Provider Contracts

Provider Contracts

Below is a list of the various documents associated with the current grant agreement between the SCA and the Contractors. 

DDAP Manuals

• Fiscal Manual
• Operations Manual
• Prevention Manual
• Case Management and Clinical Services (formerly Treatment Manual)
• Client Liability Determination Form (Excel)
• Outpatient Client Liability Table
• Intensive Outpatient/Partial Hospitalization Client Liability Table
• Inpatient Residential Client Liability Table

Appendix E 

• Blair Case Management and Clinical Service Policies 7/1/2026
  • Policy Bulletin No. 26-01 8/1/2026
• Attachment 01 County – CPOC Contact List 7/1/2026
• Attachment 02 Network of Care Chart 7/1/2026
• Attachment 03 Liability Procedure 7/1/2026
• Attachment 03A Drug and Alcohol Client Liability Determination Form 7/1/2026
• Attachment 03B Request for Liability Reduction or Elimination Form 7/1/2026
• Attachment 03C Request for Reduction-Elimination Checklist 7/1/2026
• Attachment 04 SCA-BHMCO Medical Assistance Interface 7/1/2026
• Attachment 05 Care Coordination-Case Management-CRS Service Guideline 7/1/2026
• Attachment 05Ca ICM-RD Referral Form 7/1/2026
• Attachment 05Cb Non Treatment Needs Screening Tool 7/1/2026
• Attachment 05Da CRS Referral Form 7/1/2026
• Attachment 06 Interim Service Policy 7/1/2020
• Attachment 06A Interim Service Brochure 7/1/2026
• Attachment 07A Ancillary Service Tool 7/1/2020
• Attachment 07B Blair Ancillary Service Brochure 7/1/2026
• Attachment 08A TB Screen 4/1/2022
• Attachment 08B HepC-HIV Screen 7/1/2020
• Attachment 09A MOUD MAUD Consideration Guideline 7/1/2026
• Attachment 09B MOUD-MAUD Consideration Form 7/1/2026
• Attachment 10 MOUD-MAUD Authorization Protocol 7/1/2026
• Attachment 11 Blair SCA Medication Authorization Form 7/1/2026
• Attachment 12 TX Brochure-Benefits 7/1/2026
• Attachment 13 Grievance/TX Limitations/Interim Service Client Choice Notification Form 4/1/2022
• Attachment 14 Network of Care Choice Form-REMOVED 7/1/2026
• Attachment 15 Waiting List – Funding 7/1/2020
• Attachment 16 Release of Information 7/1/2026
• Attachment 17 Client Registration 7/1/2026
• Attachment 18 Admission-Re-Admission Notification Form 7/1/2026
• Attachment 19 Authorization Guidelines 7/1/2026
• Attachment 20 Blair SCA Funding Transfer Form 7/1/2025
• Attachment 21 Grievance and Appeals Policy Brochure 7/1/2026
• Attachment 22 Blair County Drug and Alcohol Complaint Form 7/1/2020

Authorization Paperwork

• Abatement
  • Attachment 03A Drug and Alcohol Client Liability Determination Form 7/1/2026
  • Attachment 03B Request for Liability Reduction or Elimination Form 7/1/2026
  • Attachment 03C Request for Reduction-Elimination Checklist 7/1/2026
• Admission
  • Attachment 16 Release of Information 7/1/2026
  • Attachment 18 Admission-Re-Admission Notification Form 7/1/2026
• Assessment
  • Attachment 03A Drug and Alcohol Client Liability Determination Form 7/1/2026
  • Attachment 13 Grievance/TX Limitations/Interim Service Client Choice Notification Form 4/1/2022
  • Attachment 16 Release of Information 7/1/2026
  • Attachment 17 Client Registration 7/1/2026
• Change of Funding
  • Attachment 20 Blair SCA Funding Transfer Form 7/1/2025
• Continued Stay
  • Attachment 18 Admission-Re-Admission Notification Form 7/1/2026
• Referrals
  • CRS Referral
    • Attachment 05Da CRS Referral Form 7/1/2026
  • ICM Referral
    • Attachment 05Ca ICM-RD Referral Form 7/1/2026
    • Attachment 05Cb Non Treatment Needs Screening Tool 7/1/2026
• Suboxone Admission/Continued Stay
  • Attachment 11 Blair SCA Medication Authorization Form 7/1/2026