2025 Behavioral Health Information Notices

• Enclosure 1: Mental Health Plan and Drug Medi-Cal Member Handbook Template
• Enclosure 2: Mental Health Plan and Drug Medi-Cal Organized Delivery Systems Member Handbook Template
• Enclosure 3: Notice of Availability of Language Assistance Services and Auxiliary Aids and Services
• Enclosure 4: Nondiscrimination Notice 

25-041

The Community Transition In-Reach BHIN provides implementation guidance for Community Transition In-Reach Services under the Behavioral Health Community-Based Organized Networks of Equitable Care and Treatment (BH-CONNECT) initiative. 

• Enclosure 1: BHP Readiness Assessment
• Enclosure 2: Occupational Therapist Exemption
• Enclosure 3: Facility Participation Agreement

Communicates the allocation schedule the Department of Health Care Services provided to the State Controller’s Office, describes the methodology used to determine those allocation schedules, and provides the amount of money the Governor’s budget has estimated will be available in the Mental Health Services Fund.

Enclosure 1: Need for Services
Enclosure 2: Population Most Likely to Apply for Services 
Enclosure 3: Population Most Likely to Access Services 
Enclosure 4: Self-Sufficiency Standard 
Enclosure 5: Adjustments Self-Sufficiency
Enclosure 6: FY 2023-24 Available Resources 
Enclosure 7: Resources Adjustment Option 1
Enclosure 8: Resources Adjustment Option 2
Enclosure 9: Resources Adjustment Option 3
Enclosure 10: Revised Need Adjusted by Resource 
Enclosure 11: MHSA Component Allocation Percentages 
Enclosure 12: FY 2025-26 Allocation Percentages 

• Exhibit A: Budget Allocation Overview
• Exhibit B: State Fiscal Year (SFY) 2025-26 Allocation Summary
• Exhibit C: Exchange Program Summary

Modifications to the Rate Methodology for Fee-for-Service Medi-Cal Contract (FFS/MC) Hospitals and Reporting Requirement Submissions.

Informs Mental Health Plans (MHP) of modifications to the rate methodology for rates negotiated between MHPs and FFS/MC Contract Hospitals and the new requirements for reporting those rates to DHCS.

• Enclosure 1: DHCS 3144 (Revised 12/04/2025)
• Enclosure 2: DHCS 3145 – Rate Change Form (Revised 12/04/2025)
• Enclosure 3: DHCS 3146 – Request for an Alternative Standardized Cost of Living Index (Revised 12/04/2025)

Provides guidance to County Behavioral Health Plans (BHPs) on how to implement and manage Activity Funds as part of the broader BH-CONNECT initiative, which aims to expand access to behavioral health services for Medi-Cal members, including children and youth involved in the child welfare system.

Please note that BHIN 25-037 was revised on November 21, 2025 to correct section heading references and add information regarding strengths-developing activities as an eligible use of Activity Funds that was inadvertently omitted in the original BHIN – refer to the bold/underlined and strike through text.

Traditional Health Care Practices Benefit Implementation – Supersedes BHIN 25-007

Provides updated guidance on the delivery of Traditional Health Care Practices in residential and inpatient settings under the Drug Medi-Cal Organized Delivery System (DMC-ODS). For questions related to traditional health care practices or this BHIN, please email traditionalhealing@dhcs.ca.gov.

• Attachment 1: Required Opt-In Template for Participating Providers
• Attachment 2: Additional Substance Use Disorder Services Available

• Attachment 3: Indian Health Care Programs & Approved IHCPs

Mental Health Block Grant (MHBG) Annual Program Review

10/10/2025

• Referral for Qualified Individual Assessment
• Qualified Individual Assessment Report 

• LPS Reporting Data Element Dictionary Phase IV
• SB 929 Phase IV: Attachment A
• SB 929 Phase IV: Attachment B
• SB 929 Phase IV: Attachment C

• Enclosure 1: Enclosure for Member Handbooks

Enclosures:

• Attachment A: PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY INTERIM REGULATIONS (Version I)
• Attachment B: DHCS 6030 – APPLICATION FOR INITIAL LICENSURE FOR PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY 
• Attachment C: DHCS 6031 – PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY AFFIDAVIT REGARDING RESIDENT MONEY
• Attachment D: DHCS 6032 – ANNUAL ATTESTATION OF COMPLIANCE WITH SUBPART G OF PART 483 OF TITLE 42 OF THE CODE OF FEDERAL REGULATIONS
• Attachment E: DHCS 6033 – APPLICATION FOR RENEWAL OF LICENSE FOR PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY

• Attachment A: Network Adequacy Certification Enforcement Actions
• Attachment B: Timely Access Enforcement Actions

• LEFU and PFU
• DHCS 1735, 1736, 1737

• Enclosure 1: Population Estimate FY 25-26

Supersedes BHIN 22-065. Adult and Youth Screening and Transition of Care Tools for Medi-Cal Mental Health Services.

Payer of Last Resort Requirements and Protocols for Family First Prevention Services Act Part I and the Family First Prevention Services Program.

• Please email BHFSOps@dhcs.ca.gov for updated claim forms while they are still in the process of being published to the MedCCC Library. 

Supersedes BHIN 22-070 (in part)and Superseded by BHIN 25-026 (in part). Parity Requirements for Drug Medi-Cal State Plan Counties
Enclosure 1 – Notice of Grievance Resolution
Enclosure 2 – Denial Notice
Enclosure 3 – Payment Denial Notice
Enclosure 4 – Delivery System Notice
Enclosure 5 – Modification Notice
Enclosure 6 – Termination Notice
Enclosure 7 – Delay in Processing Authorization of Services
Enclosure 8 – Timely Access Notice
Enclosure 9 – Financial Liability Notice
Enclosure 10 – Failure to Timely Resolve Grievances and Appeals NOABD
Enclosure 11 – NOABD Your Rights Attachment
Enclosure 12 – Adverse Benefit Determination Upheld NAR
Enclosure 13 – NAR Your Rights Attachment
Enclosure 14 – Adverse Benefit Determination Overturned NAR
Enclosure 15 – Non-Discrimination Notice
Enclosure 16 – Notice of Availability

Supersedes MHSUDS 18-010E. Mental Health Plan and Drug Medi-Cal Organized Delivery System Plan Grievance and Appeal Requirements with Revised Member Notice Templates
Enclosure 1 – Notice of Grievance Resolution
Enclosure 2 – Denial Notice
Enclosure 3 – Payment Denial Notice
Enclosure 4 – Delivery System Notice
Enclosure 5 – Modification Notice
Enclosure 6 – Termination Notice
Enclosure 7 – Delay in Processing Authorization of Services
Enclosure 8 – Timely Access Notice
Enclosure 9 – Financial Liability Notice
Enclosure 10 – Failure to Timely Resolve Grievances and Appeals NOABD
Enclosure 11 – NOABD Your Rights Attachment
Enclosure 12 – Adverse Benefit Determination Upheld NAR
Enclosure 13 – NAR Your Rights Attachment
Enclosure 14 – Adverse Benefit Determination Overturned NAR
Enclosure 15 – Non-Discrimination Notice
Enclosure 16 – Notice of Availability

Supersedes BHIN 24-020 and superseded by BHIN 26-015. 2025 Network Certification Requirements for County Mental Health Plans (MHPs), Drug Medi-Cal Organized Delivery System (DMC-ODS) Plans, Drug Medi-Cal (DMC) State Plan Counties, Integrated Behavioral Health Plans (IBHPs) and Integrated DMC Behavioral Health Delivery Systems (DMC-IBHDS)
For copies of the BHIN attachments listed below, please contact NAOS@dhcs.ca.gov:
Attachment A – DMC-ODS Expected Utilization (DMC-ODS_IBHP)
Attachment B – Time or Distance Standards
Attachment C.1– Alternative Access Standards Request Template (BHP)
Attachment C.2 – Alternative Access Standards Request Template (IBHP)
Attachment C.3 – Alternative Access Standards Request Template (DMC-IBHDS)
Attachment D.1 – Timely Access Data Tool (MHP)
Attachment D.2 – Timely Access Data Tool (DMC-ODS Plan)
Attachment D.3 – Timely Access Data Tool (DMC State Plan County)
Attachment D.4 – Timely Access Data Tool (IBHP)
Attachment D.5 – Timely Access Data Tool (DMC-IBHDS)
Attachment E – Certification of Network Adequacy Data
Attachment F.1 – Continuity-Transition of Care Report Template (BHP)
Attachment F.2 – Continuity-Transition of Care Report Template (IBHP)
Attachment G.1 – Language Line Encounter Template (BHP)
Attachment G.2 – Language Line Encounter Template (IBHP)
Attachment H – Supplemental Data Tool
Attachment I – Significant Change Attestation Template
Attachment J – Significant Change Disclosure Template

• CARE Facility Referral Form TEMPLATE. For training and technical assistance, please visit CARE Act Resource Center.

• ENCLOSURE1: BH-CONNECT Option to Receive FFP for SMHS in IMDs

• ENCLOSURE for BHIN 25-010 Peer Support Specialist Ethics Code

Coverage of BH-CONNECT Evidence Based Practices
Enclosure 1: Medi-Cal Service Components for BH-CONNECT EBPs 
Enclosure 2: Enclosure for Member Handbooks 
EBP Policy Guide

• Attachment 1: Narcotic Treatment Programs Regulation Text
• Application for License Renewal (DHCS 4029)
• Interim Treatment Patient Notification (DHCS 4032)
• Narcotic Treatment Program Initial Application (DHCS 5014)
• Facility and Geographical Area (DHCS 5025)
• Staff Information (DHCS 5026)
• County Certification (DHCS 5027)
• Affiliated and Associated Acknowledgement (DHCS 5134)
• Application for Protocol Amendment (DHCS 5135)

25-007

Traditional Health Care Practices Benefit Implementation

• Attachment 1: Required Opt-In Template for Participating Providers
• Attachment 2: Additional Substance Use Disorder Services Available
• Attachment 3: Indian Health Care Programs & Approved IHCPs

• Exhibit A: Overview of Programs, Funding, and Allocation Methodologies
• Exhibit B: SUBG Statewide Allocation SFY 2024-25
• Exhibit C Part 1: State Fiscal Year (SFY) 2024-25 and 2025-26 SUBG Exchange Program
• Exhibit C Part 2: State Fiscal Year (SFY) 2024-25 and 2025-26 SUBG Exchange Program Summary of Exchanges

• Attachment 1: DHCS Certification for Alcohol and Other Drug Programs

• Attachment A: CalOMS Tx Data Collection Guide Section 8 Discharge Data Collection Excerpt