Drug Medi-Cal Organized Delivery System

Welcome to the County of San Diego’s Behavioral Health Services (BHS) Drug Medi-Cal Organized Delivery System (DMC-ODS) document library. From this site you will be able to access any communications, forms, and manuals that BHS has sent out to providers. If you are looking for more general information regarding DMC-ODS, please visit the BHS DMC-ODS website by clicking here.  

Training

If you are provider and are looking for a comprehensive list of required provider trainings for DMC-ODS, click here to visit the DMC-ODS Training site.

SUDPOH

DHCS Form MC 6700 - Multiple Billing Override Certification
DHCS Form MC 6700 - Multiple Billing Override Certification 2017-10-16
SUDPOH Appendix C.2 - Waitlist Tracking Log 4-1-17.docx
2017-10-16
SUDPOH Appendix D.2 - Program Accessibility Assessment 9-14-17.xlsx
2017-10-16
SUDPOH Appendix G.2 - Gift Card Approval Form 7-21-14.xlsx
2017-10-16
SUDPOH Appendix I.1 - SUD Complaint Report Form 8-30-17.docx
2017-10-16
SUDPOH Appendix I.2 - Serious Incident Report SIR 04 01 17.doc
2017-10-16
SUDPOH Appendix I.3 - Serious Incident Report of Findings SIROF 04 01 17.doc
2017-10-16
SUDPOH Appendix I.4 - Root Cause Analysis RCA WORKSHEET 1-1-11.doc
2017-10-16
Substance Use Disorder Provider Operations Handbook (pdf)
2017-10-10
Substance Use Disorder Provider Operations Updates Sept. 2017 (pdf)
2017-10-10

SUDURM

00 - SUD Client File Updates April 2017.pdf
2017-05-01
00 - SUD Uniform Record Manual (pdf)
2018-03-07
01 - Uniform Record Manual (pdf)
2018-02-01
01 - Uniform Record Manual (pdf)
2018-03-09
02 - Client File Order (pdf)
2018-02-01
02 - Client File Order (pdf)
2018-03-09
03 - Section 1 Detail (pdf)
2018-02-01
04 - 101 Instruction DMC Tracking Form 04-12-17.pdf
2017-05-01
06 - 101a-placement-non medi-cal tracking.pdf
2017-05-01
07 - 102a Instruction QAR Initial Review Form 4-12-17.pdf
2017-05-01
09 - 102b Instruction QAR Extention-Stay-Discharge Form 4-12-17.pdf
2017-05-01
12 - 103 Instruction Medi-Cal Eligibility Printout 4-12-17.pdf
2017-05-01
13 - 104a Instruction Supplement Minor Children 04-12-17.pdf
2018-01-24
14 - 104a Minor Children Form 04-12-17.pdf
2018-01-24
15a - 104b Instructions Brief ASAM Phone Screening 1-22-18.pdf
2018-01-24
15b - 104b Brief ASAM Phone Screening 1-22-18.pdf
2018-01-24
15c - 104b Form Fill Brief ASAM Phone Screening 01-22-18.docx
2018-01-24
16a -104c Instructions Intake Adult ASAM Screening 1-22-18.pdf
2018-01-24
16b - 104c Intake Adult ASAM Screening 1-22-18.pdf
2018-01-24
16c - 104c Form Fill Intake Adult ASAM Screening 01-22-18.docx
2018-01-24
17a - 104d Instructions Intake Adolescent ASAM Screening 1-22-18.pdf
2018-01-24
17b - 104d Intake Adolescent ASAM Screening 01-22-18.pdf
2018-01-24
17c - 104d Form Fill Intake Adolescent ASAM Screening 01-22-18.docx
2018-01-24
18a - 104e Instructions Intake Parent ASAM Screening 1-22-18.pdf
2018-01-24
18b - 104e Intake Parent ASAM Screening 1-22-18.pdf
2018-01-24
18c - 104e Form Fill Intake Parent ASAM Screening 01-22-18.docx
2018-01-24
21 - 105-placement-fee collection 4-12-17.pdf
2017-05-01
23 - 106-placement-ID-SS-cards 4-12-17.pdf
2017-05-01
25 - 107-placement-Medi Cal Card 4-12-17.pdf
2017-05-01
26 - 108 Instruction Financial Responsibility and Info Form 4-12-17.pdf
2017-05-01
27a - S109 Instruction CalOMS Profile rev 3-2017.pdf
2017-05-01
27c - S109B CalOMS Profile Collateral Contacts.pdf
2017-05-01
28 - S110 Instruction SanWITS Intake rev 3-2017.pdf
2017-05-01
28a - S110 SanWITS Intake.pdf
2017-05-01
29 - S111 Instruction CalOMS Admission rev 3-2017.pdf
2017-05-01
29a - S111 CalOMS Admission 5-17.pdf
2017-05-23
30 - S112 Instruction CalOMS Annual Update 3-2017.pdf
2017-05-01
31 - S112 CalOMS Annual Update 5-17.pdf
2017-05-23
32 - Section 2 Detail 4-12-17.pdf
2017-05-01
33 - 201-placement-consent to release 4-12-17.pdf
2017-05-01
34 - 202-placement-Admissions Agreement-Consent to Treatment 4-12-17.pdf
2017-05-01
35 - 203 Instruction Client Personal Rights 8-30-17.pdf
2017-10-19
36 - 203 Client Personal Rights 8-29-17.pdf
2017-10-19
37 - 204 Instruction Title 22 Fair Hearing Rights 4-12-17.pdf
2017-04-27
38 - 204 Title 22 Fair Hearing Rights 4-12-17.pdf
2017-04-27
39 - 205-placement-Notice of Privacy-HIPAA 4-12-17.pdf
2017-05-01
40 - 206-placement-Consent to Follow up 4-12-17.pdf
2017-05-01
41 - 207-placement-Consent for photo-tv-video 4-12-17.pdf
2017-05-01
42 - 208 Instruction Coordination of Care 4-12-17.pdf
2017-05-01
43 - 208 Coordination of Physical Behavioral Health.pdf
2017-05-01
44 - Form Fill - 208 Coordination of Physical Behavioral Health.doc
2017-05-01
45 - Section 3 Detail (pdf)
2018-03-09
45 - Section 3 Detail 4-12-17.pdf
2017-05-01
46 - 301 Instruction Stay Review 4-12-17.pdf
2017-05-01
47 - 301 Stay Review Form 4-12-17.pdf
2017-05-01
47a - Form Fill - 301 Stay Review Form 4-12-17.docx
2017-05-01
48 - 302 Instruction Alcohol and Drug Hx 4-12-17.pdf
2017-05-01
50 - 302 Alcohol and Drug History Form 4-12-17.pdf
2017-05-01
51 - 303 Instruction ASI-YAI 4-12-17.pdf
2017-05-01
52 - 303 ASI Lite.pdf
2017-04-27
53 - 303a YAI.pdf
Image 2017-05-01
54 - 304 Instruction Co-occurring Form 4-12-17.pdf
2017-05-01
55 - 304 Co-occurring Screening Form 4-12-17.pdf
2017-04-27
56 - Form Fill - 304 Co-occurring Screening Form 4-12-17.doc
2017-04-27
57 - 305a Instruction HRA (pdf)
2018-02-01
58 - 305a High Risk Assessment 4-12-17.pdf
2017-05-01
59 - Form Fill - 305a High Risk Assessment 4-12-17.docx
2017-05-01
60 - 305b Instruction HRI 4-12-17.pdf
2017-05-01
61 - 305b High Risk Index 4-12-17.pdf
2017-05-01
62 - Form Fill - 305b High Risk Index 4-12-17.docx
2017-05-01
62a - 306 Instructions ASAM LOC Recomendation (pdf)
2018-03-09
62b - 306 ASAM LOC Recommendation (pdf)
2018-03-09
62c - 306 Form Fill ASAM LOC Recommendation (docx)
2018-03-09
63 - Section 4 Detail.pdf
2017-05-01
64 - 401 Instruction Client 12-hr Intensive Observation Log Detox 4-12-17.pdf
2017-05-01
66 - 402 Instruction Centrally Stored Medication & Destruction Record 4-12-17.pdf
2017-05-01
68 - 403 Instruction Health Questionnaire Form 4-12-17.pdf
2017-05-01
69 - 403 Health questionnaire 4-12-17.pdf
2017-05-01
69a - 403 - Form Fill Health Questionnaire.pdf
2017-05-01
70 - 404 Instruction TB questionnaire 4-12-17.pdf
2017-05-01
71 - 404 TB screening form 4-12-17.pdf
2017-05-01
74 - 406 Instruction Physician Direction form 4-12-17.pdf
2017-05-01
75 - 406 Physician Direction Form 4-12-17.pdf
2017-05-01
76 - 407 MD Recomendation to client 4-12-17.pdf
2017-05-01
78 - 408-placement-proof of pregnancy 4-12-17.pdf
2017-05-01
79 - 409 Instruction Diagnosis Determination Note 4-20-17.pdf
2017-05-01
80a - Form Fill - 409 Diagnosis Determination Note 5-5-17.docx
2017-05-10
81 - Section 5 Detail (pdf)
2018-03-09
81 - Section 5 Detail.pdf
2017-05-01
82 - 501 Instruction Treatment Plan 4-12-17.pdf
2017-05-01
82a - 501 Instructions Inital Treatment Plan (pdf)
2018-03-09
82b - 501 Initial Treatment Plan (pdf)
2018-03-09
82c - 501 Form Fill Initial Treatment Plan (docx)
2018-03-09
83 - 501 Treatment Plan 4-12-17.pdf
2017-05-01
83a - 502 Instructions Updated Treatment Plan (pdf)
2018-03-09
83b - 502 Updated Treatment Plan (pdf)
2018-03-09
83c - 502 Form Fill Updated Treatment Plan (docx)
2018-03-09
84 - Form Fill - 5-01 Treatment Plan 4-21-17.docx
2017-05-01
84a - 503 Instructions Addendum Treatment Plan (pdf)
2018-03-09
84b - 503 Addendum Treatment Plan (pdf)
2018-03-09
84c - 503 Form Fill Addendum Treatment Plan (docx)
2018-03-09
85 - Section 6 Detail.pdf
2017-05-01
86 - 601a b Instruction Progress Note 5-23-17.pdf
2017-05-30
87a - Form Fill - 601a Progress Notes 5-8-17.docx
2017-05-10
88a - 601b - Form Fill - Weekly Progress Notes 4-12-17.docx
2017-05-10
89 - Section 7 Detail.pdf
2017-05-01
90 - 701 Instruction Discharge Summary 4-12-17.pdf
2017-05-01
91a-79-Form Fill - Discharge Summary 5-19-17.docx
2017-05-22
92 - 702 Instruction 10 Day Letter to Client 4-12-17.pdf
2017-05-01
94 - S703 Instruction CalOMS Discharge 3-2017.pdf
2017-05-01
95 - S703 CalOMS Discharge 5-17.pdf
2017-05-23
96 - 704 Instruction Client Discharge Plan 4-12-17.pdf
2017-05-01
97a - 704 Form Fill Client Discharge Plan 4-12-17.docx
2017-05-01
98 - Section 8 Detail 4-12-17.pdf
2017-05-01
99 - 801 Instruction Drug Test and Results Log.pdf
2017-05-01
99a - 801 Drug Test and Result Log Form.pdf
2017-05-01
99b - 802 placement Drug Test Results From Lab 4-12-17.pdf
2017-05-01
99c - 803 placement Progress Reports.pdf
2017-05-01
99d - 804 placement Case Management Notes-Plans.pdf
2017-05-01
99e - 805 placement Referral Source Documents.pdf
2017-05-01
County of San Diego, Department of Health Services, Alcohol and Drug Services
2017-04-27
County of San Diego, Department of Health Services, Alcohol and Drug Services
2017-04-27
D/MC CLIENT TRACKING FORM
2017-04-27
DHCS 5078 - Centrally Stored Medication and Destruction Record (07/13)
2017-04-27
DISCHARGE SUMMARY
2017-04-27
Date:
2017-04-27
MEDICAL NECESSITY NOTE
2017-04-27
McALISTER INSTITUTE
2017-04-27
McALISTER INSTITUTE
2017-04-27
McALISTER INSTITUTE
2017-04-27
McALISTER INSTITUTE
2017-04-27
McAlister Institute
2017-04-27
Medical office registration form
2017-04-27
SUD Uniform Record Manual January 2018 (pdf)
2018-02-01

Communications

Budget Addendum - Start Up Costs for Cost Reimbursement DMC ODS (xlsx)
2018-01-19
Budget Addendum - Start Up Costs for NNR DMC ODS (xlsx)
2018-01-19
CoSD Proposed Interim Rate Caps (pdf)
2017-12-11
DMC ODS Waiver Implementation Plan (pdf)
2017-10-12
DMC ODS Waiver Implementation Plan - Frequently Asked Questions (docx)
2016-08-24
DMC ODS Waiver Implementation Plan Appendix (pdf)
2017-10-12
How to Access BHETA Trainings (pdf)
2017-11-03
One-Page Flyer Templates with Paired Logo
2018-02-09
Original Notice – October 14, 2017 - PREPARING FOR CONTRACTING UNDER THE DRUG MEDI-CAL ORGANIZED DELIVERY SYSTEM (pdf)
2017-12-11
Press release (Professional design)
Behavioral Health Services 2018-01-19
Update – December 7, 2017 - UPDATES ON BHS DRUG MEDI-CAL ORGANIZED DELIVERY SYSTEM IMPLEMENTATION (pdf)
2017-12-11

QM Training

DMC Application Table of Contents - Revised.pdf
2018-05-10
DMC Certification for SUD Providers” Webinar Material Descriptions (pdf)
2017-11-03
PowerPoint Presentation
General Overview 2017-11-03
“DMC Certification Process Checklist” (pdf)
2017-11-03
“DMC Site Visit Documents” (pdf)
2017-11-03

Manuals

Changes in STC 6-1-17 (pdf)
2017-11-03
STC 6-1-17 (pdf)
2017-11-09

ASAM

ASAM Case Presentation Format (docx)
2017-11-03
ASAM Criteria Dimensions at a Glance (docx)
2017-11-03
ASAM Levels of Care Key tool (docx)
2017-11-03
ASAM Risk Rating (docx)
2017-11-03
ASAM Risk Rating Checklist (docx)
2017-11-03
ASAM Training Q and A (docx)
2017-11-30
ASAM Training Tracking Log 01-29-18.xlsx
2018-02-09
Assessment Considerations for Each Dimension of the ASAM Criteria (docx)
2017-11-03
CIBHS - ASAM Criteria B Online Training Flyer.pdf
2018-02-09
CIBHS ASAM Criteria A Online Training Flyer with handouts.pdf
2018-02-09
Change Companies e-trainings.pdf
2018-02-09
Determining ASAM Criteria Risk Level Three Hs (docx)
2017-11-03

Toolbox

One-Pager (FINAL) Benefit Limitations - Recovery Residency.pub
2018-05-04
One-Pager (FINAL) Case Management.pub
2018-05-04
One-Pager (FINAL) General Outpatient Tx Assumptions.pub
2018-05-04
One-Pager (FINAL) General Residential Tx Assumptions.pub
2018-05-04

Beneficiary

NOABD

UTTM

For versions of the UTTM prior to September 2018, please see the “UTTM” tab on the Organizational Provider Public Documents page.

SanWITS

Billing

PC1000 2-track Pilot