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Behavioral Health Plan and Provider Information

Medi-Cal Behavioral Health Plan - Provider Directory Website updated

MC BHP Handbook and Provider Directory Lobby Notice updated

Behavioral Health Plan Member Handbook

BH Member Handbook 2026 small picture

This guide will help you know what specialty mental health services are, if you may get them, and how you can get help from the Orange County BHP.

For general information and accessibility issues please call:

Orange County Behavioral Health Plan
Phone: 800-723-8641
For TTY/TDD users, call 711

updated

 

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This guide is available for listening in MP3 audio format in multiple languages.
About listening to files

Handbook Audio Recording (February 2026)EnglishArabic Chinese (Simplified)FarsiKorean Russian Spanish Vietnamese  

 

BH Provider Handbook Coding Manual 

Behavioral Health Provider Handbook Coding Manual Version 11 (November 2020)
(121 page pdf file)

 

Forms / Brochures

 

TitleArabicChineseEnglishFarsiKoreanRussianSpanishVietnamese
Advance Health Care Directives (F346-705)Acrobat Reader Icon Adobe Acrobat IconAdobe Acrobat IconAdobe Acrobat Icon Adobe Acrobat IconAdobe Acrobat Icon
Grievance or Appeal Form (F346-706)
Grievance Tracking Form		Grievance or Appeal Form (Arabic)Grievance or Appeal Form (Chinese)Grievance or Appeal Form (English)Grievance or Appeal Form (Farsi)Grievance or Appeal Form (Korean)Grievance or Appeal Form (Russian)Grievance or Appeal Form (Spanish)Grievance or Appeal Form (Vietnamese)
Grievance & Appeal Process Posters *** UPDATED ***Grievance and Appeal Process Posters (Arabic)Grievance and Appeal Process Posters (Chinese)Grievance and Appeal Process Posters (English)Grievance and Appeal Process Posters (Farsi)Grievance and Appeal Process Posters (Korean)Grievance or Appeal Form (Russian)Grievance and Appeal Process Posters (Spanish)Grievance and Appeal Process Posters (Vietnamese)
Grievance & Appeal Process Posters *** Large Print ***Grievance and Appeal Process Posters (Arabic)Grievance and Appeal Process Posters (Chinese)Grievance and Appeal Process Posters (English)Grievance and Appeal Process Posters (Farsi)Grievance and Appeal Process Posters (Korean)Grievance or Appeal Form (Russian)Grievance and Appeal Process Posters (Spanish)Grievance and Appeal Process Posters (Vietnamese)
Grievance Fact Sheet BHPGrievance and Appeal Process Posters (Arabic)Grievance and Appeal Process Posters (Chinese)Grievance and Appeal Process Posters (English)Grievance and Appeal Process Posters (Farsi)Grievance and Appeal Process Posters (Korean)Grievance or Appeal Form (Russian)Grievance and Appeal Process Posters (Spanish)Grievance and Appeal Process Posters (Vietnamese)
Authorization to Use and Disclose Protected Health Information (County only)        
Consent to Record (F346-474)  Adobe Acrobat Icon Adobe Acrobat Icon Adobe Acrobat IconAdobe Acrobat Icon
Mental Health Plan Intake/Advisement Checklist (F346-753)Adobe Acrobat IconupdatedAdobe Acrobat IconnewAdobe Acrobat IconupdatedAdobe Acrobat IconupdatedAdobe Acrobat IconInformed ConsentnewAdobe Acrobat IconAdobe Acrobat Iconupdated
Psychiatric Medication Consent (F346-7921)Psychotropic Medication Consent (English)Psychotropic Medication Consent (Chinese)Psychotropic Medication Consent (English)Psychotropic Medication Consent (English)Psychotropic Medication Consent (English) Psychotropic Medication Consent (Spanish)Psychotropic Medication Consent (English)

BHS Combined Informed and Telehealth Consent

new

Informed ConsentInformed ConsentInformed Consent Informed ConsentInformed Consent Informed ConsentInformed Consent Informed Consent
BHS Telehealth Email Acknowledgement FormInformed ConsentInformed ConsentInformed Consent Informed Consent Informed ConsentInformed Consent
QMS Continuity of Care Request Form  Adobe Acrobat Icon     
National Voter Registration Act (NVRA) Preference Forms (County Operated Provider Use Only)
National Voter Registration FAQs		 NVRA FormsNVRA Forms NVRA Forms NVRA FormsNVRA Forms
Interpretation Services Poster  NVRA Forms     

Supervision Reporting Forms

Clinical Supervision Reporting Form
*** UPDATED ***		  NVRA Forms     
Clinical Supervisor Agreement (for County Programs only) *** NEW ***  NVRA Forms     
Medical Supervision Reporting Form
*** UPDATED ***		  Acrobat icon     
Qualified Provider Supervision Form *** Updated 10/2025 ***  

Acrobat icon

 

     

NOABD

Notice of Adverse Benefit Determination-Delivery SystemWord IconWord IconWord IconWord IconWord IconWord IconWord IconWord Icon
Notice of Adverse Benefit Determination- Modification NoticeWord IconWord IconWord IconWord IconWord IconWord IconWord IconWord Icon
Notice of Adverse Benefit Determination- Termination NoticeWord IconWord IconWord IconWord IconWord IconWord IconWord IconWord Icon
Notice of Adverse Benefit Determination- Denial Notice Word IconWord IconWord IconWord IconWord IconWord IconWord Icon
NOABD Member Non-Discrimination NoticeAdobe Acrobat IconAdobe Acrobat IconAdobe Acrobat IconAdobe Acrobat IconAdobe Acrobat IconGrievance and Appeal Process Posters (Chinese)Adobe Acrobat IconAdobe Acrobat Icon
Notice of Adverse Benefit Determination-Your Rights Under Medi-CalWord IconWord IconWord IconWord IconWord IconWord IconWord IconWord Icon
Notice of Availability  Adobe Acrobat Icon     

Car Seat Safety Flyers (County Operated Provider Use Only) 
Notice of Privacy Practices (NPP) (County Operated Provider Use Only) 
Patients' Rights Downloads
 

MOU between CalOptima Health and Health Care Agency

  • General MOU between CalOptima Health and HCA - PDF
  • Execution Date: 02/14/2025
Behavioral Health Quarterly Meeting Dates - Calendar Year 2025
  • 01/15/2025
  • 03/19/2025
  • 05/21/2025
  • 07/16/2025
  • 09/17/2025
  • 11/19/2025

These meetings are not intended to be open to the public.

MOU between Kaiser Permanente and Health Care Agency

  • General MOU between Kaiser Permanente and HCA - PDF
  • Execution Date: 10/27/2025
Behavioral Health Quarterly Meeting Dates - Calendar Year 2025
  • 12/11/2025

These meetings are not intended to be open to the public.

MOU Between the Managed Care Plans (MCP) and Health Care Agency, Behavioral Health Annual Reporting to the Department of Health Care Services (DHCS)


For information and resources about the Drug Medi-Cal Organized Delivery System (DMC-ODS), visit http://www.ochealthinfo.com/DMC-ODS