Regional CCS Resources
As part of our regional shared services, the CWHP has developed several regional CCS forms. Individual CWHP counties may modify the forms to meet their specific needs.
​Email Lori at lori.martin@cwhpartnership.org to request the unlocked documents.
​
​
-
CCS Consumer Handbook (updated 11/16/18) - a resource for Consumers who are referred to CCS. The document can be used "as is" or can be customized to the individual county's CCS program.
​
-
CCS Provider Contract Addendum (6/29/21) outlines regional expectations for contracting with CCS providers
-
Internal File / Process Review Checklist (updated 1/11/18)
-
Referral Form (updated 7-27-17)
​
-
Application and Admission Agreement (updated 7-27-17)
​
-
Physician Prescription (updated 1-11-18)
​
-
Determination of Need (updated 9-16-19)
​
Assessment Tools. Following are 3 sets of CCS assessment tools that CWHP counties may chose to use and/or adapt:
- Narrative Assessment (6-30-21)
- Companion Document (6-30-21)
- CCS Comprehensive Assessment Summary (June 2021)
- (original) Comprehensive Assessment (updated 9-16-19)
Additional Assessment Resources:​
-
Medicaid Mental Health and Substance Abuse Documentation Requirements
-
Marquette County's Individual Service Plan for CLTS and CCS (please note: this plan has been approved for use by Marquette County; other counties interested in utilizing this tool would have to go through he CLTS approval process)
-
CCS Discharge Summary (4-22-16)
Additional Optional Tools
-
​Sample Service Facilitator Checklist (30 day, 6 month, 1 year)
-
Service Array Summary (updated 6-25-18)
-
-
video: ​Billing and Rate Setting​​
-
​