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QA Manual
SECTION
1
PROVIDER TRAINING
1-1
ACBHD Provider Training Requirements Policy
-
ADDED 2/05/2025
1-2
PROVIDER TRAINING REFERENCE GUIDE
-
ADDED 2/05/2025
2
ETHICAL CONDUCT CODE
2-1
ETHICAL CONDUCT POLICY AND PROCEDURE
2-2
MEDICARE CODE OF CONDUCT
2-3
PROFESSIONAL STANDARDS FOR MFT; MD; LCSW; & PHD PROFESSIONS
3
PROFESSIONAL LICENSING WAIVERS and CREDENTIALING/RE-CREDENTIALING
3-1
CREDENTIALING AND RE-CREDENTIALING POLICY AND PROCEDURE
3-2
GUIDANCE REGARDING PROVIDER TYPES REQUIRED FOR CREDENTIALING
-
ADDED 7/02/2025
3-3
RESTRICTION OF PRIVILEGES FOR PRACTITIONERS (INITIAL APPLICANT)
3-4
PROFESSIONAL LICENSURE WAIVER POLICY AND PROCEDURE
-
REVISED 6/24/2025
3-5
PROFESSIONAL LICENSING WAIVER (PLW) INSTRUCTIONS AND RESOURCES
-
REVISED 6/24/2025
3-6
PROFESSIONAL LICENSURE WAIVER APPLICATION LINK
4
SPECIALTY SERVICES
4-1
INTENSIVE CARE COORDINATION (ICC), INTENSIVE HOME-BASED SERVICES (IHBS), AND THERAPEUTIC FOSTER CARE (TFC)
-
11/05/2024
4-2
EPSDT CHART DOCUMENTATION MANUAL
5
NETWORK ADEQUACY/TIMELY ACCESS REPORTING
5-1
100-2-3 TIMELY ACCESS TO SERVICE STANDARDS AND TRACKING REQUIREMENTS (10/02/2025)
5-2
Accessing the Timely Access Data Reporting Tool (TADT)
-
REVISED 2/14/2025
5-3
TADT Printable Form /
TADT Fillable Form
-
REVISED 5/27/2025
5-4
ACBHD Timely Access Data Collection Requirements and Definitions
-
REVISED 10/08/2025
5-5
Crosswalk from TADT to CSI e-Form
-
NEW 12/17/2024
6
UNUSUAL OCCURRENCES/SENTINEL EVENTS and FORMALIZED TREND REVIEW
Note: You must be logged into the
ACBH network
with your username/password to use E-Forms
6-1
UNUSUAL OCCURRENCE NOTIFICATION -
E-FORM
,
FILLABLE PDF FORM
-
12/28/2023
6-2
UNUSUAL OCCURRENCE POLICY AND DEATH REPORTING POLICY
-
REVISED 04/25/2022
7
CLINICAL RECORD DOCUMENTATION STANDARDS
7-1
CalMHSA Documentation Guides
7-2
SUPPLEMENTAL DOCUMENTATION GUIDE- SMHS
-
NEW 3/03/2025
7-3
MENTAL HEALTH INDIVIDUAL PROVIDER (MHIP) HANDBOOK
-
REVISED 11/4/2025
7-4
STANDARD ABBREVIATIONS
7-5
GUIDELINES AND OPERATIONAL STANDARDS FOR CANS/ANSA TOOLS WITHIN THE MENTAL HEALTH SYSTEM OF CARE
7-6
ACBH MEDICATION CONSENT FORM
-
REVISED 11/2/2023
7-7
TELEHEALTH CONSENT REQUIREMENTS AND ACBH TELEHEALTH CONSENT FORM
English -
Word
,
PDF
Arabic -
Word
,
PDF
Chinese Tradition -
Word
,
PDF
Chinese Simplified -
Word
,
PDF
Farsi -
Word
,
PDF
Korean -
Word
,
PDF
Spanish -
Word
,
PDF
Tagalog -
Word
,
PDF
Vietnamese -
Word
,
PDF
7-8
SUICIDE HOMICIDE RISK ASSESSMENT
7-9
DHCS STANDARD SCREENING AND TRANSITION OF CARE TOOLS
7-10
MEDICATION AND PHARMACY USER GUIDE
- NEW 1/23/24
7-11
ACBH PRACTICE GUIDELINES
- NEW 1/23/2024
7-12
ASSESSMENT REQUIREMENTS FOR ACBH DMC-ODS PROVIDERS
- NEW 2/28/24
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
CQRT COMMENTS
CQRT TRACKING TOOL
CQRT ELECTRONIC HEALTH RECORD ATTESTATION FORM
- UPDATED 12/1/22
8-3
SMHS CQRT CHECKLISTS AND GLOSSARIES
SMHS CQRT CHECKLIST:
PDF
|
Word
- UPDATED 11/16/2023
SMHS CQRT CHECKLIST GLOSSARY
- UPDATED 11/16/23
DMC-ODS CQRT OP AND RESIDENTIAL
- UPDATED 5/31/24
SHORT-TERM RESIDENTIAL THERAPEUTIC PROGRAM (STRTP) CQRT CHECKLIST
- UPDATED 8/12/24
STRTP CQRT CHECKLIST GLOSSARY
- UPDATED 8/12/24
INTENSIVE CARE COORDINATION (ICC), INTENSIVE HOME-BASED SERVICES (IHBS) CQRT CHECKLIST
- UPDATED 5/21/2025
ICC, IHBS CQRT CHECKLIST GLOSSARY
- UPDATED 5/21/2025
ADULT RESIDENTIAL CQRT CHECKLIST
- UPDATED 1/14/2026
ADULT RESIDENTIAL CQRT GLOSSARY
- UPDATED 1/14/2026
9
FORTHCOMING
10
BENEFICIARY RIGHTS INFORMING MATERIALS
10-1
NOTIFICATION OF BENEFICIARY RIGHTS
10-2
INFORMING MATERIALS PAGE
10-3
CONSUMER AND FAMILY GRIEVANCE PROCESS AND FORMS:
Process:
English
,
Spanish
,
Arabic
,
Simplified Chinese
,
Chinese Traditional
,
Farsi
,
Korean
,
Vietnamese
, and
Tagalog
- REVISED 8/07/2025
Grievance and Appeal Request Form:
English
,
Spanish
,
Arabic
,
Simplified Chinese
,
Chinese Traditional
,
Farsi
,
Korean
,
Vietnamese
, and
Tagalog
- REVISED 8/07/2025
Release of Information:
English
,
Spanish
,
Arabic
,
Simplified Chinese
,
Chinese Traditional
,
Farsi
,
Korean
,
Vietnamese
, and
Tagalog
- REVISED 8/07/2025
10-4
GRIEVANCE AND APPEAL POSTER (MULTI-LANGUAGES)
10-5
RESPONSE TO SUBPOENA FOR THE PRODUCTION OF PSYCHIATRIC AND/OR SUBSTANCE ABUSE RECORDS
10-6
CONSUMER GRIEVANCE AND APPEAL SYSTEM
10-7
PROCEDURE FOR TEST CALLS TO ACCESS PROGRAM
10-8
NOTICE OF ADVERSE BENEFIT DETERMINATION (NOABD) POLICY
- NEW 9/15/25
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
- REVISED 5/10/24
11-5
SMARTSHEET PRIVACY INCIDENT REPORT FORM
- REVISED 5/23
11-6
RECORD AND DATA RETENTION AND DESTRUCTION OF PROTECTED HEALTH INFORMATION
11-7
SECURE COMMUNICATIONS POLICY
- NEW 1/2/14
11-8
RELEASE OF INFORMATION FORMS AND RESOURCES
MH/SUD RELEASE OF INFORMATION (ROI) TRACKER LOG FORM
MENTAL HEALTH AUTHORIZATION TO DISCLOSE INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION
SUD SERVICES INCIDENTAL DISCLOSURE FORM [BP2]
12
SERVICE DESCRIPTIONS AND SCOPE OF PRACTICE
12-1
SERVICE DESCRIPTIONS MH AND SUD -
MH
,
SUD
-
REVISED 8/15/23
12-2
MH AND SUD PROVIDER DEFINITIONS AND QUALIFICATIONS
- NEW 4/22/24
12-3
ACBHD GUIDELINES FOR SCOPE OF PRACTICE (MH)
-
REVISED 9/20/24
12-4
ACBHD SUD Scope of Practice Reference Guide
-
NEW 10/28/24
12-5
MINIMUM REQUIRED SERVICE ACTIVITIES RESIDENTIAL CALAIM 3.2-WM 24-001
12-6
MINIMUM REQUIRED SERVICE ACTIVITIES RESIDENTIAL CALAIM 3.1 3.3 3.5 24-001
12-7
REQUESTING ACBHD BBS-CANDIDATE PROVIDER DESIGNATION
13
SERVICE AND BILLING RESOURCES
13-1
MH LOCKOUT GRID
-
REVISED 7/6/23
13-2
SMARTCARE DIAGNOSIS DOCUMENT INSTRUCTIONS
- NEW 11/16/23
13-3
ACBHD DIAGNOSIS AND CODE GUIDANCE
- NEW 2/11/26
13-4
MH SMARTCARE PROCEDURE CODE TABLE FY 23/24 EFF. 7-1-2023
- UPDATED 4/12/24
13-5
SUD SMARTCARE PROCEDURE CODE TABLE FY 23/24 EFF. 7-1-2023
- UPDATED 8/2/23
13-6
FY24-25 PROLONGED ADD-ON AND REPLACEMENT CODES GRID
- NEW 8/23/24
13-7
DHCS SERVICE TABLES FY 24-25
- NEW 8/26/24
13-8
PROFESSIONAL SERVICES EM SERVICE CODES DEFINITIONS
- NEW 11/6/24
13-9
IHBS Service Table
- NEW 1/27/25
13-10
MH SmartCare Procedure Code Table - FY24-25
- NEW 4/24/25
13-11
SUD SMARTCARE PROCEDURE CODE TABLE FY 25-26
- NEW 11/7/25
13-12
PUBLICATION OF FY25-26 ACBHD SMHS SMARTCARE PROCEDURE CODE TABLE
- NEW 12/16/25
14
CALIFORNIA REPORTING LAWS
14-1
Reporting Disorders Characterized by Lapses of Consciousness
14-2
CHILDREN’S AND ADULT OUTPATIENT CLINIC POLICY REGARDING COURT ORDERED REFERRALS
14-3
ELDER/DEPENDANT ADULT ABUSE REPORTING POLICY
- REVISED 5/13
14-4
CHILD ABUSE REPORTING POLICY
14-5
WARNING AND REPORTING REQUIREMENTS IN TARASOFF-LIKE SITUATIONS
15
PROGRAM INTEGRITY
15-1
SERVICE VERIFICATION POLICY
- REVISED 5/16/24
15-2
Exclusion Screening Policy
- REVISED 8/5/21
May 2016 Memo Regarding Exclusion List Monitoring & Monthly Provider Attestation
August, 2014 Draft Office of Inspector General (OIG) Policy
August, 2014 Memo Regarding the OIG Policy and Procedure from the Director of ACBHCS
15-3
WHISTLEBLOWER PROGRAM FOR FRAUD, WASTE, AND ABUSE
- REVISED 8/13/24
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
- REVISED 12/8/22
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 1/13/26
16-3
MEDI-CAL SITE CERTIFICATION PROTOCOL: DAY TREATMENT
- REVISED 8/7/24
16-4
MEDI-CAL SITE CERTIFICATION PROTOCOL: CRISIS STABILIZATION UNIT (CSU)
- REVISED 8/7/24
16-5
PROVIDER CHECKLIST for MEDI-CAL CERTIFICATION OF PUBLIC SCHOOL SITES
- REVISED 5/23/25
16-6
PROVIDER CHECKLIST for MEDI-CAL CERTIFICATION OF COMMUNITY BASED ORGANIZATIONS
- REVISED 5/23/25
16-7
FIRE CLEARANCE REQUIREMENTS
- REVISED 1/2/25
17
MISCELLANEOUS POLICIES AND PRACTICES
17-1
TOBACCO POLICIES
17-2
EARLY & PERIODIC SCREENING DIAGNOSIS AND TREATMENT (EPSDT) NOTIFICATION POLICY
- REVISED 9/27/21
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
1303-1 PROVIDER PROBLEM RESOLUTION P&P
18
24/7 LANGUAGE ASSISTANCE
18-1
24/7 LANGUAGE ASSISTANCE TO BENEFICIARIES (1/27/20)
18-2
LANGUAGE LINE POSTER
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
19-3
DEPARTMENT OF HEALTH CARE SERVICES (DHCS) CALAIM BEHAVIORAL HEALTH INITIATIVE FAQ
-
Updated regularly by DHCS
19-4
COVID FAQ
-
POSTED 6/1/22
19-5
CALAIM PAYMENT REFORM FAQ
-
POSTED 2/6/23
19-6
HCPC/CPT CODES FAQs
-
REVISED 4/22/24
20
TIPS SHEETS (TREATMENT INTERVENTIONS, PROTOCOLS and SUGGESTIONS)
20-1
DOCUMENTATION TIME
- POSTED 1/30/25
20-2
TRAVEL TIME
-
- REVISED 2/18/25
20-3
INTERPRETATION SERVICE
- POSTED 4/14/25
20-4
INTERACTIVE COMPLEXITY
- POSTED 4/22/25
20-5
MINOR CONSENT FOR MEDI-CAL MENTAL HEALTH SERVICES
- POSTED 10/02/2025
20-6
ASSESSMENT CODING
- POSTED 12/8/2025
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