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| SECTION | | |
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| 1 | | QUALITY MANAGEMENT AND IMPROVEMENT PROGRAM* |
| | 1-1 | ACBHCS ORGANIZATIONAL CHART |
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| | | *OTHER CONTENT FOR THIS SECTION IS UNDER REVIEW |
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| 2 | | ETHICAL CONDUCT CODE |
| | 2-1 | ETHICAL CONDUCT POLICY AND PROCEDURE |
| | 2-2 | MEDICARE CODE OF CONDUCT |
| | 2-3 | SUPERVISION AND PROFESSIONAL STANDARDS POLICY *FORTHCOMING UNDER REVIEW |
| | 2-4 | PROFESSIONAL STANDARDS FOR MFT; MD; LCSW; & PHD PROFESSIONS |
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| 3 | | PROFESSIONAL LICENSING WAIVERS and CREDENTIALING/RE-CREDENTIALING |
| | 3-1 | CREDENTIALING AND RE-CREDENTIALING POLICY AND PROCEDURE |
| | 3-2 | RESTRICTION OF PRIVILEGES FOR PRACTITIONERS (INITIAL APPLICANT) |
| | 3-3A | PROFESSIONAL LICENSING WAIVER - 5/2/2023 |
| | 3-3B | CREDENTIALING & RE-CREDENTIALING VERIFICATION FOR ACBH MENTAL HEALTH & SUBSTANCE USE SERVICE PROVIDERS - REVISED 10/25/2022 |
| | 3-4 | MENTAL HEALTH PROFESSIONAL LICENSURE WAIVER (BHIN 20-069) |
| | 3-5 | PROFESSIONAL LICENSING WAIVER FORM |
| | 3-6 | DHCS PROFESSIONAL LICENSING WAIVER RESOURCES |
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| 4 | | PROVIDER PROBLEM RESOLUTION |
| | 4-1 | PROVIDER PROBLEM RESOLUTION AND APPEALS |
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| 5 | | NETWORK ADEQUACY/TIMELY ACCESS REPORTING |
| | 5-1 | DMC-ODS AND SMHS TIMELY ACCESS DATA COLLECTION DEFINITIONS - 5/2/2023 |
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- DMC-ODS: Also see “Substance Use Disorder (SUD) Timely Access Data Collection” section on the QA Training page
- SMHS: Also see “Network Adequacy- Client Service Information (CSI) Data Documentation” section on the QA Training page
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| 6 | | UNUSUAL OCCURRENCES/SENTINEL EVENTS and FORMALIZED TREND REVIEW |
| | 6-1 | UNUSUAL OCCURRENCE NOTIFICATION FORM - REVISED 4/19/2023 |
| | 6-2 | UNUSUAL OCCURRENCE POLICY AND DEATH REPORTING POLICY - REVISED 04/25/2022 |
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| 7 | | CLINICAL RECORD DOCUMENTATION STANDARDS |
| | 7-1 | CalMHSA Documentation Guides |
| | 7-2 | CLINICAL RECORD DOCUMENTATION STANDARDS for SMHS |
| | 7-3 | MHP NETWORK PROVIDER DOCUMENTATION STANDARDS |
| | 7-4 | STANDARD ABBREVIATIONS |
| | 7-5 | EPSDT CHART DOCUMENTATION MANUAL |
| | 7-6 | GUIDELINES AND OPERATIONAL STANDARDS FOR CANS/ANSA TOOLS WITHIN THE MENTAL HEALTH SYSTEM OF CARE |
| | 7-7 | ACBH MEDICATION CONSENT FORM - REVISED 11/2/2023 |
| | 7-8A | Telehealth Consent Form: English - Word, PDF |
| | 7-8B | Telehealth Consent Form: Arabic - Word, PDF |
| | 7-8C | Telehealth Consent Form: Chinese Tradition - Word, PDF |
| | 7-8D | Telehealth Consent Form: Chinese Simplified - Word, PDF |
| | 7-8E | Telehealth Consent Form: Farsi - Word, PDF |
| | 7-8F | Telehealth Consent Form: Korean - Word, PDF |
| | 7-8G | Telehealth Consent Form: Spanish - Word, PDF |
| | 7-8H | Telehealth Consent Form: Tagalog - Word, PDF |
| | 7-8I | Telehealth Consent Form: Vietnamese - Word, PDF |
| | 7-9 | SUICIDE HOMICIDE RISK ASSESSMENT |
| | 7-10 | DHCS STANDARD SCREENING AND TRANSITION OF CARE TOOLS |
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| 8 | | QUALITY ASSURANCE: AUDITS and CQRT REVIEWS |
| | 8-1 | AUDIT OF MEDICAL CHARTS OF PROVIDERS OF SMHS AND NON-SMHS |
| | 8-2 | CQRT PROCEDURES-SMHS and DMC-ODS - UPDATED 10/17/2023 |
| | 8-2A | SMHS CQRT CHECKLIST: PDF | Word - UPDATED 11/16/2023 |
| | 8-2B | CQRT CHECKLIST GLOSSARY - UPDATED 11/16/2023 |
| | 8-2C | DMC-ODS CQRT OP AND RESIDENTIAL - UPDATED 11/27/2023 |
| | 8-2D | CQRT COMMENTS SHEET |
| | 8-2E | CQRT TRACKING TOOL |
| | 8-2F | CQRT ELECTRONIC HEALTH RECORD ATTESTATION FORM - UPDATED 12/1/2022 |
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| 9 | | ULTIZATION MANAGEMENT PROGRAM |
| | 9-1 | UTILIZATION MANAGEMENT REVIEW POLICY LEVEL I ADULT SERVICES - Forthcoming |
| | 9-2 | DRUG MEDI-CAL UTILIZATION REVIEW REQUIREMENTS |
| | 9-3 | UTILIZATION MANAGEMENT PROGRAM |
| | 9-4 | SB785 POLICY |
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| 10 | | BENEFICIARY RIGHTS INFORMING MATERIALS |
| | 10-1 | NOTIFICATION OF BENEFICIARY RIGHTS |
| | 10-2A | BENEFICIARY HANDBOOK - English |
| | 10-2B | BENEFICIARY HANDBOOK - Spanish |
| | 10-2C | BENEFICIARY HANDBOOK - Arabic |
| | 10-2D | BENEFICIARY HANDBOOK - Chinese (Traditional) |
| | 10-2E | BENEFICIARY HANDBOOK - Chinese (Simplified) |
| | 10-2F | BENEFICIARY HANDBOOK - Farsi |
| | 10-2G | BENEFICIARY HANDBOOK - Vietnamese |
| | 10-2H | BENEFICIARY HANDBOOK - Korean |
| | 10-2I | BENEFICIARY HANDBOOK - Tagalog |
| | 10-3 | HOW TO USE INFORMING MATERIALS PACKET |
| | 10-3A | INFORMING MATERIALS PACKET - English |
| | 10-3B | INFORMING MATERIALS PACKET - Chinese Traditional |
| | 10-3C | INFORMING MATERIALS PACKET - Farsi |
| | 10-3D | INFORMING MATERIALS PACKET - Spanish |
| | 10-3E | INFORMING MATERIALS PACKET - Vietnamese |
| | 10-3F | INFORMING MATERIALS PACKET - Chinese Simplified |
| | 10-3G | INFORMING MATERIALS PACKET - Korean |
| | 10-3H | INFORMING MATERIALS PACKET - Tagalog |
| | 10-3I | INFORMING MATERIALS PACKET - Arabic |
| | 10-3J | INFORMING MATERIALS PACKET- ANNUAL SIGNATURE PAGE IN ALL LANGUAGES |
| | 10-4 | CONSUMER GRIEVANCE AND APPEAL PROCESS FOR MEDI-CAL SMHS AND MHSA PROGRAMS |
| | 10-4A | CONSUMER AND FAMILY GRIEVANCE FORMS - English - REVISED 12/15/2022 |
| | 10-4B | CONSUMER AND FAMILY GRIEVANCE FORMS - Farsi |
| | 10-4C | CONSUMER AND FAMILY GRIEVANCE FORMS - Spanish |
| | 10-4D | CONSUMER AND FAMILY GRIEVANCE FORMS - Chinese Simplified |
| | 10-4E | CONSUMER AND FAMILY GRIEVANCE FORMS - Chinese Traditional |
| | 10-4F | CONSUMER AND FAMILY GRIEVANCE FORMS - Vietnamese |
| | 10-4G | CONSUMER AND FAMILY GRIEVANCE FORMS - Tagalog |
| | 10-4H | CONSUMER AND FAMILY GRIEVANCE FORMS - Korean |
| | 10-5 | CONSUMER AND FAMILY GRIEVANCE POSTER (MULTILANGUAGES) |
| | 10-6 | ADVANCE DIRECTIVE POLICY |
| | 10-8 | INFORMING MATERIALS LIST - REVISED 5/31/23 |
| | 10-9 | RESPONSE TO SUBPOENA FOR THE PRODUCTION OF PSYCHIATRIC AND/OR SUBSTANCE ABUSE RECORDS |
| | 10-10 | CONSUMER RIGHTS GRIEVANCE: FAIR HEARING FOR SUD SERVICES |
| | 10-11 | PROCEDURE FOR TEST CALLS TO ACCESS PROGRAM |
| | 10-12 | NOTICE OF ADVERSE BENEFIT DETERMINATION (NOABD) POLICY - New 6/27/19
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| 11 | | CONFIDENTIALITY POLICIES |
| | 11-1 | POSITION STATEMENT ON COMMUNICATION OF CLIENT INFORMATION |
| | 11-2 | MANAGEMENT OF PROTECTED HEALTH INFORMATION |
| | 11-3 | POLICY ON CLINICAL DATA SECURITY |
| | 11-4 | PRIVACY, SECURITY AND CONFIDENTIALITY STATEMENT OF CLIENT SERVICES, RECORDS AND INFORMATION |
| | 11-4a | E-FORM FOR ACBH EMPLOYEES |
| | 11-4b | E-FORM FOR ACBH CONTRACTORS |
| | 11-5 | HIPAA BREACH REPORTING POLICY |
| | 11-5A | SMARTSHEET PRIVACY INCIDENT REPORT FORM - REVISED 5/2023 |
| | 11-6 | RECORD AND DATA RETENTION AND DESTRUCTION OF PROTECTED HEALTH INFORMATION |
| | 11-7 | SECURE COMMUNICATIONS POLICY - NEW 1/2/14 |
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| 12 | | CONSUMER SATISFACTION SURVEY |
| | 12-1 | CONSUMER SATISFACTION SURVEY |
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| 13 | | SERVICE AND BILLING RESOURCES |
| | 13-1 | SERVICE DESCRIPTIONS MH AND SUD - MH, SUD - REVISED 8/15/2023 |
| | 13-2 | ACBH GUIDELINES FOR SCOPE OF PRACTICE CREDENTIALING (MH) |
| | 13-3 | ACBH GUIDELINES FOR SCOPE OF PRACTICE CREDENTIALING (SUD) |
| | 13-4 | MH LOCKOUT GRID - REVISED 7/6/2023 |
| | 13-5 | SMARTCARE DIAGNOSIS DOCUMENT INSTRUCTIONS - NEW 11/16/23 |
| | 13-6 | ACBH SMHS OP ICD-10-CM DIAGNOSES FOR CLAIMING - NEW 11/16/23 |
| | 13-7 | ACBH SUD OP ICD-10-CM DIAGNOSES FOR CLAIMING - NEW 11/16/23 |
| | 13-8 | BHIN 20-043 ENCLOSURE 1 - SMHS INPATIENT INCLUDED DIAGNOSIS - NEW 11/16/23 |
| | 13-9 | BHIN 20-074E ENCLOSURE 1 - SUD RESIDENTIAL AND INPATIENT INCLUDED DIAGNOSIS - NEW 11/16/23 |
| | 13-10 | MH SMARTCARE PROCEDURE CODE TABLE EFF. 7-1-2023 - UPDATED 10/4/23 |
| | 13-11 | SUD SMARTCARE PROCEDURE CODES TABLE EFF. 7-1-2023 - UPDATED 8/2/23 |
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| 14 | | CALIFORNIA REPORTING LAWS |
| | 14-1 | POLICY ON REPORTING DEMENTING CONDITIONS |
| | 14-2 | CHILDREN’S AND ADULT OUTPATIENT CLINIC POLICY REGARDING COURT ORDERED REFERRALS |
| | 14-3 | ELDER/DEPENDANT ADULT ABUSE REPORTING POLICY - REVISED MAY, 2013 |
| | 14-4 | CHILD ABUSE REPORTING POLICY |
| | 14-5 | WARNING AND REPORTING REQUIREMENTS IN TARASOFF-LIKE SITUATIONS |
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| 15 | | PROGRAM INTEGRITY |
| | 15-1 | SERVICE VERIFICATION POLICY - NEW 11/2015 |
| | 15-2 |
OIG and OTHER EXCLUSION LIST MONTIORING OVERSIGHT, AND REPORTING - REVISED 8/2021
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| | 15-3 |
WHISTLEBLOWER PROGRAM FOR FRAUD, WASTE, AND ABUSE |
| | 15-4 |
WHISTLEBLOWER REPORTING FORM |
| | 15-5 |
WHISTLEBLOWER POSTER |
| | 15-6 |
ACBH COMPLIANCE AND PROGRAM INTEGRITY PLAN |
| | 15-7 |
CONTRACT COMPLIANCE AND SANCTIONS FOR BHCS-CONTRACTED PROVIDERS |
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| 16 | | MEDI-CAL SITE CERTIFICATION |
| | 16-1 | MEDI-CAL SITE CERTIFICATION FOR PROVIDERS OF MENTAL HEALTH SERVICES POLICY - REVISED 8/15/22 |
| | 16-2 | MEDI-CAL SITE CERTIFICATION PROTOCOL - REVISED 7/28/23 |
| | 16-3 | MEDI-CAL SITE CERTIFICATION PROTOCOL: DAY TREATMENT - REVISED 7/28/23 |
| | 16-4 | MEDI-CAL SITE CERTIFICATION PROTOCOL: CRISIS STABILIZATION UNIT (CSU) - REVISED 7/28/23 |
| | 16-5 | PROVIDER CHECKLIST for MEDI-CAL CERTIFICATION OF PUBLIC SCHOOL SITES - REVISED 1/23/23 |
| | 16-6 | PROVIDER CHECKLIST for MEDI-CAL CERTIFICATION OF COMMUNITY BASED ORGANIZATIONS - REVISED 1/17/23 |
| | 16-7 | FIRE CLEARANCE REQUIREMENTS - REVISED 5/5/22
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| 17 | | MISCELLANEOUS POLICIES AND PRACTICES |
| | 17-1 | TOBACCO POLICIES |
| | 17-2 | EARLY & PERIODIC SCREENING DIAGNOSIS AND TREATMENT (EPSDT) NOTIFICATION POLICY |
| | 17-3 | OBTAINING AUTH FOR PRESCRIBING PSYCH MED TO YOUTH - JV PROTECTION |
| | | JV Forms Link |
| | 17-4 | CLINICAL PSYCHIATRIC PHARMACIST SCOPE OF PRACTICE FOR MEDICATION THERAPY MANAGEMENT |
| | 17-5 | GUIDELINES FOR PSYCHOTROPIC MEDICATION PRACTICES |
| | 17-6 | TIMELY ACCESS TO SERVICE STANDARDS AND TRACKING REQUIREMENTS |
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| 18 | | 24/7 LANGUAGE ASSISTANCE |
| | 18-1 | 24/7 LANGUAGE ASSISTANCE TO BENEFICIARIES (1/27/20) |
| | 18-2 | LANGUAGE LINE POSTER |
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| 19 | | FREQUENTLY ASKED QUESTIONS (FAQ) |
| | 19-1 | SMHS FREQUENTLY ASKED QUESTIONS - POSTED 4/11/22 |
| | 19-2 | CAL-AIM FREQUENTLY ASKED QUESTIONS - REVISED 12/30/22 |
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19-3 | DEPARTMENT OF HEALTH CARE SERVICES (DHCS) CALAIM BEHAVIORAL HEALTH INITIATIVE FAQ - Updated regularly by DHCS |
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19-4 | COVID FAQ - POSTED 6/1/2022 |
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19-5 | CALAIM PAYMENT REFORM FAQ - POSTED 2/6/2023 |
| | 19-6 | CPT CODES FREQUENTLY ASKED QUESTIONS (FAQ) - REVISED 9/6/23
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