BH-CONNECT and BHSA EBP Requirements: Key Roles
Overview
DHCS established Centers of Excellence (COEs) to support county behavioral health agencies and their county-contracted and county-operated behavioral health practitioners in fidelity implementation of evidence-based practices (EBPs) for Californians living with significant behavioral health needs.
Some EBPs supported by COEs are optional for counties, while others are required either under the Behavioral Health Services Act (BHSA) or under the Medi-Cal Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit.
| Required Under the BHSA1 | Required Under Medi-Cal EPSDT Benefit | Optional as Bundled Medi-Cal Service2 | |
|---|---|---|---|
| Assertive Community Treatment (ACT) | |||
| Forensic ACT (FACT) | |||
| Coordinated Specialty Care (CSC) for First Episode Psychosis | |||
| Individual Placement and Support (IPS) Supported Employment | |||
| High Fidelity Wraparound (HFW) | |||
| Clubhouse Services | |||
| Multisystemic Therapy (MST) | |||
| Functional Family Therapy (FFT) | |||
| Parent-Child Interaction Therapy (PCIT) |
1 State law permits counties with a population of less than 200,000 to request exemptions from offering ACT, FACT and/or IPS under the BHSA. Counties must request exemptions in their BHSA Integrated Plans.
2 Optional as bundled Medi-Cal services. Counties that do not opt in to cover EBPs as bundled Medi-Cal services must still claim Medi-Cal payment for Medi-Cal-covered service components delivered to Medi-Cal members.
The tables below outline how the processes and requirements for these EBPs established in DHCS’ policy guidance apply to key behavioral health stakeholders, including DHCS, COEs, county behavioral health agencies, and their county-contracted and county-operated behavioral health practitioners. They include roles related to:
- Implementation planning and meeting foundational requirements for ACT, FACT, CSC and IPS under the BHSA and as optional Medi-Cal services;
- Training to deliver EBPs;
- Fidelity monitoring to ensure EBPs are being delivered consistent with evidence-based standards;
- Data collection to support outcomes monitoring;
- Service delivery; and
- Payment for EBPs.
Table 1 includes processes and requirements for EBPs that are required under the BHSA: ACT, FACT, CSC, IPS and HFW.
Table 2 includes processes and requirements for other EBPs under Medi-Cal: Clubhouse Services, MST, FFT and PCIT. Clubhouse is fully optional for counties; MST, FFT and PCIT are required under the Medi-Cal EPSDT benefit.
All activities included below are conducted on an ongoing, rolling basis except where a specific deadline is indicated, and all activities are required except where noted as “optional” or “as needed.”
More information about DHCS’ EBP requirements can be found in BHIN 25-009, BHIN 26-XXX, BHIN 26-XXX, the EBP Training and Fidelity Manual, the HFW Policy Manual, and the BHSA Policy Manual. Operational guidance to support implementation of EBPs is also available in the EBP Policy Guide. Appendix 1 identifies which DHCS policy guidance is relevant for each EBP.
Table 1. Key Roles for Implementing ACT, FACT, CSC, IPS and HFW
This table outlines processes and requirements for EBPs that are required under the BHSA. All counties3 and their county-contracted and county-operated practitioners delivering EBPs are required to engage with the respective COEs to support fidelity implementation of these services.
Implementation Planning (through June 30, 2026)
Behavioral Health Practitioners
- Contract with counties to deliver specified EBPs
- Review DHCS’ EBP requirements and operational guidance
- Review COEs’ EBP implementation resources
- Engage in training and technical assistance provided by COEs to support early implementation of EBPs
Counties
- Review DHCS’ EBP requirements and operational guidance
- Review COEs’ EBP implementation resources
- Submit Engagement Initiation Form to initiate consultations with COEs (by March 31, 2026)
- Initiate consultation with COEs to support continued implementation planning (by June 30, 2026)4
- Complete BHSA Integrated Plan (IP) with additional information about EBP implementation planning (draft by March 31, 2026; final by June 30, 2026)
- Contract with behavioral health practitioners to deliver EBPs
- Share initial list of county-contracted and county-operated EBP practitioners with respective COEs
- Engage in additional consultations provided by COEs to support early implementation of EBPs
- Opt-in to offer one or more EBPs as bundled services under Medi-Cal (optional)
Centers of Excellence
- Establish EBP implementation resources available on COE Resource Hub website
- Deliver webinar sessions to provide background information on EBPs and information available COE resources
- Consult with counties to support EBP implementation planning
- Provide additional technical assistance to counties and practitioners to support early implementation of EBPs
- Refer county and practitioner questions regarding EBP policy and payment to DHCS
DHCS
- Establish EBP requirements and operational guidance
- Ensure counties submit Engagement Initiation Forms and consult with COEs
- Ensure counties complete BHSA Integrated Plan
- Respond to questions regarding EBP policy and payment
- Engage with counties, practitioners and other stakeholders to understand ongoing EBP implementation adjust EBP requirements (as needed)
- Acknowledge receipt of county Medi-Cal EBP opt-in letters and provide technical assistance (as needed)
- Oversee county compliance with EBP requirements
Training
Behavioral Health Practitioners
- Complete required trainings provided by COEs (foundational, role-based, ongoing)
- Identify practitioner to serve as team lead (ACT, FACT, CSC), employment supervisor (IPS), or provider site lead (HFW)
- Maintain roster of team members and respective roles (team lead, employment supervisor, or provider site lead)
- Review training reports from COEs (team lead, employment supervisor, or provider site lead)
Counties
- Ensure all county-contracted and county-operated EBP practitioners complete required trainings
- Review training reports from COEs
Centers of Excellence
- Develop and deliver required trainings
- Support EBP practitioners in completing training requirements
- Track the training status of all EBP practitioners
- Send training reports to EBP practitioners (team lead, employment supervisor, or provider site lead), counties, and DHCS
DHCS
- Establish EBP training requirements
- Review training data from COEs
- Oversee COEs in developing and delivering trainings
- Oversee county compliance with training requirements
Technical Assistance
Behavioral Health Practitioners
- Meet with COE for ongoing individualized technical assistance (as needed)
- Participate in webinars or other group technical assistance offerings (as needed)
Counties
- Consult with COEs to support implementation planning
- Notify COEs of new county-operated and county-contracted EBP practitioners
- Meet with COE for ongoing individualized technical assistance (as needed)
- Participate in webinars or other group technical assistance offerings (as needed)
Centers of Excellence
- Develop and deliver individualized and group-based technical assistance
- Recommend specific technical assistance opportunities to counties and EBP practitioners (as needed)
DHCS
- Establish EBP technical assistance requirements
- Oversee COEs in developing and delivering technical assistance
- Oversee county compliance with technical assistance requirements
- Respond to questions and provide technical assistance on BHSA and BH-CONNECT requirements
Fidelity Monitoring
Behavioral Health Practitioners
- Complete required fidelity assessments (baseline, first, second, ongoing)
- Coordinate with COEs and counties to schedule fidelity assessments on required timelines (e.g., to schedule baseline fidelity assessment within 9 months of the EBP team beginning to deliver services or HFW provider site established) (team lead, employment supervisor or provider site lead)
- Review fidelity reports from COEs (team lead, employment supervisor or provider site lead)
Counties
- Ensure all county-contracted and county-operated EBP practitioners complete fidelity assessments on required timelines
- Review fidelity reports from COEs
- Ensure the projected number of EBP teams indicated in the BHSA IP for FY26-27:
- Complete a baseline fidelity assessment (by December 31, 2027)
- Complete a first fidelity assessment and achieve Minimum Fidelity Designation (by June 30, 2028)
- Complete a second fidelity assessment and achieve Full Fidelity Designation (by June 30, 2029)
Centers of Excellence
- Develop and conduct fidelity assessments
- Educate EBP practitioners on fidelity assessment requirements and protocols
- Track timing and fidelity status of all EBP teams
- Send fidelity reports to EBP practitioners (team lead, employment supervisor, or provider site lead), counties and DHCS
- Coordinate with EBP practitioners (team lead, employment supervisor, or provider site lead) to schedule fidelity assessments on required timelines
- Recommend specific actions (e.g., additional training or technical assistance) to EBP practitioners to improve performance on fidelity assessments (as needed)
- Refer county and practitioner questions regarding EBP policy and payment to DHCS
DHCS
- Establish EBP fidelity requirements
- Review fidelity data from COEs
- Oversee COEs in developing and conducting fidelity assessments
- Oversee county compliance with fidelity monitoring requirements
- Respond to questions regarding EBP policy and payment
- Approve exceptions to policy requirements
- Engage with COEs on fidelity monitoring processes and make adjustments (as needed)
Data Collection
Behavioral Health Practitioners
- Collect member outcomes data and submit data to COEs
- Submit process metrics to COEs (e.g., number of individuals receiving EBPs, discharged, etc.)
- Review outcomes data and process metrics to support EBP implementation
Counties
- Ensure all county-contracted and county-operated EBP practitioners collect required data
- Review data from COEs
Centers of Excellence
- Develop and share data collection tools
- Support EBP practitioners in collecting and reporting required data
- Share data with counties and DHCS
DHCS
- Establish data collection and reporting requirements
- Review data from COEs
- Establish and calculate performance on relevant BH-CONNECT Incentive Program measures using de-identified aggregate member outcomes data
- Oversee COEs in developing and sharing data collection tools
- Oversee county compliance with data collection and reporting requirements
Service Delivery
Behavioral Health Practitioners
- Conduct outreach and engagement about EBPs
- Identify and enroll individuals for whom EBPs are medically necessary
- Deliver EBPs consistent with evidence-based standards and DHCS’ requirements
Counties
- Conduct outreach and engagement about EBPs
- Ensure all county-contracted and county-operated EBP practitioners are delivering services consistent with DHCS’ requirements
Centers of Excellence
- Support EBP practitioners in delivering services consistent with evidence-based standards and DHCS’ requirements
- Support counties in establishing EBP teams and HFW provider sites
DHCS
- Establish EBP requirements
- Establish operational guidance for delivering EBPs
- Oversee county compliance with service delivery requirements
Payment
Behavioral Health Practitioners
- Submit Medi-Cal claims to the county
- Submit individual and service-level (ISL) encounters to the county
Counties
- Submit Medi-Cal claims to DHCS
- Counties that opt in to cover EBPs as bundled services must claim monthly rate for Medi-Cal services that meet DHCS’ requirements
- Counties that do not opt in to cover EBPs as bundled services must claim for unbundled Medi-Cal service components
- Submit ISL encounters to DHCS
- Ensure all county-contracted and county-operated EBP practitioners’ claims for services are paid in accordance with DHCS’ requirements
Centers of Excellence
- Refer county and practitioner questions regarding EBP payment processes to DHCS
DHCS
- Establish Medi-Cal EBP payment requirements
- Establish ISL requirements
- Oversee county compliance with Medi-Cal EBP payment and ISL requirements
- Respond to questions regarding EBP payment processes
3 Counties that have approved exemptions for ACT, FACT and/or IPS are not required to engage with the respective COEs.
4 For HFW, counties must have an initial meeting with the COE by June 30, 2026, and initiate consultation by October 1, 2026.
Table 2. Key Roles for Implementing Clubhouse Services, MST, FFT, and PCIT
This table outlines processes and requirements for other EBPs under Medi-Cal. All counties are required to ensure they have county-contracted and/or county-operated practitioners trained and certified to deliver MST, FFT and PCIT. However, counties are encouraged but not required to engage with respective COEs for FFT and PCIT.5 Coverage of Clubhouse Services and engagement with Clubhouse International is fully optional for counties and practitioners.
Implementation Planning
Behavioral Health Practitioners
- Contract with counties to deliver specified EBPs
- Review DHCS’ EBP requirements and operational guidance
- Review COEs’ EBP implementation resources
Counties
- Review DHCS’ EBP requirements and operational guidance
- Review COEs’ EBP implementation resources
- Submit Engagement Initiation Form to initiate consultations with COEs
- Initiate consultation with COEs
- Contract with behavioral health practitioners to deliver EBPs
- Share initial list of county-contracted and county-operated EBP practitioners with respective COEs
Centers of Excellence
- Establish EBP implementation resources available on COE Resource Hub website
- Deliver webinar sessions to provide background information on EBPs and information available COE resources
- Consult with counties to support EBP implementation planning
- Refer county and practitioner questions regarding EBP policy and payment to DHCS
DHCS
- Establish EBP requirements and operational guidance
- Respond to questions regarding EBP policy and payment
- Engage with counties, practitioners, and other stakeholders to understand ongoing EBP implementation adjust EBP requirements (as needed)
- Acknowledge receipt of county Medi-Cal EBP opt-in letters and provide technical assistance (as needed; only Clubhouse Services is optional; MST, FFT and PCIT are required)
- Oversee county compliance with EBP requirements
Training
Behavioral Health Practitioners
- Complete required trainings provided by COEs
Counties
- Ensure all county-contracted and county-operated EBP practitioners complete required trainings
- Review training reports from COEs
Centers of Excellence
- Develop and deliver required trainings
- Support EBP practitioners in completing training requirements
- Track the training status of all practitioners delivering EBPs
- Send training reports to practitioners, counties and DHCS
DHCS
- Review training data from COEs
- Oversee COEs in developing and delivering trainings
Technical Assistance
Behavioral Health Practitioners
- Meet with COE for ongoing individualized technical assistance (as needed)
- Participate in webinars or other group technical assistance offerings (as needed)
Counties
- Consult with COEs to support implementation planning
- Notify COEs of new county-operated and county-contracted EBP practitioners
- Meet with COE for ongoing individualized technical assistance (as needed)
- Participate in webinars or other group technical assistance offerings (as needed)
Centers of Excellence
- Develop and deliver individualized and group-based technical assistance
- Recommend specific technical assistance opportunities to counties and EBP practitioners (as needed)
DHCS
- Oversee COEs in developing and delivering technical assistance
- Respond to questions and provide technical assistance on BHSA and BH-CONNECT requirements
Accreditation/Certification
Behavioral Health Practitioners
- Coordinate with COEs and counties to complete required processes to achieve accreditation (Clubhouse Services) or certification (MST, FFT, PCIT)
- Review accreditation/certification reports from COEs
Counties
- Ensure all county-contracted and county-operated EBP practitioners complete required processes to achieve accreditation/ certification
- Review accreditation/ certification reports from COEs
Centers of Excellence
- Develop and conduct accreditation/certification processes
- Educate EBP practitioners on accreditation/certification requirements and protocols
- Track accreditation/certification status of all EBP teams
- Send accreditation/certification reports to EBP practitioners, counties and DHCS
- Recommend specific actions (e.g., additional training or technical assistance) to EBP practitioners to achieve accreditation/certification
- Refer county and practitioner questions regarding EBP policy and payment to DHCS
DHCS
- Establish accreditation/certification requirements
- Review accreditation/certification data from COEs
- Oversee COEs in conducting accreditation/certification processes
- Oversee county compliance with accreditation/certification requirements
- Respond to questions regarding EBP policy and payment
- Approve exceptions to policy requirements
Data Collection
Behavioral Health Practitioners
- Collect member outcomes data and submit data to COEs (as needed to achieve accreditation/certification)
- Submit process metrics to COEs (e.g., number of individuals receiving EBPs, discharged, etc.)
- Review outcomes data and process metrics to support EBP implementation
Counties
- Ensure all county-contracted and county-operated EBP practitioners collect required data (as needed to achieve accreditation/certification)
- Review data from COEs
Centers of Excellence
- Develop and share data collection tools
- Support EBP practitioners in collecting and reporting required data (as needed to achieve accreditation/certification)
- Share data with counties and DHCS
DHCS
- Review data from COEs
- Oversee COEs in developing and sharing data collection tools
Service Delivery
Behavioral Health Practitioners
- Conduct outreach and engagement about EBPs
- Identify and enroll individuals for whom EBPs are medically necessary
- Deliver EBPs consistent with evidence-based standards and DHCS’ requirements
Counties
- Conduct outreach and engagement about EBPs
- Ensure all county-contracted and county-operated EBP practitioners are delivering services consistent with DHCS’ requirements
Centers of Excellence
- Support EBP practitioners in delivering services consistent with evidence-based standards and DHCS’ requirements
- Support counties in establishing EBP programs
DHCS
- Establish EBP requirements
- Establish operational guidance for delivering EBPs
- Oversee county compliance with service delivery requirements
Payment
Behavioral Health Practitioners
- Submit Medi-Cal claims to the county
- Submit ISL encounters to the county
Counties
- Submit Medi-Cal claims to DHCS
- Counties that opt in to cover EBPs as bundled services must claim monthly rate for Medi-Cal services that meet DHCS’ requirements
- Counties that do not opt in to cover EBPs as bundled services must claim for unbundled Medi-Cal service components
- Submit ISL encounters to DHCS
- Ensure all county-contracted and county-operated EBP practitioners’ claims for services are paid in accordance with DHCS’ requirements
Centers of Excellence
- Refer county and practitioner questions regarding EBP payment processes to DHCS
DHCS
- Establish Medi-Cal EBP payment requirements
- Establish ISL requirements
- Oversee county compliance with Medi-Cal EBP payment and ISL requirements
- Respond to questions regarding EBP payment processes
Appendix 1. DHCS Policy Guidance
| BHIN 25-009 | BHIN 26-XXX | BHIN 26-XXX | EBP Training and Fidelity Manual | HFW Policy Manual | BHSA Policy Manual | EBP Policy Guide | |
|---|---|---|---|---|---|---|---|
| Assertive Community Treatment (ACT) | |||||||
| Forensic ACT (FACT) | |||||||
| Coordinated Specialty Care (CSC) for First Episode Psychosis | |||||||
| Individual Placement and Support (IPS) Supported Employment | |||||||
| High Fidelity Wraparound (HFW) | |||||||
| Clubhouse Services | |||||||
| Multisystemic Therapy (MST) | |||||||
| Functional Family Therapy (FFT) | |||||||
| Parent-Child Interaction Therapy (PCIT) |
5 Additional information about training and certification requirements for MST, FFT and PCIT are forthcoming.