Community Mental Health Clinic
Initial Application Packet
A Community Mental Health Center (CMHC) means an entity that provides outpatient services, including specialized outpatient services for children, the elderly, individuals who are chronically mentally ill, and residents of its mental health service area who have been discharged from inpatient treatment at a mental health facility; provides 24-hour-a-day emergency care services; provides day treatment or other partial hospitalization services, or psychosocial rehabilitation services; provides screening for patients being considered for admission to State mental health facilities to determine the appropriateness of this admission; meets applicable licensing or certification requirements for CMHCs in the State in which it is located; and provides at least 40 percent of its services to individuals who are not eligible for benefits under title XVIII of the Social Security Act, pursuant to Title 42 Code of Federal Regulation (CFR) section 410.2.
General Medicare Process Reminder
Providers seeking Medicare certification must first complete and submit an enrollment application through the Centers for Medicare and Medicaid Services (CMS), prior to submitting a CMHC application packet to the Centralized Applications Branch (CAB). Information on Medicare enrollment, applicable forms, and instructions can be found at the CMS website: (https://www.cms.gov/medicare/provider-enrollment-and-certification). If you receive a recommendation of approval letter from the Medicare Administrative Contractor (MAC) for California, Noridian Healthcare Solutions, please include a copy of this letter along with your CMHC application packet to CAB.
Medi-Cal Certification Note
CMHC applicants interested in Medi-Cal certification will contact their county’s mental health program. Providers cancontact the Department of Health Care Services’ (DHCS) Mental Health Services Division (MHSD) at DMHCertification@dhcs.ca.gov for information on the Medi-Cal certification process.
To apply for Initial certification, you must complete the required application packet. Refer to 42 CFR Part 410, Subpart A for the Conditions Of Participation for Community Mental Health Centers.
How to Apply
An applicant must submit a completed application packet to the Centralized Applications Branch (CAB). The provider instructions are a resource to guide you through the process. The provider checklist identifies the required forms and supporting documents needed to apply for certification.
Please refer to the following links to get started:
Where to Submit Applications
Submit completed application packets to the CAB at the address listed below. Do not send any completed application packets, forms, or supporting documents to the local CDPH, District Office.
California Department of Public Health
Center for Health Care Quality
Centralized Applications Branch
P.O. Box 997377, MS 3207
Sacramento, CA 95899-7377