bhcsproviders.acgov.org - /providers/network/docs/Forms/
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4/2/2020 11:16 AM 70250 1. Exhibit A_Table of Contents Template.pdf
6/23/2021 3:12 PM 1243106 200-1 Psych Testing Authorization P&P.pdf
6/25/2020 8:17 AM 518047 2020 spring provider slides_Final .pdf
6/19/2020 10:37 AM 518047 2020 spring provider slides_Final.pdf
6/19/2020 3:26 PM 701713 2020 Spring Provider TOC and References.pdf
6/12/2017 10:39 AM 169906 AC_MASTER_CONTRACT_TEMPLATE.pdf
6/19/2020 3:03 PM 241016 ACBH QUALITY ASSURANCE (QA) OFFICE PROVIDER RESOURCES.pdf
6/19/2020 3:03 PM 452408 ACBH QUALITY ASSURANCE Medi-Cal Site Certification June 2020 Key Highlights.pdf
4/2/2020 11:17 AM 239390 ACBH Remote Services Memo_3-16-2020.pdf
7/28/2020 8:37 AM 160192 ACBH Responses to FY 20-21 Spring Provider Presentation Final.pdf
6/19/2020 10:37 AM 277909 Admin_Org_chart.pdf
8/2/2023 12:50 PM 84886 Adult and Older Adult Level of Care Tool for FFS therapists_8.2.23.pdf
3/25/2015 2:35 PM 88711 Adult_BH_Screen.pdf
5/19/2017 12:55 PM 465508 Attach_1_Cert_Lobbying.pdf
5/19/2017 12:55 PM 339857 Attach_2_Disclosure_Lobbying.pdf
3/25/2015 2:35 PM 1423488 BHCS_Provider_Trans_Memo.pdf
1/11/2024 4:35 PM 499142 Brief Application.pdf
4/18/2018 10:39 AM 5866493 Cash_Advance_Form.pdf
5/6/2019 2:49 PM 22922 Cash_Advance_Form.xlsx
3/25/2015 2:35 PM 96483 Cash_Advance_Policy.pdf
3/15/2017 8:19 AM 316055 CBO_Sample_Signature_Authorization_Form.pdf
3/8/2017 2:20 PM 16367 CBO_Signature_Authorization_Form.pdf
2/18/2022 4:41 PM 42984 CBO_Signature_Authorization_Form_FILLABLE.docx
3/25/2015 2:35 PM 89462 Child_0-5_BH_Screen.pdf
3/25/2015 2:35 PM 90822 Child_6-17_BH_Screen.pdf
6/19/2020 3:03 PM 196950 Covid-19 SiteCert MEMO.pdf
6/25/2020 11:37 AM 115782 COVID-19 Waiver Site Cert INSERT .pdf
6/25/2020 11:37 AM 115782 COVID-19 Waiver Site Cert INSERT.pdf
3/13/2025 8:49 AM 269602 DRAFT_Exhibit_A-1-MH_Standard_Requirements_FY25-26_Yellow_Highlighting_for_Web_Posting.pdf
3/13/2025 8:49 AM 329301 DRAFT_Exhibit_A-1-SUD_Standard_Requirements_FY25-26_tracked_changes-Combined_version_All_Highlights_for_Webposting.pdf
4/18/2019 1:47 PM 164474 DRAFT_FY_19-20 MH_Exhibit_A-3_QA_Medi-Cal_Treatment.pdf
4/18/2019 1:47 PM 150269 DRAFT_FY_19-20_Exhibit_A-2_CBO Lobbying_Disclosure.pdf
4/18/2019 1:47 PM 338938 DRAFT_FY_19-20_MH_Exhibit_A-1_Provisions_Treatment.pdf
4/18/2019 1:47 PM 310918 DRAFT_FY_19-20_SUD_Exhibit_A-1_Provisions. Current.pdf
6/14/2018 2:50 PM 214045 ERMHS_info.pdf
4/19/2024 2:41 PM 474552 Exhibit A-1 - MH Standard Requirements_Yellow Highlights01.pdf
4/19/2024 8:32 AM 428770 Exhibit A-1 - SUD Standard Requirements_Yellow Highlights (003).pdf
4/18/2024 3:59 PM 428770 Exhibit A-1 - SUD Standard Requirements_Yellow Highlights.pdf
4/11/2022 4:19 PM 206898 Exhibit B - MH.pdf
6/21/2019 11:55 AM 180288 Exhibit B MH FY 19-20_Final.pdf
3/10/2020 9:14 AM 212389 Exhibit B SUD FY 19-20 Final.pdf
3/10/2020 9:14 AM 137063 Exhibit B SUD OTP FY 19-20 Final.pdf
4/15/2024 12:21 PM 117398 Exhibit B-4 Final Report Submission Timeline.pdf
4/15/2024 12:21 PM 147366 Exhibit B-5 MH Final Settlement Appeal Procedures-old.pdf
4/18/2024 4:00 PM 142606 Exhibit B-5 MH Final Settlement Appeal Procedures.pdf
9/15/2016 3:42 PM 180544 Exhibit_D_audit_req.pdf
9/15/2016 3:42 PM 251540 Exhibit_E_Bus_Associate_Agreemnt.pdf
9/15/2016 3:42 PM 22139 Exhibit_F.pdf
5/19/2017 12:55 PM 19776 Exhibit_G_Lobbying_Disclosure.pdf
5/19/2017 12:55 PM 12014 Exhibit_H_QSOA.pdf
2/1/2017 10:37 AM 123893 Exhibit_O_Iran_Contracting_Act.pdf
4/2/2020 11:17 AM 311291 FINAL Ex A-1 FY 20-21 (clean).pdf
6/16/2020 3:19 PM 289492 FINAL Ex A-1 FY 20-21 (updated).pdf
3/10/2020 9:14 AM 311462 FINAL Ex A-1 FY 20-21.pdf
4/2/2020 11:16 AM 159387 FINAL Ex A-P Adult Outpatient (formerly Level III) FY 20-21 (clean).pdf
4/28/2020 9:54 AM 171409 FINAL Ex A-P CalWORKS FY 20-21 (clean).pdf
4/2/2020 11:17 AM 147041 FINAL Ex A-P CESDC (clean).pdf
4/2/2020 11:17 AM 134997 FINAL Ex A-P Child & Youth Outpatient (MH-clean).pdf
4/28/2020 9:54 AM 166960 FINAL Ex A-P CRT FY 20-21 (clean).pdf
6/1/2020 11:18 AM 148627 FINAL Ex A-P Eating Disorder FY 20-21 (clean).pdf
4/2/2020 11:17 AM 210988 FINAL Ex A-P FSP-Child FY 20-21 (clean).pdf
4/2/2020 11:17 AM 227882 FINAL Ex A-P FSP-TAY, Adult, OA (clean).pdf
4/2/2020 11:16 AM 164251 FINAL Ex A-P Housing Navigation FY 20-21 (clean).pdf
7/10/2020 1:42 PM 144508 FINAL Ex A-P HSP Ex A-P FY 20-21 (clean).pdf
6/16/2020 3:19 PM 188032 FINAL Ex A-P IBH FY 20-21 (clean).pdf
4/28/2020 9:54 AM 164301 FINAL Ex A-P IHOT FY 20-21 (clean).pdf
6/1/2020 11:18 AM 154688 FINAL Ex A-P Interim Housing FY 20-21 (clean).pdf
3/10/2020 9:14 AM 170983 FINAL Ex A-P PATH FY 20-21 (clean).pdf
6/1/2020 11:18 AM 134189 FINAL Ex A-P Primary Prevention - Older Adult FY 20-21 (clean).pdf
6/1/2020 11:18 AM 163261 FINAL Ex A-P Primary Prevention - Youth FY 20-21 (clean).pdf
4/2/2020 11:16 AM 150643 FINAL Ex A-P PSH FY 20-21 (clean).pdf
7/10/2020 1:42 PM 136714 FINAL Ex A-P SBBH FY 20-21 (clean).pdf
4/2/2020 11:17 AM 163148 FINAL Ex A-P Service Team (clean).pdf
4/2/2020 11:17 AM 149299 FINAL Ex A-P STRTP In County (clean).pdf
4/2/2020 11:17 AM 162644 FINAL Ex A-P STRTP Out of County (clean).pdf
8/4/2020 8:40 AM 171909 FINAL Ex A-P SUD OTP (clean).pdf
6/1/2020 11:17 AM 176979 FINAL Ex A-P SUD Outpatient Services (clean).pdf
6/1/2020 11:17 AM 150160 FINAL Ex A-P SUD Recovery Residence (clean).pdf
6/19/2020 10:53 AM 223959 FINAL Ex A-P SUD Residential (clean).pdf
4/2/2020 11:17 AM 139818 FINAL Ex A-P TBS FY 20-21 (clean).pdf
4/2/2020 11:17 AM 181164 FINAL Ex A-P UELP FY 20-21 (clean).pdf
4/28/2020 9:54 AM 174483 FINAL Ex A-P Wellness Centers FY 20-21.pdf
4/28/2020 9:54 AM 151432 FINAL FY 20-21 Ex A-P Language ACCESS (clean).pdf
6/3/2019 1:08 PM 107464 FY 19-20 Exhibit A-2 - CBO Lobbying Disclosure.pdf
6/25/2020 2:53 PM 723230372 FY 20-21 Contracts Unit Annual Spring Provider Presentation June 16, 2020.mp4
6/19/2020 10:37 AM 447571 Handout - ACBH Departmental Reorganization - UPDATE.pdf
6/19/2020 4:19 PM 184185 Handout - ACBH Providers Ex A Redesign_3-27-2020.pdf
6/19/2020 10:37 AM 180062 Handout - ACBH_FY 20-21_Budget Impacts - Final.pdf
6/19/2020 3:03 PM 264000 Handout - NPI Instructions.pdf
6/19/2020 10:37 AM 192551 Handout - Self-Care Supportive Resources during the COVID-19 Pandemic (FINAL).pdf
6/19/2020 10:38 AM 357226 Handout Spring Provider Mtg FY 20-21 - Summary of Exhibit A-1 Standard Changes.pdf
6/19/2020 10:38 AM 931281 Handout Spring Provider Mtg FY 20-21 - Summary of MH Exhibit A-P Changes.pdf
6/19/2020 10:38 AM 985939 Handout Spring Provider Mtg FY 20-21 - Summary of SUD Exhibit A-P Changes.pdf
2/22/2018 2:35 PM 108280 Housing-Homeless_Criteria_Def.pdf
9/15/2016 3:42 PM 124397 Insurance_Exhibit_C-13A.pdf
9/15/2016 3:42 PM 123395 Insurance_Exhibit_C-2C.pdf
9/15/2016 3:42 PM 126867 Insurance_Exhibit_C-4.pdf
6/21/2019 11:55 AM 280744 Master Contract Amendment Coversheet FY 19-20.pdf
6/3/2019 1:08 PM 342575 MH Exhibit A-1 Provisions_Treatment_053019.pdf
6/3/2019 1:08 PM 164297 MH Exhibit A-3 QA (Medi-Cal Treatment)_053019.pdf
6/25/2019 1:12 PM 32696 MH Exhibit B-4 FY 19-20.pdf
6/25/2019 1:11 PM 143057 MH Exhibit B-5 FY 19-20.pdf
3/20/2018 8:32 AM 197662 MH_Budget_Req&Instruct.pdf
3/23/2018 2:47 PM 106299 MH_Exh_A-1_Prov_FY18-19.pdf
9/1/2017 2:16 PM 98539 MH_Exh_A-1_Provisions.pdf
2/23/2018 9:33 AM 19564 MH_Exh_A-2_CBO_Lobbying_FY18-19.pdf
5/19/2017 12:55 PM 26870 MH_Exh_A-2_QA_addendum.pdf
2/23/2018 9:33 AM 22785 MH_Exh_A-3_Medi_Cal_Treatment_FY18-19.pdf
3/25/2015 2:35 PM 170974 MH_Exhibit_B-1_Req_Instruct.pdf
9/15/2016 3:42 PM 185560 MH_Exhibit_B_T&C_Payment.pdf
5/26/2023 12:58 PM 627407 MHP-FFS-Handbook-Oct2019.pdf
2/16/2024 2:20 PM 335949 MHP-FFS-Provider-Update-Form.pdf
2/16/2024 4:51 PM 120582 MHP-FFS-Voluntary-Disenrollment-Form.pdf
5/1/2015 9:30 AM 93939 MHP_Brief_Application.docx
12/22/2015 9:37 AM 200010 MHP_Provider_Network_FAQ.pdf
6/19/2020 3:03 PM 221178 PrivacySecurity Requirements for Contract Providers 6.4.20 Revised (002).pdf
11/10/2020 12:12 PM 68351 Program_Change_Request.docx
6/1/2020 11:18 AM 1461003 Prop 47 Agreement BSCC 354-19_signed by HCSA (executed 10-2-19).pdf
6/1/2020 11:18 AM 376341 Prop 47_No Cost Extension Agreement_signed_4-19-2019 (executed 4-17-19).pdf
6/1/2020 11:18 AM 8582414 Prop 47_Standard Agreement_Signed1_complete packet (executed 8-23-17).pdf
3/25/2015 2:35 PM 570740 Provide_Program_Changes_Process.pdf
3/8/2017 2:21 PM 126846 Provider_Contact_Info.pdf
4/11/2022 4:19 PM 532267 Provider_Contact_Information_Form_FILLABLE.pdf
6/4/2025 2:59 PM 312205 Provider_Contact_Information_Form_FY_25-26.pdf
3/25/2015 2:35 PM 1176923 Provider_Letter.pdf
7/7/2017 2:27 PM 90308 Provider_or_Program_Change_Notification_Form 4.26.13.docx
10/7/2020 2:35 PM 42072 Provider_or_Program_Change_Notification_Form 9.17.20.docx
5/1/2015 9:30 AM 90269 Provider_Program_Change_Notification.docx
1/26/2022 5:19 PM 43713 Provider_Program_Change_Notification_Form.docx
3/25/2015 2:35 PM 570740 Provider_Program_Changes_Process.pdf
11/16/2017 12:21 PM 79924 PROVIDER_UPDATE.docx
9/12/2018 12:57 PM 344013 Provider_Update.pdf
2/18/2022 4:41 PM 116615 SAMPLE CBO Signature Authorization Form.pdf
6/14/2018 2:50 PM 308288 SBBH_Shift_Funds_Info.pdf
6/14/2018 2:50 PM 199052 SBBH_Shift_Funds_Request_appl.pdf
6/17/2016 1:18 PM 90820 SBBH_Shift_Funds_Request_Form.DOCX
6/17/2016 1:18 PM 311275 SBBH_Shift_Funds_Requests_Info.pdf
3/25/2015 2:35 PM 420031 Screening_Tool_Referral_Instruct.pdf
9/15/2016 3:42 PM 73732 Settlement_Methodology_Form.pdf
6/3/2019 1:08 PM 312993 SUD Exhibit A-1 Provisions_053019.pdf
9/1/2017 2:16 PM 80612 SUD_Exh_A-1_Provisions.pdf
3/23/2018 2:47 PM 117564 SUD_Exh_A-1_Provisions_FY18-19.pdf
2/27/2017 12:32 PM 26878 SUD_Exh_A-2_Perinatal_Provisions.pdf
2/26/2018 2:35 PM 14049 SUD_Exh_A-3_QSOA_FY18-19.pdf
9/15/2016 3:42 PM 23435 SUD_Exh_A-3_TAY.pdf
9/15/2016 3:42 PM 298042 SUD_Exhibit_B_T&C_payment.pdf
5/1/2015 9:30 AM 78032 Voluntary_Disenrollment_Form.docx