AGREEMENT #NORTH SOUND BH-ASO-SNOHOMISH COUNTY-ICCN-20 EFFECTIVE JANUARY 1, 2020Behavioral Health • December 3rd, 2019 • Washington
BEHAVIORAL HEALTH ADMINISTRATION (BHA) AGREEMENT TO COOPERATE (REQUIREMENT UNDER COMAR 10.63.01.05)Behavioral Health • November 1st, 2016
Before applying for licensure under Subtitle 10.63 - Community-Based Behavioral Health Programs and Services, behavioral health programs in Maryland must enter into an Agreement to Cooperate with the CSA, LAA, or LBHA in each of the relevant counties or Baltimore City in which the program operates. Agreements are required when submitting an initial application, renewal application, or when a change to a program’s license is requested (e.g., change in service array or locations). Please note that separate agreements are not required per site, unless there is a change to the program’s existing license, such as adding a new location.
BEHAVIORAL HEALTH ADMINISTRATION (BHA) AGREEMENT TO COOPERATEBehavioral Health • May 31st, 2017
Before applying for licensure under Subtitle 10.63 - Community-Based Behavioral Health Programs and Services, behavioral health programs in Maryland must enter into an Agreement to Cooperate with the CSA, LAA, or LBHA in each of the relevant counties or Baltimore City in which the program operates. Agreements are required when submitting an initial application, renewal application, or when a change to a program’s license is requested (e.g., change in service array or locations). When submitting this agreement for signature, please attach page 2, all applicable pages 3-4, and proof of accreditation, if applicable, of the “Application for Licensure Under COMAR 10.63” packet. Please note that separate agreements are not required per site, unless there is a change to the program’s existing license, such as adding a new location.
Behavioral Health Court Mental Health Diversion (“BHC Diversion”) Referral to BHC Diversion for EvaluationBehavioral Health • September 25th, 2020
This document is an agreement to refer Defendant to the BHC Team, so they can decide whether BHC Diversion is appropriate. This is not an agreement that Defendant will be granted BHC Diversion. This is
BEHAVIORAL HEALTH ADMINISTRATION (BHA) AGREEMENT TO COOPERATE (REQUIREMENT UNDER COMAR 10.63.01.05)Behavioral Health • August 19th, 2020
Before applying for licensure under Subtitle 10.63 - Community-Based Behavioral Health Programs and Services, behavioral health programs in Maryland must enter into an Agreement to Cooperate with the CSA, LAA, or LBHA in each of the relevant counties or Baltimore City in which the program operates. Agreements are required when submitting an initial application, renewal application, or when a change to a program’s license is requested (e.g., change in service array or locations). Please note that separate agreements are not required per site, unless there is a change to the program’s existing license, such as adding a new location.
AGREEMENT TO COOPERATEBehavioral Health • February 2nd, 2023
Before applying for licensure under Subtitle 10.63 - Community-Based Behavioral Health Programs and Services, behavioral health programs in Maryland must enter into an Agreement to Cooperate with the CSA, LAA, or LBHA in each of the relevant counties or Baltimore City in which the program operates. Agreements are required when submitting an initial application, renewal application, or when a change to a program’s license is requested (e.g., change in service array or locations). Please note that separate agreements are not required per site, unless there is a change to the program’s existing license, such as adding a new location.
Vendor Agreement InformationBehavioral Health • October 5th, 2021
The Subject Matter Expert who submits a purchase request completes this form when a vendor-provided agreement associated with a purchase order is required to be signed. Please complete and email this form and a copy of the proposed Vendor Agreement to: the applicable CBS Purchasing Office (CBS3Institution-Purchasing@dshs.wa.gov for Western WA Facilities or esh.eshaccountingcibsemail@dshs.wa.gov for Eastern WA Facilities), to the person who will serve as the Contract Manager, and to the BHA Contracts Office at bhacontracts@dshs.wa.gov.
