Resources & References

General policy and procedure documents for the BHS Managed Care Plan and Systems of Care.

On this page, you will find current DPH wide privacy policies.

On this page, you will find current DPH wide compliance policies.

Billing resources for providers partnering with San Francisco County Behavioral Health Services.

We facilitate the development of City contracts with health service providers, thus ensuring the availability of community services.

How to meet the requirements for your contract with the Department of Public Health

The contract between Federal CMS and State DHCS--it's a "boilerplate"--only includes limited mandatory behavioral health benefits (inpatient hospital). There are optional benefits that a state can include in their State Plan (e.g., prescription drugs). California's State Plan includes the "Other Diagnostic, Screening, Preventive, and Rehabilitative Care (aka "Rehab Option).

California uses the 1915(b) Waiver to implement the SMHS program.

The contract between State DHCS and County--it's a "boilerplate", and the contract period is about 5 years. The contract defines the responsibilities of the County as a "plan" (a Medicaid Managed Care Prepaid Inpatient Health Plan) --includes Compliance ("Program Integrity").

The contract (intergovernmental agreement) between State DHCS and County--it's a "boilerplate", and the contract period is about 5 years. The contract defines the responsibilities of the County as a "plan".

The contract between DHCS and the Medicaid managed care health plans.

In San Francisco, there are three managed care health plans: (1) SF Health Plan (Public); (2) Anthem Partnership (Private); (3) Kaiser (direct contract - foster care).

These documents are revised periodically by DHCS which cover SMHS Billing Manual, DMC-ODS Billing Manual, Medi-Cal Aid Codes, and Medi-Cal Rates.

Information notices are the mechanism by which DHCS updates contract terms and establishes policy guidance for Counties.

The IN is directed to County Behavioral Health Plans and DMC/ODS providers. The document communicates the updated ODS program requirements for the period of 2022 – 2026. Note—this supersedes IN 23-001. Specifically—the ODS program requirements document now aligns to (“matches up with”) our CalAIM related laws (WIC 14184.402), DHCS IN Policy Letters (e.g., IN 23-068) and Amendments to our State Plan (e.g., SPA 23-006). with CalAIM. The 35-page document includes the list of covered DMC-ODS services, the MAT policy, etc.

Effective 1/1/2024 - The IN is directed to County Behavioral Health Plans and providers of SMHS, DMC, and DMC/ODS services. The IN communicates a major update to the CalAIM chart documentation IN #22-019 (i.e., the chart documentation guidance in effect from 7/1/22 through 12/31/2023). In this updated IN #23-068, additional details are provided about requirements for Standardized Assessments, SMHS Assessments, Problem Lists, Progress Notes, Treatment and Care Planning, and Telehealth Consent.

Effective 7/1/2023 -The IN is directed to Behavioral Health Plans and provides information and tools to help Counties ensure they are ready and prepared to implement payment reform elements that include: (1) use of CPT codes where possible; (2) use a fee schedule (comprehensive list of activities and fees) to be reimbursed; (3) use “Intergovernmental Transfers” to draw down federal funds.

Effective 4/15/2022 - the information notice describes the requirement for Behavioral Health Plans to implement Concurrent UM activities in specific settings (e.g., Acute Inpatient Psych Hospital, Psychiatric Health Facilities, etc.).

Effective 7/1/22 - This information notice is directed to County MHPs, administrators and staff that ensures all beneficiaries to receive timely mental health services without delay regardless of the delivery system where they seek care, and that beneficiaries are able to maintain treatment relationships with trusted providers without interruption.

Effective 1/1/2022 - This information notice is directed toward the County MHP administrators and SMHS Organizational Providers. This document communicates the new definition of medical necessity and the new criteria for both children and adults’ medical necessity. These new definitions and criteria are effective 01/01/2022.

Published by DHCS - this list is updated monthly and includes drugs listed on the Medi-Cal Rx Contract Drugs List (CDL), as well as drugs not listed on the CDL.

The Centers for Medicare & Medicaid Services (CMS) National Correct Coding Initiative (NCCI) promotes national correct coding methodologies and reduces improper coding, with the overall goal of reducing improper payments of Medicare Part B and Medicaid claims.

The list of IMDs (including STRTPs) are posted at the MH Licensing Section.