Informing Materials

   

Medi-Cal regulations[1] require that Specialty Mental Health Services (SMHS) and Drug Medi-Cal Organized Delivery System (DMC-ODS) providers share the information below with members or their authorized representatives.

Alternative formats, for example Braille or audio versions of this material may be requested from the ACBHD Quality Assurance Division by emailing: QAIM@acgov.org.

NOTE: In the sections below, the term member refers to individuals seeking treatment or their authorized representatives.

[1] CCR, Title 9, Section 1810.360 (b) (3), (d) and (e) and Cal. Code Regs. Tit. 9, § 1850.205 - General Provisions

A. Informing Materials that Must be Reviewed and Offered to Members

  • The Informing Materials in this section must be reviewed and offered to members 1) at intake, 2) when there is a substantial change to the content and 3) upon request.

  • Informing Materials consist of the following documents/information:
      1. Integrated Member Handbook
      2. Advance Directive Educational Material
      3. Provider Directory
      4. Other Consent Forms, as appropriate
      5. Notice of Privacy Practices (also embedded in Integrated Member Handbook)
      6. Acknowledgement of Receipt & Consent to Services

  • The Acknowledgement of Receipt & Consent to Services page must be completed and signed by the member, acknowledging that the material has been reviewed, or re-reviewed, with them and providing their consent to receive voluntary services at the start of treatment.

  • Informing Materials must be offered to members in their preferred threshold language and format.
  1. Integrated Member Handbook
    • Handbooks are integrated for SMHS and DMC-ODS and are available in standard and large format in all threshold languages:
    • The content of the Member Handbook may not be altered.

    • There is no requirement for providers to maintain paper copies of the Member Handbook onsite. However, providers are required to have the capability to electronically access the Member Handbook to print for members in their preferred language, and for ACBHD reviewers, upon request.

    • If not maintaining paper copies onsite, the following document must be posted in a visible and accessible area of your office/lobby: Copies available upon request.

    • If requested, paper copies must be provided to members free of charge, within 5 business days of request.

  2. Advance Directive Educational Material

    • As part of the State requirement to educate members about Advance Directives, a copy of the “Your Right to Make Decisions About Medical Treatment” document should be offered to members in the language and format of their choice:


  3. ACBHD Provider Directory
    • The Provider Directory, containing information about all Alameda County Behavioral Health Department services, is available in English and all threshold languages on the ACBHD Public Website. The Directory must be reviewed with the member electronically, and if requested, be provided as a paper copy.

    • There is no requirement for providers to maintain paper copies of the Provider Directory onsite. However, providers are required to have the capability to electronically access these documents to print for members in their preferred language, and for ACBHD reviewers, upon request. Instructions for printing the ACBHD Provider Directory can be accessed here: Printing ACBHD Provider Directory

    • If not maintaining paper copies onsite, the following document must be posted in a visible and accessible area of the office/lobby: Copies available upon request.

    • If requested, paper copies must be provided to members free of charge, within 5 business days of request.

  4. Other Consent Forms, As Applicable
    • Board/Licensure specific requirements:
      • Notice of Physician Open Payment Database
      • Board of Behavioral Sciences Grievance Information
      • A member notice containing the above 2 requirements can be downloaded here

    • Documentation of Telehealth Consent: See section 7 of the QA Manual for requirements and optional consent forms in all threshold languages.

    • Documentation of Medication Consent: See section 7 of the QA Manual for requirements.

    • Release of Information forms: See section 11 of the QA Manual for forms and additional information.

    • All signed consent forms should be retained in the member’s clinical record and provided to ACBHD and/or DHCS, upon request.

  5. Notice of Privacy Practices (NPP) and NPP Summary- Effective 2/16/26
    • The agencywide NPP has been updated to reflect the most recent regulatory changes.

    • All staff who interact with members must review the NPP and the NPP Summary as well as the NPP training titled “AC Health: Understanding the Notice of Privacy”. The training covers when and how to provide the NPP and Summary and how to answer member questions. Evidence of training completion should be maintained and provided to DHCS or ACBHD upon request.

    • The Notice of Privacy Practices is embedded in the Integrated Member Handbook. Standalone copies of the full NPP and NPP Summary in all threshold languages are available below:
      • Notice of Privacy Practices
      • Notice of Privacy Practices Summary

    • If standalone copies are requested, members may choose to receive them in print or electronically.

    • For questions related to the NPP, please email: ACHealth.Compliance@acgov.org

  6. Acknowledgement of Receipt & Consent to Services
    • Following review of the above information, the “Acknowledgement of Receipt & Consent to Services” page must be signed and dated by the member, acknowledging that the material has been reviewed, or re-reviewed, with them and providing their consent to receive services.

    • The signed Acknowledgement of Receipt page should be retained in the member’s clinical record and provided to ACBHD and/or DHCS upon request.

    • In case of a substantial change to the content, the changes must be reviewed with the member and a new signature and date obtained and saved in the member’s clinical record.


B. Documents that must be visible and accessible in the provider’s lobby or office

The following documents must be visible in the provider’s lobby or office and accessible without the member having to ask for them.

  1. Posters
    1. Grievance and Appeal Poster

      • The poster includes information in all threshold languages.
      • It instructs members to obtain the Grievance and Appeal Request form and ACBHD-addressed envelopes from their provider.

    2. Language Assistance Poster

      • This poster notifies members of their right to be provided with information in their language of choice.

      Posters and ACBHD-addressed envelopes may be requested here.

  2. Grievance and Appeal Process and Forms
  3. Notice of Significant Change
    • A notice regarding any significant change, as defined by DHCS, to member materials must be posted at least 30 days prior to the effective date of the change.

    • ACBHD will alert providers of any significant changes to member materials and the required notice will be posted in this section for use by providers.