The DHCS 6002 form serves as a pivotal initial treatment provider application employed by current and prospective substance use disorder (SUD) treatment program providers in California. This form is integral for organizations aiming to secure initial residential licensure, certification, or to navigate procedures like ownership changes or facility mergers. For those poised to apply, understanding every section of this form and compiling the required documentation accurately is crucial for a streamlined application process.
To embark on your application journey, click the button below and ensure a hassle-free submission of your DHCS 6002 form.
The DHCS 6002 form is a crucial document for individuals and organizations aspiring to provide substance use disorder (SUD) treatment services within the State of California. Managed by the Department of Health Care Services (DHCS), this form initiates the application process for those seeking initial licensure or certification for residential treatment facilities, as well as those undergoing changes such as mergers, ownership transfers, or service modifications. The comprehensive application requires detailed information about the facility, its operations, and compliance with specific regulations outlined by the California Code of Regulations and Health and Safety Code. It also guides applicants through a maze of prerequisites for licensure, varying from the design of the facility to the types of services offered, and sets forth the standards for achieving certification and/or qualifying for Drug Medi-Cal (DMC) certification. Additionally, the document informs about the availability of technical assistance from DHCS, underlines the importance of adhering to submission guidelines to avoid delays, and provides insight into the fee structure associated with the application. Completeness, accuracy, and adherence to specified requirements are emphasized to streamline the approval process, demonstrating the form's role not only as an application but also as a preliminary step towards ensuring quality and regulated SUD treatment services. Public access to certain information provided in the application reaffirms the state's commitment to transparency and accountability in health and human services. This introductory summary encapsulates the DHCS 6002 form's purpose, scope, and significance in regulating SUD treatment facilities in California, highlighting the meticulous attention required to navigate the process successfully.
State of CaliforniaHealth and Human Services Agency
Department of Health Care Services
INITIAL TREATMENT PROVIDER APPLICATION
Licensing and Certification Section, MS 2600
PO Box 997413
Sacramento, CA 958997413
STATE OF CALIFORNIA
HEALTH AND HUMAN SERVICES AGENCY
DEPARTMENT OF HEALTH CARESERVICES
SUBSTANCE USE DISORDER COMPLIANCE DIVISION, MS 2600
LICENSING AND CERTIFICATION SECTION
SACRAMENTO, CA 958997413
(916)3222911
FAX (916) 3222658 TTY (916) 4451942
DHCS 6002 (Rev. 06/16)
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The attached application is to be used by current and prospective providers that wish to apply for Substance Use Disorder (SUD) treatment program initial residential licensure, initialcertification, merger with another legal entity or change of ownership of an existing facility. Current providers wishing to relocate, add or delete treatment services, increase/decrease treatment beds or change target population must complete the Supplemental Application DHCS 5255 (Rev. 6/16). All items in blue underline throughout the applicationsignifies a link to the specified website.
It is vital that you carefully read each component (including the regulations and/or standards) before beginning to fill out the application. Answer each question in the application, and submit only the documentation requested and required. An incomplete application results in a delay of the application process.
If, after you have read the entire application packet, you determine that you would like technical assistance or training addressing certain elements of the application process, you mayrequest assistance, free of charge, from the Department of Health Care Services (DHCS)consulting agency. Please check the Department's website for the current technical assistance provider.
If you have any questions regarding the licensing or certification of SUD recoveryor treatment facilities, please contact DHCS’s SUD Compliance Division at (916)3222911.
Public Information
Information provided by the applicant can be made available for public review, unless otherwise exempted by law (Inspection of Public Records, Chapter 3.5, Division 7, GovernmentCode).
Requirements for License
The California Code of Regulations (CCR), Title 9, Division 4, Chapter 5, §10505, states, inpart, that no person, firm, partnership, association, corporation, or local government entity shalloperate, establish, manage, conduct, or maintain an alcoholism or drug abuse recovery or treatmentfacility without obtaining a current, valid license pursuant to thischapter.
An alcoholism or drug abuse recovery, treatment, or detoxification facility is defined as any facility, place or building which provides 24hour, residential, nonmedical services in a group settingto adults. For the purpose of further defining whether licensure is required, alcoholism or drugabuse recovery or treatment services mean services which are designed to promote treatment and maintain recovery from substance use disorder problems which include one or more of the following: detoxification, group sessions, individual sessions, educational sessions, and recovery ortreatment planning.
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Regulations
The regulations that govern the licensing of nonmedical residential facilities covered by these application instructions are under CCR, Title 9, Division 4, Chapter 5. In order to assist applicants in supplying the detailed information needed in the licensing process, a copy of the regulations maybe downloaded from the California Office of Administrative Law website. The pertinent regulations are listed under the Department and Alcohol and DrugPrograms.
For information on purchasing the regulations, including the receipt of updates, please contact Barclays West Group online or by phone at 18008883600.
Requirements forCertification
The Health and Safety Code, §11830, offers certification of residential and outpatientprograms on a voluntary basis. Although certification is voluntary, programs wanting to ensure quality assurance, while expanding the availability of funding resources, will requestcertification.
Many programs consider certification advantageous in gaining the confidence of potentialclients, insurance companies, and other thirdparty payers, as it signifies that a program meets minimal levels of service quality. In addition, many counties require that programs under contract be SUD certified as a condition of receivingfunds.
CertificationStandards
The standards that govern certified programs covered by these instructions are within the Alcohol and Other Drug Certification Standards, and may be downloaded from the DHCS website.
Requirements for Drug MediCal Certification(DMC)
CCR Title 22, offers DMC certification to programs that provide substance abuse servicesto MediCal beneficiaries that are covered by the MediCal program, when it is determined, by a physician, that alcohol and drug treatment is medicallynecessary.
If you intend to provide residential DMC services, you must first complete this application and be issued a residential license prior to submitting an application for DMC residentialservices.
The DMC certification requirements for substance abuse clinics are contained in the DrugMediCal Certification Standards for Substance Abuse Clinics; the Alcohol and/or Other Program Certification Standards; and CCR Title 22, Sections § 51341.1, § 51490.1, and §51516.1.
To assist applicants in supplying the detailed information needed in the DMC certificationprocess, a copy of the regulations and standards can be downloaded from the Drug MediCal Certification page. DMC applications must be submitted separately to:
PROVIDER ENROLLMENT DIVISION
MS 4704 PO Box 997412
Sacramento, CA 958997412
(800) 5415555 or (916) 3231945
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Treatment Provider Application Fees
DHCS assesses fees to all licensed and/or certified residential and certified outpatientSUD recovery and treatment facilities, regardless of the form of organization orownership. Please see the Department's website for the current fee structure.
The application process is normally completed within 120 days. The 120 days beginswhen an application packet is determined to be complete. To prevent delays, be sure that all the required documentation is completed, properly signed, with original signatures, dated, and submitted in the proper format and sequence, with the appropriate fee. It is recommended that you retain a copy of the completed application packet for yourrecords.
Once you have determined your application is complete, please mail thecompleted application, documentation, and a check or money order, made out to the Departmentof Health Care Services, to cover the appropriate initial application fee, to the followingaddress:
Substance Use Disorder Compliance Division
Licensing andCertificationSection
PO Box 997413, MS 2600
Sacramento, California 958997413
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APPLICATIONINSTRUCTIONS
Please follow these instructions carefully and submit your application only after it has been properly completed, the required supportive documentation has been prepared, and the entire packethas been properly formatted.
Applications received by DHCS that do not meet the requirements described in these instructions will be returned to the applicant, minus any fees, without having been reviewed. The review process will not begin until the application meets submission requirements. If your application is returned without having been reviewed, and you decide not to proceed with the application process, DHCS will refund all fees paid.
Please complete all applicable sections of the application. If a line or question does not apply to you, fill the line or question with “N/A.” If an entire section does not apply to your application, place a check mark in the “N/A” box located in the section heading.
You may attach additional documentation if your information does not fit in the appropriatearea; however, the spaces for the requested information must be completed. The application must be complete or the entire packet will be returned to you without review andprocessing.
The application and all supportive documentation must be printed single sided, with 12 point font on 8 1/2" by 11" white paper. Documentation provided by a third party, such as the lease agreementor fire clearance, must be submitted unaltered and in the original format (size, font, color) it was created. When applying for more than one type of service at a time, (i.e. residential licensure and SUD certification of the same facility, or SUD certification only), complete allthe required sections of the application, prepare the supporting documentation (as listed on the following pages), and submit the entire packet at the sametime.
If you are applying for a license and certification at the same time, please completeone application and submit one set of supportingdocumentation.
SUPPORTING DOCUMENTATION AND DESCRIPTIONS
Due to DHCS’s filing requirements, applications should not be doubled sided, bound, and must not include plastic sheet or page protectors. Each item, as listed below, must be numbered and separated by correspondingly numbered tabbed dividers.
In order to expedite the application process for all applicants, packets not submitted in this order will be rejected without review.
Tab 1 (all applicants) – Initial Treatment Provider Application, Form DHCS 6002 (Rev.06/16).
Tab 2 (all applicants) – Corporations, LLP's, or LLC's must attach their approved articles of incorporation; partnerships must attach the partnership agreement; nonprofit organizationsmust attach a copy of the 501(c)(3) filing from the California Secretary of State; sole proprietorsmust attach the Sole Proprietor Supplement. A fictitious business name statement or business licenseis required if the sole proprietor name is different from the name of the facility (see Section Hof instructions).
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Tab 3 (all applicants – except governmental entities) – Lease agreement, donated space agreement, or letter from school approving use of space (see Section C of instructions).
Tab 4 (license applicants only) – Bacteriological Analysis of Water, if applicable (see Section D3of instructions).
Tab 5 (all outpatient applicants) – Fire Clearance (see Section E5 of instructions).
Tab 6 (all outpatient applicants) – Zoning Clearance (see Section E6 ofinstructions).
Tab 7 (all applicants) – Table of Administrative Organization – This document must include achart that shows the governing board, advisory groups, including resident council when applicable,and both lines of authority (straight lines) and communication lines (broken lines) to all staff positions.
Tab 8 (all applicants) – Annual Line Item Budget – A lineitem budget (projection of revenues and expenditures) for the current fiscal year that correlates with quarterly and annual written operation reports. If the applicant is a nonprofit corporation, the budget must be approved by the board of directors.
Tab 9 (all applicants) – Community Resources – This document shows the community resourcesto be utilized by the facility as part of its program. Provide a copy of this inventory which shall beused as a resource for assisting program participants in securing additional services to meet and maintain their personal wellbeing while continuing to enhance personaldevelopment.
Tab 10 (all applicants) – Outline of Activities and Services – A written statement listing the activities and services provided by the facility. This statement should include an outline for specific activities and services such as detoxification (if applicable), group and individual sessions, recovery or treatment planning, continuing recovery or treatment planning recreation, selfhelp activities (AA, NA, CA), and other activities/services being provided by theprogram.
Tab 11(all applicants) – Program Description – A written statement that describes the program’s alcohol and/or other drug services and settings that are offered according to the severity of alcohol and/or other drug involvement, and the program's approach to recovery or treatment, which shall include, but not be limited to, an alcohol and drug freeenvironment.
Tab 12 (all applicants) – Statement of Program Goals and Objectives – A written statement that includes the program goals (intent or purpose of its existence) and objectives of the facility. The goals and objective should be timelimited, measurable, and outcome objectives that canbe verified in terms of time and results, and that serve as indicators of programeffectiveness.
Tab 13 (all applicants) – Program Evaluation Plan – A written evaluation plan formanagement decision making. Sufficient program data shall be collected to provide a meaningful assessmentof the program’s progress in meeting itsobjectives.
Tab 14 (all applicants) – Program Mission and Philosophy Statement – A written statement(s) describing the program’s mission and philosophy.
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Tab 15 – (all applicants) – Continuous Quality Management Plan – Written policies and procedures for continuous quality management, which shall include how the program monitors and/or ensures that participant files are reviewed, that services are provided to participants, the process for achieving objectives identified in the recovery or treatment plan, recovery or treatment plan reviews, and assurances that the participant’s file contains all required documents.
Tab 16 (all applicants) – Job Descriptions – A narrative description of staff needs (i.e., briefly describe staff composition) for each position at the facility (both paid and volunteer),including minimum staff qualifications and lines of supervision for each position.
Tab 17 (all applicants) – Statement of Admission, Readmission and Intake Criteria – A written statement of admission, readmission, and intake policies, procedures and criteria for determining the participant’s eligibility and suitability for services.
Tab 18 (all applicants) – Admission Agreement – A copy of the admission agreement that will be used by the program.
Minimum Requirements for Admission Agreements for License Applicants:
1.Services to be provided;
2.Payment provisions, including amount assessed and payment schedule;
3.Refund policy;
4.Those actions, circumstances or conditions which may result in resident eviction from the facility;
5.The consequences when a resident relapses and consumes alcohol and/or nonhealth sustaining drugs; and
6.Conditions under which the agreement may be terminated.
Minimum Requirements for Admission Agreements for Certification Applicants:
1.Fees assessed for services provided;
2.Activities expected of participant;
3.Program rules and regulations;
4.Participants’ statutory rights to confidentiality;
5.Participants’ grievance procedure; and
6.Reasons for termination.
The admission agreement must include all required elements for each application type if applying for multiple services, e.g. the admission agreement must include all licensure and certification elements if applying for a license and certification.
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LICENSE APPLICANTS ONLY
Tab 19 – Sketch of Building and Grounds – Submit a sketch, preferably on an 8½" x 11” sheet of paper, all building(s) to be occupied, including a floor plan of all rooms intended for resident’s use. A sketch of the grounds must show all buildings, driveways, fences, storage areas, pools,gardens, recreational area and other spaces of the property. All sketches shall show dimensions of eacharea, but need not be to scale. The floorplan shall show the number and location of beds for allresidents, dependent children and staff (if applicable), and other nonambulatory persons.
Tab 20 – Sample Menu – The total daily diet for residents shall be of the quality andquantity necessary to meet their needs, and shall be made so that each resident has available at least three meals per day. The written menu(s) shall include times of food service, food provided forbreakfast, lunch, and dinner for one week, including the type and availability of snacks.
Tab 21 – Safeguarding of Personal Property of Residents – Describe the process for safeguarding of resident’s personal property accepted by the licensee for safekeeping, if it is the licensee’s policy to accept such valuables.
As previously stated, please see the chart below to ensure you have submitted the appropriate documentation related to yourapplication:
APPLICANT CONTENT GUIDE
TYPE OF APPLICATION
Tab Number
Facility Licensing
Program
Certification
Tab 1
X
Tab 2
Tab 3
X*
Tab 4
Tab 5
Tab 6
Tab 718
Tabs 19 21
X* excludes governmental agencies
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The following information matches, in order, the information, sections and numbers on the "Initial Treatment Provider Application" that must be completed. Incomplete applicationswill be returned withoutreview.
SECTION A – APPLICATION INFORMATION
This section must be completed by all applicants
1.Application Type – Check the appropriate box(es) for the service(s) which you are applying for with this application. If you are applying for more than one type of service at the same location check all the boxes that apply.
2.Application Purpose – Check all box(es) best describing the purpose of this application. If youare changing ownership of an existing facility, please list the license and/or certification number of the program that is being abolished. If you are merging this program with another program, please list the license and/or certification number of that program. You must include the change ofownership documents and board resolution documents authorizing the merge and/or sale under Tab #2.
SECTION B – LEGAL ENTITY INFORMATION
This section must be completed by applicants
1.Legal Entity Name – Enter the legal entity name. Below are specified instructions for:
Corporation only: For a corporation or Limited Liability Company (LLC) of any type this box must match exactly the name of the corporation (or LLC) as filed withthe Secretary of State (SOS) and on the entities articles ofincorporation.
Partnership only: For a partnership that has filed a certification of limited partnershipwith the SOS, this box must match exactly the name filed. For a partnership of any typethat has not filed a certification of limited partnership with the SOS, this box must containthe surnames of the partners.
Sole Proprietor only: For a sole proprietorship, this box must be the full legal name ofthe sole proprietor and include the Sole Proprietor Supplement. A fictious business name statement or business license is required if the sole proprietor name is different fromthe name of the facility.
If the entity has filed any of the above mentioned documents with the SOS, you can look upyour entities legal name at the SOS website. The entities status with the SOS must remain validand active during the licensing or certification period.
2.Program/Facility Name – Enter the name of the Program/Facility. Do not include the legal entity name in this box unless the Program/Facility name is the same as the legal entity name. Do not include the words or abbreviation for “Doing Business As” unless you actually intend to use those words or the abbreviation in the program’s name.
Below are specified instructions for:
Sole proprietors only: Must submit a copy of the fictitious business name statement if different from their full legal name.
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3.Administrative/Corporate Address – This box must contain the physical address of the legal entities main office. This address may match the programs address if the entity does not have a separate Administrative/Corporate address. P.O. Boxes or other mail receipt addresses will not be accepted as an administrative address; however, a P.O. Box may be used as a mailing address, as identified in instruction #5 below.
3a. Room/Suite – If applicable, enter the room or suite number of the administrative/ corporate address.
3b. City – Enter the city of the administrative/corporate address.
3c. State – Enter the state of the administrative/corporate address.
3d. Zip code (zip) – Enter the zip code of the administrative/cooperate address.
4.Entity/Program Website Address – If the legal entity has a website, the website must be entered in this box. If the entity has a website and has a separate website specifically for the program, please enter both website addresses. If the entity/program has no website, enter “None” in this box.
5.Mailing Address – Enter the facility’s mailing address. P.O. Box maybe used as a mailing address. Note: The department will use this address to send all official mail.
5a. Room/Suite – If applicable, enter the room/suite number of the mailing address. 5b. City – Enter the city of the mailing address.
5c. State – Enter the state of the mailing address
5d. Zip code (zip) – Enter the zip code of the mailing address.
6.Entity Type – Check the box that describes the type of legal entity in which yourorganization operates. Below are specified instructions for:
Corporation, LLC, or Limited Liability Partnership (LLP) – For a corporation of any type, LLC, or LLP include the articles of incorporation under Tab #2.
Partnerships or General Partnership – For a partnership of any type include the partnership agreement under Tab #2. If the entity is registered with the SOS, include the articles of incorporation under Tab #2.
Sole Proprietor only – Submit a copy of the fictitious business name statement or business license if different from your full legal name.
Governmental Entities only – Governmental entities do not need to provide documentation.
7.Type of Organization – Check the box that describes the tax status of your entity. If you check ‘other’, please give a detailed description, including the government entity that granted the status. Below are specified instructions for:
Nonprofit organizations only – must include a copy of the 501(c)(3) filing from the California Secretary of State under Tab #2.
8.Does the applicant currently hold any licenses or certifications issued by DHCS (or the former Department of Alcohol and Drug Programs) or the Department of Social Services (DSS)? – Check ‘Yes’ if your legal entity has any other programs currently licensed and/or certified by the listed departments; check ‘No’ if not. If you check ‘Yes’ enter the license, certification and/or DMC billing number of all of your other facilities and select the type of facility from the drop down list. For entities with more facilities than the form allows, please attach a separate list of all licensed and/or certified facilities, their license number(s), certification(s) and/or DMC billing numbers, including the type of license and/or certification that has been issued under Tab#1.
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Before beginning the task of filling out the DHCS 6002 form, it is crucial for applicants to ensure they possess a comprehensive understanding of each section and its requirements. This form serves as an application for licensing and/or certification for Substance Use Disorder (SUD) treatment programs within California. A meticulous review of the regulations, standards, and specific documentation needed is essential for a successful application process. An incomplete application could cause delays, preventing the applicant from proceeding with their treatment facility’s operations. Following the steps below will guide applicants through the process of completing and compiling their application packet effectively.
After submission, the application process generally takes up to 120 days to complete, starting from the day a complete packet is received. To avoid delays, it is critical that the application and supporting documents are thoroughly prepared and comply with all listed instructions. The process will move forward efficiently if all steps are followed diligently.
What is the DHCS 6002 form used for?
The DHCS 6002 form is an initial treatment provider application used by current and prospective providers who wish to apply for a Substance Use Disorder (SUD) treatment program. This includes applications for initial residential licensure, initial certification, mergers with another legal entity, or changes in ownership of an existing facility. It is also used for current providers looking to relocate, add or delete treatment services, change the number of treatment beds, or target a different population, although in such cases, the Supplemental Application DHCS 5255 must be completed instead.
Who needs to fill out the DHCS 6002 form?
Any person, firm, partnership, association, corporation, or local government entity planning to operate, establish, manage, conduct, or maintain an alcohol or drug abuse recovery or treatment facility in California must fill out the DHCS 6002 form to obtain a current, valid license or certification from the Department of Health Care Services (DHCS).
Can the information provided in the DHCS 6002 form be made public?
Yes, the information provided by applicants on the DHCS 6002 form can be made available for public review, unless it is otherwise exempted by law, as per the Inspection of Public Records, Chapter 3.5, Division 7, of the Government Code.
What regulations govern the licensing of SUD facilities as per the DHCS 6002 application process?
The licensing of non-medical residential facilities as outlined in the DHCS 6002 application instructions is governed by the California Code of Regulations (CCR), Title 9, Division 4, Chapter 5. Applicants are advised to review these regulations thoroughly, which can be downloaded from the California Office of Administrative Law website, to ensure compliance.
Is certification voluntary for SUD treatment programs?
Yes, certification of residential and outpatient programs for Substance Use Disorder treatment is voluntary according to the Health and Safety Code, §11830. However, certification is often pursued by programs to demonstrate a minimum level of service quality, and it may be required by counties for contract eligibility and funding.
What are the requirements for Drug Medi-Cal (DMC) Certification?
DMC certification is offered to programs providing substance abuse services covered by the Medi-Cal program and is necessary when treatment is deemed medically necessary by a physician. To be eligible for DMC certification for residential services, a facility must first obtain a residential license through the DHCS 6002 application process.
How long does it typically take to process the DHCS 6002 application?
The application process normally takes up to 120 days, starting from when the application packet is deemed complete. It is crucial for applicants to ensure that all required documentation is complete, correctly signed, and submitted in the proper order to avoid delays.
What should be included in the supporting documentation for the DHCS 6002 application?
Supporting documentation should be tailored to the specific application type but generally includes the initial treatment provider application form (DHCS 6002), articles of incorporation for corporations, partnership agreements for partnerships, 501(c)(3) filings for non-profit organizations, and a sole proprietor supplement where applicable. Additionally, a fictitious business name statement or business license may be required.
Will fees be refunded if the application is not processed?
If an application is returned without review and the applicant decides not to proceed with the process, DHCS will refund all fees paid. It's essential to ensure that applications meet all submission requirements to avoid such scenarios.
Where should the completed DHCS 6002 form and supporting documentation be mailed?
The completed application, along with all supporting documentation and the appropriate fee, should be mailed to: Department of Health Care Services, Substance Use Disorder Compliance Division, Licensing and Certification Section, PO Box 997413, MS 2600, Sacramento, California 95899-7413.
Filling out the DHCS 6002 form, necessary for applying for initial treatment provider licenses for Substance Use Disorder treatment programs in California, can be a complex process. Here are nine mistakes people often make on this crucial document:
First, a common oversight is failing to provide complete answers to each question. Every query in the application needs a response, even if it's not applicable (N/A) to your situation. Omitting answers or leaving sections blank can result in the need for resubmission, delaying the application process.
Second, applicants sometimes submit documentation that isn’t requested or required. This mistake can slow down the review process, as it complicates the task of the Licensing and Certification Section of the Department of Health Care Services (DHCS). Submit only the documents specifically requested in the application instructions to avoid unnecessary delays.
Third, not retaining a copy of the completed application packet for personal records is another frequent error. Having a copy on hand is useful for reference and in case the original documents need to be resubmitted due to loss or an error in the submission process.
Fourth, submitting documentation in an incorrect format is a common pitfall. The application and all supportive documents must be printed single-sided, in 12-point font, on 8 1/2" by 11" white paper. Failure to adhere to these specifications can result in the rejection of your application.
Fifth, overlooking the need to submit documentation in its original format, particularly for items provided by third parties such as lease agreements or fire clearance. Altering these documents or not presenting them as originally formatted can lead to processing delays or outright rejection.
Sixth, the mistake of binding the application packet or using plastic sheet protectors. The DHCS’s specific filing requirements exclude double-sided submissions, binding, or the use of sheet protectors. Such presentations can result in the packet being returned to you unprocessed.
Seventh, neglecting to number each item and separate them with correspondingly numbered tabbed dividers. This organizational requirement helps expedite the review process. Ignoring this guideline can cause your packet to be rejected without review.
Eighth, not completing all applicable sections of the application or failing to check the “N/A” box when entire sections do not apply. This oversight suggests an incomplete application and will lead to the return of the packet without review.
Ninth, applicants sometimes submit the application without the appropriate initial application fee or with a check or money order made out incorrectly. This financial oversight will halt the application process until the correct fee and payee are submitted.
Avoiding these mistakes can significantly smooth the path to obtaining or altering a Substance Use Disorder treatment license or certification in California. Careful attention to detail and strict adherence to the DHCS’s application instructions, including the preparation and submission of supporting documentation as described, can streamline the review process and facilitate a successful application outcome.
When preparing and submitting the Initial Treatment Provider Application (DHCS 6002) for Substance Use Disorder (SUD) treatment programs in California, there are several other documents and forms that often accompany or are necessary for a complete application package. Each of these documents plays a crucial role in providing detailed information required for licensing and certification by the Department of Health Care Services (DHCS).
Together, these documents provide a comprehensive overview of the program’s operational, legal, and safety standards, thereby ensuring a thorough review process by DHCS. Applicants are reminded to carefully read the instructions for each required document and submit them in the specified format and order to facilitate efficient processing of their application.
The DHCS 6002 form shares similarities with the CMS-855A form used by Medicare providers for institutional enrollment. Both forms are integral to the application process for healthcare facilities seeking governmental authorization to operate and bill for services. They require detailed information about the facility, ownership, management, and operational specifics. This data ensures compliance with state (DHCS 6002) or federal (CMS-855A) regulations, making them foundational documents for facility certification and licensure.
Parallel to the DHCS 6002, the IRS Form 1023 is used by organizations seeking tax-exempt status under Section 501(c)(3) of the Internal Revenue Code. While targeting different government agencies – the Department of Health Care Services for DHCS 6002 and the Internal Revenue Service for Form 1023 – both are comprehensive applications that demand extensive information about the organization's structure, purpose, governance, and financial projections. This comprehensive scrutiny aims to ensure the organizations' operations align with statutory requirements for their respective benefits.
The JCAHO (Joint Commission on Accreditation of Healthcare Organizations) accreditation application is another similar document, focusing on ensuring healthcare institutions meet critical safety and quality standards. Like the DHCS 6002 form, which targets substance use disorder treatment facilities, the JCAHO application requires facilities to demonstrate compliance with industry-specific standards and best practices. Both processes are designed to promote high levels of care and accountability within healthcare settings.
The CARF (Commission on Accreditation of Rehabilitation Facilities) accreditation application closely mirrors the DHCS 6002 form in its purpose for rehabilitation centers. Both serve as a gateway to validate the quality and effectiveness of care provided by health service organizations. The application processes involve rigorous evaluation of the facilities' adherence to certain operational, clinical, and administrative standards, underscoring a commitment to excellence and continuous improvement in patient care.
Similar to the DHCS 6002 form, the application for a DEA (Drug Enforcement Administration) license, specifically for healthcare providers who dispense controlled substances, mandates detailed organizational and operational information. Both applications are crucial for compliance and operational licensing within their respective scopes – substance use disorder treatment for DHCS 6002 and controlled substance management for the DEA license. These forms help ensure that entities are legally and properly managing health-related services and substances.
The ACHC (Accreditation Commission for Health Care) certification application also shares common ground with the DHCS 6002 form in terms of ensuring healthcare facilities meet specific quality standards. While the DHCS 6002 is more specialized towards substance use disorder treatment facilities within California, both applications assess organizational compliance with health care standards and best practices to safeguard high-quality patient care and safety.
Finally, the application for certification under the National Committee for Quality Assurance (NCQA) is akin to the DHCS 6002 form in its goal of certifying quality healthcare provision. Although the NCQA focuses on a broad spectrum of healthcare organizations and the DHCS 6002 is specific to substance use disorder treatment facilities, both applications involve an in-depth review of the facilities' performance and operations against established quality standards, ensuring that they are equipped to provide high-quality care.
When undertaking the process of filling out the DHCS 6002 form for your substance use disorder treatment program, certain practices can streamline your application or hinder its progress. Below are essential tips to help ensure that your application is completed accurately and efficiently.
Things You Should Do
Read through the entire application packet carefully before beginning. Understanding each component, including the regulations and standards, is critical for a successful submission.
Answer every question on the application thoroughly. If a question does not apply to your situation, indicate this by writing “N/A” for “not applicable.”
Submit only the requested and required documentation along with the application form. Adding unnecessary documents can delay the review process.
Ensure all documentation is printed on one side only, using 12-point font on 8 1/2" by 11" white paper. This requirement aids in the readability and processing of your application.
Organize your application packet as instructed, using tabbed dividers to separate each section or document. This organization helps expedite the review process by making information easier to locate.
Retain a copy of the entire application packet for your records. Having your own copy will be invaluable for reference or in case of submission issues.
Things You Shouldn't Do
Do not ignore links to websites provided throughout the application. These links offer important information and resources that can assist you in completing the application correctly.
Do not attach additional documents that were not requested. Unnecessary documentation can clutter your application and slow down the review process.
Do not submit the application and documentation in formats other than those specified (such as double-sided printing or alternate paper sizes and colors).
Avoid submitting the application without original signatures, dates, and correct formatting. This can lead to immediate rejection.
Do not bind the application packet or use plastic sheet/page protectors, as these materials can complicate the filing and review process.
Do not rush through the completion of the application without checking for errors or omissions. A thorough review before submission can save time by avoiding back-and-forth corrections.
By following these guidelines, you contribute to a smoother application process, helping you move one step closer to providing substance use disorder treatment services to those in need.
Many people have misunderstandings about the DHCS 6002 form, which is necessary for the application process for initial treatment providers under the Department of Health Care Services in California. Clarifying these misconceptions can streamline the process for applicants and ensure a smoother application journey. Here are six common misconceptions and the truths behind them:
It’s just a formality. Some think that completing the DHCS 6002 is a mere formality and doesn’t require much attention. In reality, the form is a critical component of the licensing and certification process for substance use disorder treatment facilities. It requires careful and thorough completion, as it helps ensure that facilities meet essential quality and safety standards.
Any missing information can be easily added later. This is not the case. The application must be fully completed upon submission. Missing information can lead to delays or the return of the application. It's imperative to review the application in its entirety before submitting to ensure all necessary information and documentation are included.
Electronic submissions are accepted. As of the last update, the DHCS prefers that applications, including the DHCS 6002 form, are mailed in hard copy to their office. This includes all required documentation, completed in the specified format and sequence. Applicants should verify the current submission process in case of updates.
The process is quick. While DHCS aims to complete the application process within 120 days, this timeframe starts only when a complete application package is received. Delays in gathering and submitting required documents or errors in the application can extend this period. Proper preparation and thorough checking can help avoid delays.
Tech support or guidance is hard to come by. DHCS offers technical assistance and training for applicants who need help with the application process. This support is available free of charge, and applicants are encouraged to take advantage of it to ensure their application meets all requirements.
The form is all you need for the application. The DHCS 6002 form is only one part of the application packet. Additional documentation, including but not limited to, copies of incorporation for corporations or partnership agreements for partnerships, is required. Each piece of documentation plays a crucial role in the application process.
Understanding the DHCS 6002 form and its role in the application process can significantly impact the success and efficiency of obtaining licensure or certification for substance use disorder treatment facilities. Applicants are encouraged to approach this process with the diligence and attention to detail it requires.
The process of completing the DHCS 6002 form and using it for Substance Use Disorder (SUD) treatment program applications is a critical step for providers in California. The form is required for initial residential licensure, certification, and other significant changes like mergers or change of ownership. The following are key takeaways to ensure the process is as smooth and efficient as possible:
Adhering to these guidelines and preparing a meticulous application will not only comply with the regulatory requirements set by DHCS but also expedite the licensing or certification process. It's a vital step for providers who aim to offer critical support services to individuals struggling with substance use disorders in California.
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