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

Forms & Documents By Category

   

Contract Renewal Documents  

Standard Documents for FY 20-21

  • Standard Exhibit A Attachments
    • Exhibit A: Table of Contents (Template)
    • Exhibit A-1: Standard Requirements
    • Exhibit A-2: CBO Lobbying Restrictions & Disclosure Certification (Master Contracts Only - See Exhibit G for Services-As-Needed Contracts) FY 19-20
      • 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 (Exhibit A-P) for Mental Health Contracts
      • Exhibit A-P: CalWORKs – Pending
      • Exhibit A-P: Counseling-Enriched Special Day Class (CESDC)
      • Exhibit A-P: Full Service Partnership (FSP) – Child
      • Exhibit A-P: FSP – Transition-Age Youth, Adult and Older Adult
      • Exhibit A-P: Housing Navigation – Pending
      • Exhibit A-P: In-Home Outreach Team (IHOT) – Pending
      • Exhibit A-P: Integrated Behavioral Health Care Coordination (IBH)
      • Exhibit A-P: Permanent Supportive Housing (PSH) – Pending
      • Exhibit A-P: Promoting Access to Health (PATH)
      • Exhibit A-P: School-Based Behavioral Health (SBBH) – Pending
      • Exhibit A-P: Service Team
      • Exhibit A-P: Short-Term Residential Therapeutic Program (STRTP) – In-County
      • Exhibit A-P: Short-Term Residential Therapeutic Program (STRTP) – Out-of-County
      • Exhibit A-P: Therapeutic Behavioral Services (TBS)
      • Exhibit A-P: Underserved Ethnic and Language Populations (UELP)
    • Exhibit A – Program Requirements (Exhibit A-P) for Substance Use Disorder (SUD) Contracts
      • Exhibit A-P: Opioid Treatment – Pending
      • Exhibit A-P: Outpatient and Intensive Outpatient Treatment – Pending
      • Exhibit A-P: Primary Prevention – Pending
      • Exhibit A-P: Recovery Residence – Pending
      • Exhibit A-P: Residential Treatment – Pending
  • Standard Exhibit B: Payment Terms and Conditions
    • MH Exhibit B: Terms and Conditions of Payment – Pending
    • SUD Exhibit B: Terms and Conditions of Payment – Pending
    • Exhibit B-4: MH Cost Report Submission Timeline
    • Exhibit B-5: MH Mental Health Cost Settlement Appeal Procedures
  • Standard Exhibit C: Insurance Requirements
  • 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 (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

Standard Documents for FY 19-20 (if different than those for FY 20-21)

  • Exhibit A-1: Mental Health Additional Terms and Conditions FY 19-20
  • Exhibit A-1: Substance Use Disorder (SUD) Additional Terms and Conditions FY 19-20
  • Exhibit A-3: Mental Health QA Addendum for Medi-Cal Treatment Programs (Master Contracts Only – See Exhibit H for Services-As-Needed Contracts) FY 19-20
  • MH Exhibit B: Terms and Conditions of Payment FY 19-20
  • SUD Exhibit B: Terms and Conditions of Payment, Opioid Treatment Programs (OTP) FY 19-20
  • SUD Exhibit B: Terms and Conditions of Payment, Other SUD FY 19-20

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

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