A copy of standard lease agreement used or other similar residential agreements detailing required tenant/ landlord requirements as applicable through California’s Consumer Affairs. A copy of the settings policies and procedures or onsite manual with pages earmarked identifying compliance with each federal characteristic.
Forms - DHCS
2025年1月16日 · Access forms used by the Department of Health Care Services.
Who Should Fill Out This Form? You need to enroll in a Medi-Cal Managed Care Plan (i.e. Plan) now. You need to continue the medical care you get from your Regular Medi-Cal (Fee-for-Service) doctor (doctors and midwives can complete Part II of this form); Your doctor is not part of a Plan in the county where you live; AND.
Department of Health Care Services (DHCS) | CA.gov
2024年11月21日 · As the state single state agency overseeing Medi-Cal, California’s Medicaid program, DHCS provides health care to low-income individuals, children, older adults, and persons with disabilities. Medi-Cal covers physical and mental health, substance use disorder treatment, dental, pharmacy, and long-term services and supports.
Forms By Name - P - pan.dhcs.ca.gov
2024年10月1日 · Proof of Citizenship and Identity--New Requirements for Medi-Cal Beneficiaries who are U.S. Citizens or Nationals (DHCS 0002, 1/08)
Provider Forms Home Page - dental.dhcs.ca.gov
Listed below are all available provider forms for the Medi-Cal Dental program. These forms can be downloaded, printed and mailed.
Please use one form to report each quarter. PROVIDER CODE: Enter the provider code for the facility assigned for the Cost Reporting System. If the facility is not a Short-Doyle provider, then leave blank. FACILITY NAME: Enter the names of all …
In order for the California Department of Health Care Services to ensure compliance with the new Federal Home and Community-Based (HCB) Setting final Rule, 42 CFR §441.301(c)(4) (5), prior to enrollment or continued enrollment as a provider for Home and Community-based Services (HCBS), applicants/providers must complete the following disclosure.
Reporting Instructions and Forms - Marin BHRS
Marin BHRS Substance Use Services provide a range of substance use treatment and recovery support options for Marin County Medi-Cal beneficiaries and low income uninsured community members. Primary-Prevention-Data-Quality-Standards (Februar... Monthly Provider Attestation Procedure (Updated Ma...
Licensing and Certification Applications Forms and Fees - DHCS
2025年2月24日 · This page contains the applications, forms and resources needed for licensure and certification. Applications. Initial Treatment Provider Application (DHCS 6002) Initial Application for Certification (DHCS 6040) Initial Application for Existing Certified Programs To Obtain Initial Certification for New Program (DHCS 6041)