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Maternal, Child & Adolescent Health Section

Child Health & Disability Prevention (CHDP) Program - Provider Information

New Announcements:

Effective September 1, 2019, Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs) and Indian Health Services (IHS) clinics will no longer need to submit the PM 160 (Confidential Screening/Billing Report Information Only) to fulfill reporting requirements, or to request care coordination. PM 160s should no longer be ordered beginning September 1, 2019. If care coordination support is needed, please submit the new care coordination request form to the SF CHDP office.

Effective January 1, 2018, the State no longer requires Medi-Cal Managed Care plans (MCMCP) to collect CHDP PM160 forms, however, FQHCs must still submit CHDP Informational-only PM160s (brown form) for fee-for-service Medi-Cal/Gateway patients. Please refer to your managed care plans for details on their submission requirements.

As of July 1, 2017, Green PM160 forms are no longer used for billing or care coordination.

CHDP Provider Information Notices and Provider Manual

Enrollment Information

NEW! SF CHDP Care Coordination Request Form

Periodicity Schedule

Facility Site Review