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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Forms & Documents By Category

   

Contract Renewal Documents  

  • Standard Exhibit A Attachments
    • Exhibit A-1: Mental Health (MH) Additional Terms and Conditions FY 17-18
    • Exhibit A-1: Mental Health (MH) Additional Terms and Conditions FY 18-19
    • Exhibit A-2: MH QA Addendum for Medi-Cal Treatment Programs FY 17-18
    • Exhibit A-2: CBO Lobbying Restrictions & Disclosure Certification FY 18-19
      • Attachment 1: Certification Regarding Lobbying – Certification form
      • Attachment 2: Certification Regarding Lobbying – Disclosure form
    • Exhibit A-3: MH QA Addendum for Medi-Cal Treatment Programs FY 18-19
    • Exhibit A-1: Substance Use Disorder (SUD) Additional Terms and Conditions FY 17-18
    • Exhibit A-1: Substance Use Disorder (SUD) Additional Terms and Conditions FY 18-19
    • Exhibit A-2: SUD Additional Provisions for Perinatal Programs FY 17-18
    • Exhibit A-3: SUD Qualified Service Organization Agreement FY 18-19
  • Standard Exhibit B: Payment Terms and Conditions
  • Standard Exhibit C: Insurance Requirements
    • Exhibit C-2C: Insurance Requirements for For-Profit Health Care Services
    • Exhibit C-4: Insurance Requirements for Non-Profit Health Care Services
    • Exhibit C-13A: Insurance Requirements for Medical Services Providers
  • Other Exhibits
    • Exhibit D: Audit Requirements
    • Exhibit E: Business Associate Provisions (HIPAA)
    • Exhibit F: Debarment and Suspension Certification
    • Exhibit G: Lobbying Restrictions and Disclosure Certification (Contracts with >$100,000 in federal funding) FY 17-18
    • Exhibit H: Qualified Service Organization Agreement (SUD Contracts Only) FY 17-18
    • Exhibit O: The Iran Contract Act (ICA) of 2010
  • Reference Only

Mental Health  

Unaccompanied Youth – Alameda County: Letter to Providers

Housing/Homeless Criteria and Definition of Terms
EveryOne Home Alameda County Continuum of Care (CoC) Council Prioritization for Permanent Supportive Housing Opportunities

School Based Behavioral Health Programs Shift of Funds Request Psychological Testing Family Engagement and Group Services Reminder
 

MHP FFS Provider Forms  


Substance Use Disorder  


Coming soon

 

Standard  



Organizational and/or Program Changes Forms

Other Standard Forms