This is a list for Alameda County BHCS providers to ensure that the appropriate informing materials are available to Medi-Cal beneficiaries, as required by the California Department of Health Care Services. [1]
- Initial Forms that Must be in the Chart & Signed by Beneficiaries at Intake
- Signature page from the packet:
Informing Materials – Your Rights and Responsibilities (available in
Arabic,
Chinese Traditional,
Farsi,
Spanish,
Vietnamese,
Chinese Simplified,
Korean &
Tagalog).
This packet must be offered to Medi-Cal beneficiaries at intake, annually thereafter, and upon request.
The packet contains:
- Consent for Services
- Freedom of Choice
- Explanation of the three (3) items noted in B. & C. (below): Provider Referral List, Guide to Medi-Cal Mental Health Services & BHP Member Handbook
- Confidentiality & Privacy statement (Duty to Report)
- Advance Directive Information
- Beneficiary Problem Resolution Information
- Maintaining a Welcoming & Safe Place (not a required informing material)
- Notice of Privacy Practices (HIPAA/HITECH)
- Written Policy regarding Confidentiality of Records (provider policy)
- Releases of Information, as necessary (provider form)
- Documents You Must Offer Beneficiaries to Review
The documents below must be offered to beneficiaries when they begin receiving a specialty mental health service and upon request. Providers are not required to maintain a supply of these documents onsite, however, this notice, “Copies available upon request.” The notice must be posted for beneficiaries in a visible and accessible area of the office or lobby. Thus, providers are not required to maintain current copies of these documents onsite2:
- Provider Directory[3] of all Alameda County Behavioral Health services (in English and all threshold languages).
- For Mental Health Providers: Guide to Medi-Cal Mental Health Services - available in English, Spanish, Arabic, Chinese Traditional, Farsi, Chinese Simplified, Vietnamese, Korean and Tagalog Audio CD upon request.
- For Substance Use Disorder Providers: Guide to Drug Medi-Cal Services - available in English, Spanish, Arabic, Chinese Traditional, Farsi, Chinese Simplified, Vietnamese, Korean and Tagalog. Audio CD upon request.
- Beneficiary Handbook Consumer Notice (Note: Translations forthcoming): Beneficiary Handbook Consumer Notice - available in English
- Documents You Must Make Available in Your Lobby/Office
The following documents must be posted for beneficiaries in a visible and accessible area of the office or lobby without having to make a request:
- Consumer & Family Grievance and Appeals Poster
- Consumer & Family Grievance/Appeal Forms available in English,
Spanish,
Arabic,
Simplified Chinese,
Chinese Traditional,
Farsi,
Korean,
Vietnamese, and
Tagalog with envelopes addressed to BHCS. with envelopes addressed to BHCS. Audio files are available here on our public grievance page.
To replenish your supply of the above materials, visit QA’s Informing Materials Page on the Provider website BHCS Providers Website. To request the Grievance and Appeals poster (it should not be printed), email the ACBH Quality Assurance informing materials desk at qainformingmaterials@acbhcs.org, or call (510) 567-8233.
Footnotes
[1] CCR, Title 9, Section 1810.360 (b) (3), (d) and (e) and Cal. Code Regs. Tit. 9, § 1850.205 - General Provisions
[2] Please click here for instructions on how to print the ACBH Provider Directory.
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