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Division of Mental Health and Addiction Services
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Forms, publications and instructional material related to the DMHAS community services contracting program are made available on this website for your easy reference and download. If you encounter any difficulty with your selections, or have additional questions, please contact the DMHAS Bureau of Contract Administration at (609) 438-4230.

NOTE:   Some documents are stored in Adobe Acrobat PDF format. In order to view and print PDF formatted documents, you must have a PDF viewer (Adobe Acrobat Reader) on your system, which is available at no charge from Adobe. Click on the image below to download the latest version of Acrobat Reader.

 

Cash Advance Policy - Administrative Bulletin
Cash Flow Worksheet Advance Payment Request
Advance Payment Request Narrative
DHS Contract Manuals (CRM & CPIM)
Standard Language Document (contract "boilerplate" agreement) and Contracted State Agency Agreement
DHS Business Associate Agreement (Revised 04/01/19)
Standardized Board Resolution Form (P1.06)
Executive Order 129 Certification:  Source Disclosure Certification Form


 


Public Law 2005, Chapter 51 (McGreevey Executive Order 134) Forms
(No longer applicable for non-profit agencies - February 2008)

Click here to download Chapter 51 information
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Annual Charities
° 
Filing Information
° Registration
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Affirmative Action AA302 Forms and Instructions
°
Employee Information Report - AA302
° AA302 Instructions
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Agreement Form and Instructions for Electronic (ACH) Payments
°
Agreement Form
° Instructions
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Vendor Payment Inquiry System
For more information and to sign up, please 
click here.
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Addictions Contract Information Management System (CIMS)
Payment Voucher for Cost Reimbursement Payment Contracts
CIMS Log-in
Contract Application


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Mental Health Contracting Information
Address/Phone List for Contract Providers, by County

Annex B - Budget Matrix:
°Budget Matrix Software Applications
°User Manual (REVISED Manual Coming Soon)

Budget Schedules

Budget Modification Signature Page
Budget Categories Before/After Summary
Program Elements Before/After Summary

Contract Information Form
Annex A Forms
QCMR Forms & Documentation

Program and Unit of Service Definitions

Cluster Form
Report of Expenditures (ROE) Summary Form
Annex C - Supporting Information
Annex C - Permanent File Checklist
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FY 19 Mental Health Fee for Service (MH FFS)
Addendum to DHS SLD for Mental Health Fee for Service (MH FFS) (Revised 04/10/18)
Annex B-2 (Revised 04/20/18)
FFS Rates Chart (Revised 04/20/18)
DOH DMHAS MH FFS Agency Administrative Information Form, FY19 (Revised 04/18/18)
Community Residences for Adults with Mental Illness Annex A (Revised 06/01/17)
Community Support Services (CSS) FFS Annex A (Revised 03/28/2018)
Integrated Case Management (ICMS) Annex A (Revised 11/09/17)
Outpatient Annex A (Revised 06/01/17)
Partial Care Annex A (Revised 06/01/17)
Partial Hospitalization Annex A (Revised 06/01/17)
Programs for Assertive Community Treatment (PACT) Annex A (Revised 04/30/18)
Supported Education (SEd) Annex A (Revised 05/01/18) 
Supported Employment (SE) Annex A (Revised 04/16/17)

 
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Required Contract Documents

Addendum to DHS SLD for Mental Health Fee for Service (MH FFS)  (Revised 04/01/19)
Annex B-2  (Revised 04/01/19)
FFS Rates Chart  (Revised 04/01/19)
DHS DMHAS MH FFS Agency Administrative Information Form, FY20  (Revised 04/01/19)



  Annex A's

Community Residences for Adults with Mental Illness Annex A  (Revised 06/01/17)
Community Support Services (CSS) FFS Annex A  (Revised 03/28/2018)
Integrated Case Management (ICMS) Annex A   (Revised 04/05/19)
Outpatient Annex A  (Revised 06/01/17)
Partial Care Annex A  (Revised 06/01/17)
Partial Hospitalization Annex A  (Revised 06/01/17)
Programs for Assertive Community Treatment (PACT) Annex A  (Revised 04/30/18)
Supported Education (SEd) Annex A  (Revised 05/01/18) 
Supported Employment (SE) Annex A  (Revised 04/16/18)


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