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Drug Medi-Cal Certification

ANY DMC PROVIDER WHO IS CURRENTLY DMC CERTIFIED TO PROVIDE DAY CARE HABILITATIVE SERVICES (DCH) IS NOT REQUIRED TO SUBMIT AN APPLICATION FOR EXPANDED BENEFITS TO ADD INTENSIVE OUTPATIENT (IOP); HOWEVER, IF THE PROVIDER WISHES TO PROVIDE ANY SERVICES OTHER THAN THE MODALITIES CURRENTLY APPROVED, A NEW APPLICATION WOULD BE REQUIRED.

This is the entire package of materials required for initial Drug Medi-Cal certification of a substance abuse treatment program also known as a DMC Clinic. The DMC Application can also be used to add a satellite site; to request re-certification following relocation of a clinic or satellite site; to add services or funding; and to apply for DMC certification following a change of ownership.

Please print out and/or save every document below. You will need to refer to them often. The documents may be downloaded in PDF format.

You will be able to fill out the majority of all required form fields electronically. You will also be able to save a completed version (with your organization's information) of the document locally. After doing so, the completed application can be printed, additional fields (eg. signatures) can be completed manually, and the complete application can be sent to DHCS. It is not recommended that you view or complete the Adobe application documents within your Internet browser window. Please download or save these documents first and then open them in Adobe.

You may download the application documents in Adobe's .pdf format. This format CAN be electronically completed and saved. To access the PDF format you need Acrobat Reader on your computer. If you do not have Acrobat Reader on your computer, download and install Acrobat Reader for free on your computer.

After reviewing all of these documents, print and complete all applicable forms and submit a hard copy to the Department of Health Care Services, Provider Enrollment Division, MS 4704, PO Box 997412, Sacramento, CA 95899-7412. Retain a copy of all information submitted to the Department for your files.

Please Note:

In order to implement various provisions of the federal Patient Protection and Affordable Care Act (Affordable Care Act), effective January 1, 2014, the Department of Health Care Services (DHCS) has adopted additional DMC services included in the essential health benefits package, as adopted by the state and approved by the United States Secretary of Health and Human Services. The revised DMC application (DHCS 6001) includes these additional services, which includes ‘intensive outpatient’ and ‘non-perinatal residential’ services. The guidelines for parent, satellite, and relocation applications have also been included within the revised DHCS 6001. For further information please see SUD Letter #13-01.       

 

Recertification

For questions about the DMC recertification process, please contact DHCS’ Provider Enrollment Division (PED) through the DHCSDMCRecert@dhcs.ca.gov mail box and PED staff will provide a direct response.  PED can also be reached by phone at (916) 323-1945.

  • Continued Certification for Drug Medi-Cal Providers Bulletin (PDF)
  • All DMC Providers Letter   (PDF  |  Text Version
  • 30-day Notice Letter  (PDF  |  Text Version)   
  • Facility Staffing Form (PDF
  • Medi-Cal Disclosure Statement  (PDF
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Last modified on: 2/26/2015 3:12 PM