Forms & Documents By Category
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Contract Renewal Documents
Standard Documents for FY 24-25
- Exhibit A - Attachments
- Exhibit A: Table of Contents (Template)
- Exhibit A-1: Standard Requirements for Mental Health (MH) Contracts
- Exhibit A-1: Standard Requirements for Substance Use Disorder (SUD) Contracts
- Exhibit A-2: CBO Lobbying Restrictions & Disclosure Certification (Master Contracts Only - See Exhibit G for Services-As-Needed Contracts)
- Attachment 1: Certification Regarding Lobbying – Certification form
- Attachment 2: Certification Regarding Lobbying – Disclosure form
- Exhibit A-3: SUD Qualified Service Organization Agreement (Master Contracts Only - See Exhibit H for Services-As-Needed Contracts)
- Exhibit A – Program Requirements/Scopes of Work (Exhibit A-P/SOWs) for Mental Health Contracts
- Exhibit A – Program Requirements/Scopes of Work (Exhibit A-P/SOWs) for Substance Use Disorder Contracts
- Exhibit B – Terms and Conditions of Payment
Standard Documents for FY 23-24
- Exhibit A - Attachments
- Exhibit A: Table of Contents (Template)
- Exhibit A-1: Standard Requirements for Mental Health (MH) Contracts
- Exhibit A-1: Standard Requirements for Substance Use Disorder (SUD) Contracts
- Exhibit A-2: CBO Lobbying Restrictions & Disclosure Certification (Master Contracts Only - See Exhibit G for Services-As-Needed Contracts)
- Attachment 1: Certification Regarding Lobbying – Certification form
- Attachment 2: Certification Regarding Lobbying – Disclosure form
- Exhibit A-3: SUD Qualified Service Organization Agreement (Master Contracts Only - See Exhibit H for Services-As-Needed Contracts)
- Exhibit A – Program Requirements/Scopes of Work (Exhibit A-P/SOWs) for Mental Health Contracts
- Exhibit A – Program Requirements (Exhibit A-P/SOWs) for Substance Use Disorder (SUD) Contracts
- Exhibit B: Terms and Conditions of Payment
Standard Exhibit and Reference Only
- Standard Exhibit C: Insurance Requirements
- Other Exhibits
- Exhibit B-4: Exhibit B-4 Final Report Submission Timeline
- Exhibit B-5: Exhibit B-5 MH Final Settlement Appeal Procedures
- Exhibit D: Audit Requirements
- Exhibit E: Business Associate Provisions (HIPAA)
- Exhibit F: Debarment and Suspension Certification
- Exhibit G: Lobbying Restrictions and Disclosure Certification (Services-As-Needed Contracts Only - See Exhibit A-2 for Master Contracts)
- Exhibit H: SUD Qualified Service Organization Agreement (Services-As-Needed Contracts Only - See Exhibit A-3 for Master Contracts)
- Exhibit O: The Iran Contract Act (ICA) of 2010
- Reference Only
Mental Health
Housing/Homeless Criteria and Definition of Terms
EveryOne Home Alameda County Continuum of Care (CoC) Council Prioritization for Permanent Supportive Housing Opportunities
Shift of Funds Request
Family Engagement and Group Services Reminder
Provider Resources
MHP FFS Provider Forms
- MHP FFS Provider Handbook
- Provider Update Form (Form No. 50-02) – Use this form to updated BHCS of changes such as:
- your location/address
- email, phone, or fax
- name
- a change to status with any licensing/oversight board that may impact your ability to provide, claim or be reimbursed for specialty mental health services
- Voluntary Disenrollment Form (Form No. 50-03) – Use this form to voluntarily dis-enroll from the MHP Provider Network
- FAQs
Substance Use Disorder
Coming soon
Standard
Organizational and/or Program Changes Forms
Other Standard Forms
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