmartCare while ensuring regulations and requirements are met.	2024-08-15
SmartCare Walk-in Workflow (pdf)	Workflow for all providers with a walk-in clinic.	2024-08-27
SmartCare Workflow for MH-SUD 10.08.24 (pdf)	High Level workflows in SmartCare including tips and naming of various aspects of workflows	2024-10-10
SmartCare how to find incomplete Scans_Imports (xlsx)		2024-10-31
Smartcare UCRM Changes (xlsx)	Revised 12/13/2024	2024-12-16
UMDAP Financial Assessment in SmartCare (pdf)		2024-10-24

SmartCare Information Notices


2024-04-04 SmartCare information notice (pdf)	Overview of SmartCare implementation to date	2024-04-08
2024-07-19 BHS Provider Memo – EHR Update (pdf)	07/19/2024	2024-07-24
2024-08-01 BHS Provider Memo – EHR Update (pdf)	08/01/2024	2024-08-12
2024-08-23 BHS Info Notice (pdf)	8/23/2024	2024-08-26
2024-08-28 BHS SmartCare Information Notice (pdf)	This information notice summarizes recently shared communication and guidance related to the SmartCare go-live on Sunday, September 1, 2024.	2024-08-30
2024-09-25 BHS Info Notice (pdf)	This information notice summarizes recently shared communication and guidance shared since the SmartCare go-live.	2024-11-01
2024-11-05 BHS Info Notice (pdf)	This information notice includes important new updates and recent guidance shared related to SmartCare as of 11/05/2024.	2024-11-07

Town Hall PowerPoint Presentations


2023-11-17 EHR Town Hall (pdf)	November 2023 Town Hall	2023-11-28
2024-01-30 EHR Town Hall (pdf)	January 2024 Town Hall	2024-02-01
2024-02-20 EHR Town Hall (pdf)	February 2024 Town Hall	2024-02-21
2024-03-19 EHR Town Hall	March 2024 Town Hall	2024-03-21
2024-04-30 EHR Town Hall (pdf)	April 2024 Town Hall	2024-04-30
2024-05-21 EHR Town Hall (pdf)	May 2024 Town Hall	2024-05-21
2024-06-18 EHR Town Hall (pdf)	June 2024 Town Hall	2024-06-18
2024-07-29 SmartCare Town Hall (pdf)	July 2024 Town Hall	2024-07-30
2024-08-13 SmartCare Town Hall (pdf)	August 13, 2024 Town Hall	2024-08-15
2024-08-27 SmartCare Town Hall (pdf)	August 27, 2024 Town Hall	2024-08-29
2024-09-19 SmartCare Town Hall (pdf)	September 19, 2024 Town Hall	2024-09-23
2024-10-08 SmartCare Town Hall (pdf)	October 8, 2024 Town Hall	2024-10-09
2024-11-12 SmartCare Town Hall (pdf)	November 12, 2024 Town Hall	2024-11-13
2024-12-17 SmartCare Town Hall (pdf)	December 17, 2024 Town Hall	2024-12-18

Serious Incident Reporting

Please go to the new MH & DMC-ODS page’s SIR tab to access files. This tab is in the process of being sunset.