Under the BH-CONNECT initiative, Behavioral Health Plans (BHPs) and Drug Medi-Cal (DMC) programs may cover some or all of the EBPs described in BHIN 25-XXX and may choose to cover EBPs at any time:
  • Assertive Community Treatment (ACT)
  • Forensic ACT (FACT)
  • Coordinated Specialty Care for First Episode Psychosis (CSC for FEP)
  • Clubhouse Services
  • Enhanced Community Health Worker (CHW) Services
  • Individual Placement and Support (IPS) Supported Employment

This letter of commitment to DHCS confirms which EBPs the BHP and/or DMC program intends to cover and the effective date for coverage of each EBP. Additional information about claiming and payment for all BH-CONNECTs is available in BHIN 25-009.

BHPs and DMC programs may submit additional letters at any time to cover additional EBPs.

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* 1. County Name:

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* 2. Contact Information of Respondent:

Please Note: This survey is for county behavioral health systems that administer Medi-Cal behavioral health services. Only submissions from county behavioral health directors or designees will be accepted. Please e-mail BH-CONNECT@dhcs.ca.gov with any questions.

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* 3. Which EBP(s) does the BHP or DMC program want to cover as a Medi-Cal service?

Note: ACT, FACT, CSC for FEP and Clubhouse Services can be covered in the Specialty Mental Health Services (SMHS) system only. Enhanced CHW Services and IPS Supported Employment can be covered in the SMHS, DMC and DMC-ODS delivery systems.

Please check all EBPs that apply:

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* 4. When does the BHP or DMC program plan to commence coverage of services?

Please leave the dates for EBPs the program does not plan to cover blank. BHP and DMC programs are allowed to submit additional letters at a later date to cover additional EBPs.

The effective date for each EBP may be no earlier than the submission date of this letter of commitment.

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* 5. Behavioral Health Director Certification Statement:

I hereby certify that, to the best of my knowledge, all information provided in this letter of commitment is true and accurate.

Please enter your full name and contact information below to confirm:

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