RUHSBH OUTPATIENT PROVIDER MANUAL

We would like to welcome you as a Riverside University Health System – Behavioral Health Plan (RUHSBHP), and Department of Public Social Services (DPSS) Project network provider. The RUHSBHP authorizes mental health services through the Community Access, Referral, Evaluation, & Support (CARES) to children and adults with Medi-Cal. including those children who reside in Group Homes and Foster Family Agencies.

The DPSS Project authorizes mental health services through the Assessment and Consultation Tem (ACT) to children (excluding those placed in group homes/FFA placements) and adults who have open cases through the DPSS.

We look forward to working with you to provide quality cost effective mental health treatment to our Medi-Cal and DPSS consumers.

The Mental Health Plan Outpatient Provider Manual contains the guidelines that will assist you in meeting the standards set for the provision of mental health services for Riverside County.

Outpatient Provider Manual Attachments

Attachment 1A:

Assessment/Care Plan:  Initial, English

Attachment 1B:

Assessment/Care Plan:  Initial, Spanish

Attachment 2:

Treatment Extension/Change Request

Attachment 3:

Discharge Summary

Attachment 4:

Medication Declaration Form

Attachment 5: 

Referral for Psychological Testing

Attachment 6A:

Consent to Treat, English

Attachment 6B:

Consent to Treat, Spanish

Attachment 7A: 

Authorization for Treatment of Minors, English

Attachment 7B: 

Authorization for Treatment of Minors, Spanish

Attachment 8:

Quarterly Report Authorization

Attachment 9A:

ACT Release of Information, English

Attachment 9B:

ACT Release of Information, Spanish

Attachment 10A:

Adult Medical History, English

Attachment 10B:

Adult Medical History, Spanish

Attachment 11A:

Child's Medical History, English

Attachment 11B:

Child's Medical, Spanish

Attachment 12:

AEVS

Attachment 13:

Incident Report Form

Attachment 14:

RUHS-BH Report of Incident Form

Attachment 15:

CSI Data Collection

Attachment 16:

Provider Referral Request Form

Attachment 17:

Certification of Integrity

Attachment 18A:

TBS Referral Form

Attachment 19:

TBS Informed Consent Form

Attachment 20A:

TBS Consent for Services Form, English

Attachment 20B:

TBS Consent for Services Form, Spanish

Attachment 21:

TBS Eligibility Criteria Form

Attachment 22:

TBS Procedure for Section B TBS Eligibility Criteria

Attachment 23:

Medi-Cal Eligibility Verification

Attachment 24:

Psychiatric Treatment Authorization Form

Attachment 25:

Medication Guidelines

Attachment 26:

IMD Psychiatric Treatment Authorization Form

Attachment 27:

Referral for Services FFA or Group Home

Attachment 28:

SB785

Attachment 29:

Informing Materials Order Form

Attachment 30A:

Riverside County Guide to Medi-Cal Mental Health Services, English

Attachment 30B:

Riverside County Guide to Medi-Cal Mental Health Services, Spanish

Attachment 31A:

HIPAA Form, English

Attachment 31B:

HIPAA Form, Spanish

Attachment 32A:

Appeal & Grievance Procedure/Request Form, English

Attachment 32B:

Appeal & Grievance Procedure/Request Form, Spanish

Attachment 33A:

Your Right to Make Decisions About Medical Treatment, English

Attachment 33B:

Your Right to Make Decisions About Medical Treatment, Spanish

Attachment 34A:

Medi-Cal Beneficiaries Flyer, English

Attachment 34B:

Medi-Cal Beneficiaries Flyer, Spanish

Attachment 35A:

Ombudsman Poster, English

Attachment 35B:

Ombudsman Poster, Spanish

Attachment 36A:

Consumer Grievance/Appeal/State Fair Hearing Information, English

Attachment 36B:

Consumer Grievance/Appeal/State Fair Hearing Information, Spanish

Attachment 37:

Grievance Log

Attachment 38A:

Advance Health Care Directives, English

Attachment 38B:

Advance Health Care Directives, Spanish

Field level help.