1.Full Name

2.Job Title and Name of Your Nonprofit

3.Briefly describe your nonprofit (e.g., community health center, counseling center, clinic, etc.) and the region(s) in the state where you operate.

4.Does your nonprofit primarily provide psychotherapy for mild to moderate conditions (e.g., non-specialty mental health services)?

Yes, primarily psychotherapy services

No, minimal to no psychotherapy services

Partially, in combination with other services

5.Is your nonprofit an approved Medi-Cal provider for psychotherapy services through one or more managed care plans? If so, did you apply via the DHCS PAVE portal or enter into a direct contract with a managed care plan? If your organization has not applied to become a Medi-Cal group provider through the DHCS PAVE portal, do you have any concerns about the approval process especially now that managed care plans are requiring recertification through PAVE?

Yes, we are an approved Medi-Cal group provider through PAVE

No, we are not an approved Medi-Cal group provider and do not contract directly with a managed care plan

Yes, we are not approved through PAVE but we do contract directly with a managed care plan (Please share any concerns you may have about the approval process through PAVE in the comment box)

6.Has your nonprofit applied to become a Medi-Cal group provider through the DHCS PAVE portal? If yes, did your application get approved or denied?

Yes, we applied and was approved through PAVE

Yes, we applied and was denied through PAVE

No, we did not apply through PAVE

7.If your nonprofit did not apply to become a Medi-Cal group provider through the DHCS PAVE portal, why not?

8.If your nonprofit could become an approved Medi-Cal group provider for psychotherapy mild to moderate conditions (non-specialty mental health services), would you enroll?

Yes

No

9.How many clinical staff currently provide psychotherapy at your nonprofit?

10.What are the license types of your clinical staff providing non-specialty mental health services? Please only count associate and licensed therapists, not trainees. Select all that apply.

Marriage and family therapist

Clinical social worker

Professional clinical counselor

Psychologist

11.Do you currently hire associate therapists (AMFT, ASW, APCC, PhD, PsyD) as employees?

Yes, we hire associates

No, but we have associates as volunteers

No, we do not have associates

12.Would you consider hiring associates as employees if you could bill Medi-Cal for the psychotherapy they provide?

Yes

No

13.If your nonprofit was approved as a Medi-Cal group provider, approximately how many clients receiving psychotherapy would you be able to bill for Medi-Cal reimbursement?

14.Can you share how this issue has affected your nonprofit, if at all, and what steps you've taken to address it?

15.Would you be open to a follow up by email? If yes, please provide your email address.