About this service
Marin Behavioral Health and Recovery Services (BHRS) provides behavioral health contractor resources to support contracted providers and agency partners that deliver services for Marin County Medi-Cal members and low income uninsured community members. These resources are intended to help contractors meet documentation, compliance, service delivery, and administrative requirements, and to support the delivery of high quality services to clients.
The resource collection includes the Behavioral Health Contractor Manual, contractor manual appendices, the Clinical Documentation Guide, policies and procedures, Notice of Adverse Benefit Determination (NOABD) forms, and related invoicing and rate materials.
Who this service is for
This information is for:
- Contracted behavioral health service providers and contracted agency partners working with Marin BHRS
- Organizations or individuals interested in becoming contracted behavioral health service providers
Behavioral Health Contractor Manual appendices
The appendices include a collection of documents available to BHRS behavioral health contract agency partners. These materials include program, client, compliance, and administrative forms and reference documents.
The documents in this list may not work with all assistive technology and are being remediated. For alternative formats, please email Behavioral Health and Recovery Services or phone 415-473-6769. To use the California relay service, dial 711.
- Advance Healthcare Directive_1.pdf (0.07 MB) — Advanced Healthcare Directive
- Advance Healthcare Directive (Español)_1.pdf (0.07 MB) — Advanced Healthcare Directive (Español)
- Advance Directives Client Rights_1.pdf (0.18 MB) — Advanced Directives Client Rights
- Advance Directives Client Rights (Español)_1.pdf (0.29 MB) — Advance Directives Client Rights (Español)
- Change of Provider Request Form (English)_1.pdf (0.19 MB) — Change of Provider Request
- Change of Provider Request - English Large Font.pdf (0.19 MB) — Change of Provider Request - Large Font
- Change of Provider Request - Spanish (1).pdf (0.12 MB) — Change of Provider Request (Español)
- Change of Provider Request - Spanish Large Font.pdf (0.12 MB) — Change of Provider Request - Large Font (Español)
- Change of Provider Request - Vietnamese (1).pdf (0.14 MB) — Change of Provider Request (Vietnamese)
- Change of Provider Request - Vietnamese Large Font.pdf (0.15 MB) — Change of Provider Request - Large Font (Vietnamese)
- Client Profile.pdf (0.34 MB) — Client Profile
- Perfil Del Cliente (Client Profile_Spanish).pdf (0.41 MB) — Client Profile (Español)
- CMS 1500 Form Blank_1.pdf (3.03 MB) — CMS 1500 Form - Blank
- CMS 1500 Form Sample_1.pdf (1.95 MB) — CMS 1500 Form - Sample
- Consent to Treatment Form 614 (4-2017)- English_1.pdf (0.16 MB) — Consent to Treatment Form 614
- Consent to Treatment Form 614S (4-2017)- Spanish_1.pdf (0.09 MB) — Consent to Treatment Form 614S (Español)
- Consent to Treatment Form 614V (4-2017)- Vietnamese_1.pdf (0.19 MB) — Consent to Treatment Form 614V (Vietnamese)
- Cultural Humility Training Tracking Form_1.xlsx (0.03 MB) — Cultural Humility Training Tracking Form
- DHCS Provider Certification and Re-Certification Protocol_1.pdf (0.81 MB) — DHCS Provider Certification and Re-Certification Protocol
- Grievance Brochure - English 1.2025.pdf (0.26 MB) — Grievance Brochure
- Grievance Brochure - English Large Font 1.2025.pdf (0.28 MB) — Grievance Brochure - Large Font
- Grievance Brochure - Spanish 1.2025.pdf (0.35 MB) — Grievance Brochure (Español)
- Grievance Brochure - Spanish Large Font 1.2025.pdf (0.36 MB) — Grievance Brochure - Large Font (Español)
- Grievance Brochure - Vietnamese 1.2025.pdf (0.55 MB) — Grievance Brochure (Vietnamese)
- Grievance Brochure - Vietnamese Large Font 1.2025.pdf (0.53 MB) — Grievance Brochure - Large Font (Vietnamese)
- Grievance Poster - English 1.2025.pdf (0.26 MB) — Grievance Poster
- Grievance Poster - Spanish 1.2025.pdf (0.10 MB) — Grievance Poster (Español)
- Grievance Poster - Vietnamese 1.2025.pdf (0.16 MB) — Grievance Poster (Vietnamese)
- County of Marin English Notice of Privacy Practices - Revised 2026.pdf (0.25 MB) — HHS Notice of Privacy Practices
- Notice of Privacy Practice Acknowledgement - English.pdf (0.10 MB) — Notice of Privacy Practice Acknowledgement
- Notice of Privacy Practice Acknowledgement Spanish.pdf (0.25 MB) — Notice of Privacy Practice Acknowledgement (Español)
- Notice of Privacy Practice Acknowledgement - Vietnamese.pdf (0.12 MB) — Notice of Privacy Practice Acknowledgement (Vietnamese)
- HHS Privacy and Confidentiality_0.pdf (0.30 MB) — Privacy and Confidentiality - HHS
- Language Assistance_2.pdf (0.60 MB) — Language Assistance
Behavioral health contractor manuals and guidance
The Behavioral Health Contractor Manual and related materials support contracted providers as they deliver services through Marin BHRS. The Clinical Documentation Guide serves as a resource for BHRS providers and outlines documentation standards and practices required within the Children, Youth and Family System of Care, Adult and Older Adult System of Care, contract providers, and Substance Use Services. It is intended to help ensure providers meet regulatory and compliance standards of competency, accuracy, and integrity in the provision and documentation of services.
All Direct Service Staff SMHS/DMC-ODS Documentation Training January 29, 2026 (Video)
The documents in this list may not work with all assistive technology and are being remediated. For alternative formats, please email Behavioral Health and Recovery Services or phone 415-473-6769. To use the California relay service, dial 711.
- BHRS 97 Service Delivery Practice Guidelines.pdf (0.16 MB) — BHRS 97 Service Delivery Practice Guidelines
- BHRS Network Provider Manual 23-24.pdf (0.38 MB) — BHRS Network Provider Manual
- BHRS Medi-Cal Site Certification Application.docx (0.03 MB) — BHRS Medi-Cal Site Certification Application
- BHRS Clinical Documentation Manual March 2025.pdf (1.23 MB) — BHRS Clinical Documentation Manual - 2025
- BHRS - 25 Documentation Requirements.pdf (5.61 MB) — BHRS-25 Documentation Requirements
- BHRS CalAIM Documentation Training Memo.pdf (0.24 MB) — BHRS CalAIM Documentation Training Memo
- SMHS-Clinical-Documentation-Guide-4.25.2025.pdf (0.87 MB) — SMHS Clinical Documentation Guide 2025
- 05-07-26 BHRS CalAIM SMHS-DMC-ODS Documentation training.pptx (2.15 MB) — 05-07-26 BHRS Cal AIM SMHS (PowerPoint)
Details
Policies and procedures
Providers may also need to use BHRS policies and procedures that relate to access to services and beneficiary requirements. These materials are part of the broader set of BHRS program, service, and support resources.
Notice of Adverse Benefit Determination (NOABD)
Behavioral health providers can access NOABD forms used for required beneficiary notices. Available notice types include forms for denial, payment denial, delivery system issues, modification, termination, delay in processing authorization of services, timely access notice, and financial liability notice. These forms are available in English, Spanish, and Vietnamese.
Invoicing and rates
Related invoicing and rate resources are available for Drug Medi-Cal and other contractor billing functions. These materials include claim submission certification forms, same day billing guidance, other health coverage questions and answers, recovery coach rate structure information, aid code reference materials, financial assessment documents, and Medi-Cal share of cost procedures.
Support and contact information
If you are interested in becoming a contracted behavioral health services provider, contact Behavioral Health Services.
If there is a resource not listed that would help support service delivery, contractors should email their contract manager listed in their contract agreement with the County.
For general BHRS assistance, call the Access Line at 888-818-1115.