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Mental Health Plan (MHP): Certifications (MHP-owned & operated Clinics)

Send certifications to:
or Fax 916-440-5497

Information Letters and Notices Relevant to Mental Health Plan (MHP) Certifications


10-04MHP Self-certification Letter.pdf 
           Encl 1Survey.pdf

           Encl 2Re-certification Protocol.pdf


02-06Day 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 and sample form (9/2014) 

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



Contact us

Helpful Links

Program Oversight and Compliance Branch - Mental Health (Overview)

Program Oversight and Compliance Branch - Mental Health (Main menu)


Last modified on: 8/10/2015 10:09 AM