Dhcs 6170 form-2025

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The document is a self-survey form for the re-certification of county-owned and operated mental health providers in California, issued by the Department of Health Care Services. It includes sections for county and provider information, services provided, evaluation criteria regarding compliance with health and safety regulations, and necessary documentation for maintaining standards in mental health service delivery. The form must be completed and submitted to ensure compliance with federal and state requirements.

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Click ‘Get Form’ to open the dhcs 6170 form in the editor.
Begin by filling in the 'County Information' section. Enter the county submitting the form, county code, and NPI number. If applicable, indicate whether the provider is activating any modes or changing names.
Next, complete the 'Provider Information' section. Fill in the provider's name, address, number, city, and zip code accurately.
In the 'Services Provided' section, check all applicable services offered by your organization. Ensure you review each service category carefully.
Proceed to answer the evaluation criteria questions. For each question, select 'Yes', 'No', or 'N/A' as appropriate based on your compliance with state requirements.
Finally, ensure that all required signatures are completed at the end of the form before saving your changes.

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2014	4.8 Satisfied (63 Votes)

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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 is the 90 day rule for DHCS?

The 90 Day Rule set by the California Board of Behavioral Sciences (BBS) allows candidates to count supervised experience toward licensure when gained during the window of time between the degree award date and the issue date of the associate registration number.

What is the 90-day cure period for Medi-Cal?

o Patients who are disenrolled from Medi-Cal as a result of not providing required information, are given 90 days to submit their information without needing to re- apply for Medi-Cal. This is referred to as the 90-day Cure Period.

What is the 3 month rule for Medi-Cal?

First things first, the 90-day waiting period is the maximum amount of time an eligible employee has to wait before enrolling in a company-sponsored health insurance plan. Once the time period ends, by law, employees must be given the opportunity to get health coverage.

What is a DHCS 1801 form?

DHCS 1801 (MH 302): Application for up to 72-Hour Assessment, Evaluation, and Crisis Intervention or Placement for Evaluation and Treatment.

What is the transition of care tool for DHCS?

The Transition of Care Tool for Medi-Cal Mental Health Services (hereafter referred to as the Transition of Care Tool) ensures that members who are receiving mental health services from one delivery system receive timely and coordinated care when their existing services need to be transitioned to the other delivery

What is the 90-day rule in California?

An applicant may be eligible for Medi-Cal coverage for services received in any of the three months immediately prior to the month of application if all requirements are met for those past months. A beneficiary who is eligible for benefits on the first day of the month is entitled to services for the entire month.

What is the full form of DHCS in California?

Department of Health Care Services (DHCS) | CA.gov.

Dhcs 6170 form-2025

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