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Mental Health Plan: Certifications (Owned & Operated Clinics)

Information Letters and Notices Relevant to Mental Health Plan Certifications

Letters

10-04: MHP Self-certification Letter.pdf
Encl 1: Survey.pdf
Encl 2: Re-certification Protocol.pdf

Notices

02-06: Day Treatment Components Letter.pdf

Encl 1: Day Treatment Components.pdf

04-09: Certification Protocol Letter.pdf

Encl 1: Protocol.doc

Encl 2: Service Definitions.pdf

Encl 3: Head of Service Definitions.pdf

Certification forms

DHCS 1735 Medi-Cal Certification Transmittal (09/2014)
DHCS 1735 Instructions
DHCS 1736 County-Owned and Operated Certification Application (09/2014)
DHCS 1736 Instructions (07/2014)
DHCS 1737 County-Owned and Operated Provider Self-Survey Form (09/2014)
DHCS 1737 Instructions (07/2014)
DHCS 1746 Director's Designee Information

References

Medi-Cal Provider Certification/Re-Certification General Overview (PDF)
Provider certification flowchart (PDF)
Certification protocol: Contact DMHCertification@dhcs.ca.gov for current version
Certification email: DMHCertification@dhcs.ca.gov
Provider file updates (PFU): ProviderFile@dhcs.ca.gov

Contact us

Email: DMHCertification@dhcs.ca.gov

Send Certifications to DMHCertification@dhcs.ca.gov or Fax to (916) 440-5497

Helpful Links

Program Monitoring and Compliance Branch - Mental Health

Last modified date: 4/12/2022 1:57 PM