Home
Forms Library
Initial Treatment Provider Application Substance Abuse Clinics - dhcs ca

Initial Treatment Provider Application Substance Abuse Clinics - dhcs ca 2026

Initial Treatment Provider Application Substance Abuse Clinics - dhcs ca Preview on Page 1

See details

4 out of 5

39 votes

The document is an Initial Treatment Provider Application from the State of California's Health and Human Services Agency, specifically for Substance Use Disorder (SUD) treatment programs. It outlines the application process for current and prospective providers seeking licensure or certification for residential and outpatient substance abuse treatment facilities. The document details requirements, regulations, necessary documentation, application fees, and instructions for completing the application to ensure compliance with state laws governing substance use disorder services.

Here's how it works

01. Edit your form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out Initial Treatment Provider Application Substance Abuse Clinics - dhcs ca with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the Initial Treatment Provider Application in the editor.
Begin with Section A, where you will select the application type and purpose. Ensure all relevant boxes are checked.
Proceed to Section B to provide your legal entity information. Fill in the legal entity name, program/facility name, and administrative address accurately.
In Section C, enter the facility/building information including address, county, and contact details. Confirm if the facility is Drug Medi-Cal Certified.
Complete Section D for residential license applicants by detailing target population and services provided. Ensure water supply information is accurate.
For SUD certification applicants, fill out Section E by checking applicable services and providing operational hours.
Review all sections for completeness before submitting. Use our platform’s features to save your progress and ensure all required documentation is attached.

Start filling out your application today using our platform for a seamless experience!

See more Initial Treatment Provider Application Substance Abuse Clinics - dhcs ca versions

We've got more versions of the Initial Treatment Provider Application Substance Abuse Clinics - dhcs ca form. Select the right Initial Treatment Provider Application Substance Abuse Clinics - dhcs ca version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2016	4.8 Satisfied (120 Votes)
2014	4 Satisfied (39 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What are title 22 regulations in California?

Title 22 encompasses a wide range of regulations, from licensing requirements and staffing ratios to safety standards and resident rights. Its primary objective is to protect the health, safety, and well-being of residents in care facilities.

Who regulates medical facilities in California?

Primary care clinics are required to be licensed through the authority of the California Department of Public Health (CDPH) Licensing Certification Program (LC). The LC program utilizes standards defined in state and federal law and regulations to evaluate health facility compliance.

What is a DMC provider?

The Drug Medi-Cal Organized Delivery System (DMC-ODS) provides a continuum of care modeled after the American Society of Addiction Medicine Criteria for substance use disorder treatment services, enables more local control and accountability, provides greater administrative oversight, creates utilization controls to

Who regulates PPOS in California?

In California, health insurance is regulated by the California Department of Insurance (CDI). Our mission is to protect consumers, foster a vibrant and stable insurance marketplace, and enforce laws related to health insurance and the health insurance code fairly and impartially.

How much is the application fee for the DHCS?

The application fee amount for the calendar year 2024 was $709.00. This amount reflects a $21. 00 increase from the calendar year 2023 application fee. This fee amount is required with any applicable enrollment application submitted on or after January 1, 2024 and on or before December 31, 2024.

Security and compliance

At DocHub, your data security is our priority. We follow HIPAA, SOC2, GDPR, and other standards, so you can work on your documents with confidence.

Learn more

Who regulates rehab facilities in California?

The DHCS, Behavioral Health Licensing and Certification Division, regulates and licenses residential SUD treatment. Additionally, a law was recently passed that will require all California adult SUD residential treatment facilities to receive an ASAM designation.

Who oversees rehabilitation centers in California?

The Department of Health Care Services (DHCS) ensures the provision of quality treatment through the enforcement of standards for professional and safe treatment. The Licensing and Certification Division (LCD) investigates complaints against Californias alcohol and other drug (AOD) recovery and treatment programs.

What is a DHCS license?

The Department of Health Care Services (DHCS) has sole authority to license facilities providing residential nonmedical services to eligible adults who are recovering from problems related to alcohol or other drug (AOD) misuse or abuse.