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CMHTA MHC/BHO Liaison Contact List
- Residential Facilities Utilizing Mental Health Services for Children and Adolescents
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Forms & Resources
Residential Facility Notification and Billing Forms
- Residential Facility Admission Notification Form, updated 9/2012
- Residential Facility Discharge Form, updated 9/2012
- Residential Facility Billing Form (for TRCCF), updated 3/2013
- PRTF Billing Form (Pre-Eligibility Period Only), updated 3/2013
- FY 09 Approved TRCCF Rates, updated 7/1/2008
- Residential Financial Agreement, updated 3/2013
- Residential Financial Agreement Instructions, updated 3/2013
CMHC - BHO Data Reporting and Care Management Forms
- CMHC - BHO Eligibility Screening Form, updated 9/2012
- CMHC - BHO Discharge Form, updated 10/2012
- CMHTA Data Collection
- Plan of Care Form, updated 4/2013
- Plan of Care Instructions, updated 3/2013
- Community Financial Agreement Form, updated 4/2013
- Community Financial Agreement Instructions, updated 3/2013
- Community-Based Contribution Percentage Calculation, updated 3/2013
- Community-Based Services Billing Form, updated 3/2013
Reference Information
- CMHTA Procedure Manual, updated 5/2008
- Schedule of Basic Child Support Obligations, updated 1/2003
- Child Support Obligations Statute
- CMHTA Matrix, updated 10/2012
- CMHTA Brochure, updated 10/2012
- CMHTA General Presentation, updated 3/2013
- CMHTA Liaison Presentation, updated 3/2013
- CMHTA Liaison Contact List, updated 3/2013
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