providing mental health &
substance abuse  services for
the people of Alameda County ...  
   

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2000 Embarcadero Cove, Suite 400, Oakland, CA  94606
Phone: (510) 567-8100    Driving Directions

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Informing Materials

To order Informing Materials please contact the QA's
Informing Materials Desk at (510)567-8233 or email
qainformingmaterials@acbhcs.org.

   

Informing Materials List   

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 Mental Health.
  1. Initial Forms that Must be in the Chart & Signed by Beneficiaries at Intake
    1. Signature page from the packet: Informing Materials – Your Rights and Responsibilities (available in English, Spanish, Chinese Traditional(Mandarin), Simplified Chinese(Cantonese), Farsi & Vietnamese). Available on CD upon request.
      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)
    2. Written Policy regarding Confidentiality of Records (provider policy)
    3. Releases of Information, as necessary (provider form)


  2. Things You Must Offer Beneficiaries to Review

  3. These documents must be offered to new beneficiaries and be available in a lobby or area where they have access to them, without having to make a request. If desired, you may make a binder for these documents and label it, “Copies available upon request.” As a courtesy, that phrase is translated into the five threshold languages for printing as a label; it is available at the website below, as are the following materials:
    1. Provider Referral List, for Alameda County Behavioral Health Care Services (updated quarterly).
    2. Guide to Medi-Cal Mental Health Services (available in English, Spanish, Chinese Traditional(Mandarin), Chinese Simplified(Cantonese), Farsi, & Vietnamese). Available on CD upon request.


  4. Things that Must be Available in Your Lobby/Office
    1. Complaint Poster (must be posted)
    2. Consumer & Family Grievance/Appeal Form (available in English, Spanish, Chinese Traditional(Mandarin), Simplified Chinese(Cantonese), Farsi & Vietnamese) with envelopes addressed to BHCS. Available on CD upon request.
To replenish your supply of the above materials, check the Provider website www.acbhcs.org/providers. For materials not available on the website, email the BHCS Quality Assurance informing materials desk at qainformingmaterials@acbhcs.org, or call (510) 567-8233.