Service Providers
Contract-Related Documents
The Council on Chemical Abuse contracts with local organizations for various prevention, intervention and treatment services. This area of the website is for the use of Council provider agencies. If you have any questions about these documents, please contact us or call 610-376-8669. Click on the links below to view and/or download the following information.
Budget Forms: (updated 03/12)
Fiscal Budget Forms
Fiscal Budget Forms Instructions
ACT 33 Compliance Certification
Billing Forms: (updated 11/11)
Cost Reimbursement
CCA Form 311General
CCA 311 Instructions-General
CCA Form 311 Creating Lasting Family Connections ( CLFC)
CCA 311 Instructions-CLFC
CCA Form 314 Annual Fixed Assets Report
CCA 314 INSTRUCTIONS
Transitional House Worksheet updated 11-1-12
Fee for Service:
Contract-Related Documents
The Council on Chemical Abuse contracts with local organizations for various prevention, intervention and treatment services. This area of the website is for the use of Council provider agencies. If you have any questions about these documents, please contact us or call 610-376-8669. Click on the links below to view and/or download the following information.
Budget Forms: (updated 03/12)
Fiscal Budget Forms
Fiscal Budget Forms Instructions
ACT 33 Compliance Certification
Billing Forms: (updated 11/11)
Cost Reimbursement
CCA Form 311General
CCA 311 Instructions-General
CCA Form 311 Creating Lasting Family Connections ( CLFC)
CCA 311 Instructions-CLFC
CCA Form 314 Annual Fixed Assets Report
CCA 314 INSTRUCTIONS
CCA Transitional House Occupancy Report
Fee for Service:
CCA 310 General
CCA 310 Pre-Treatment Groups
CCA 310 Early Recovery Support Groups
CCA Family Intervention)
CCA Student Assistance Program
CCA Tobaccol Enforcement
MCR 11-12
MCR 12-13
DOH/SCA Contract (updated 10/10)
CR01 boilerplate
CR02 Appendix A without special initiatives
CR03 Attachment 1 Drug And Alcohol Activities Definitions version 1-03-05
CR04 Appendix B Payment Provisions with County Match
CR05 Appendix D – SGT&C _Rev. 6-01_
CR06 Appendix E – Audit Appendix _Rev. September 2003_
CR07 Appendix F – Federal Lobbying Certification and Disclosure Forms
CR08 Appendix G – Substance Abuse Prevention and Treatment
CR09 Appendix H – Pro-Children Act of 1994
CR10 Appendix I _SAP_ final 7-14-04
CR11 Appendix J – Commonweatlh Travel & Subsistence Rates _Rev. 1-04_
BDAP Operations Manual (updated 10/10)
Operations Manual 7-1-10- 7/1/10
BDAP Liability Determination Procedures (updated 7/28/10)
Client Liability Materials for Addiction Treatment Services
Client Liability Form 9-3-08
BDAP Prevention Manual (updated 10/10)
BDAP Treatment Manual (updated 10/10)
Treatment Manual 7-1-10 updated
BDAP Fiscal Manual (updated 10/10)
Case Management Policies and Procedures
BERKS COUNTY 01-2013 FINAL (updated 1/1/2013)
If you have any questions about this document, please contact the Council at 610-376-8669.
Case Management Guidelines Appendices (updated 1/1/2013)
Click on each appendix below to download a PDF of the specific case management guidelines for Berks County. If you have any questions about these guidelines, please contact the Council at 610-376-8669.
Appendix A – BDAP Screening Tool
Appendix B – PCPC Summary Sheet
Appendix C – Adolescent Placement Summary Sheet
Appendix D – Non-Treatment Needs Checklist
Appendix E – Inventory of Support Services
Appendix F – ICM Service Plan
Appendix G – ISS Matrix
Appendix H – ICM Discharge Form
Appendix I – Grievance and Appeals Acknowledgement
Appendix J – Grievance Reporting Form
Appendix K – Minimum Education Requirements
Appendix L – Intensive Case Managment Activity Report
Appendix M – Case Managment Resource Report 7-1-06
Appendix N – Interim Services Resource List
Appendix O – Ancillary Services List
Appendix P – Outreach Model
Appendix Q – Service Guide Brochure
Appenidx R – Web Connect Treatment Management System Policy
County Contracted SAP Providers
Integrated Student Assistance Program (SAP) Assessment: Core Content Areas Best Practice Guidelines: BDAPSCAGuidelines and MentalHealthGuidelinesAug05
Berks County SAP Service Provider Guidelines
Berks County Service Provider Guidelines details the terms of service between the Council and SAP Service Providers. If you have any questions about this document, please contact the Council at 610-376-8669 or via email.
SAP Contract-Related Documents (updated August 2009)
Click on each appendix below to download SAP contract-related documents for Berks County. If you have any questions, please contact the Council at 610-376-8669 or via email. Forms are PDF files unless indicated otherwise. Free Adobe Acrobat Reader is available to read these documents.
Attachment A SAP Reimbursement Rates
Attachment B Best Practice Guidelines
Attachment C Student Tracking Form
Attachment D SAP PROVIDER INVOICE
Attachment E SAP Invoice Report Summary
Attachment F PBPS Requirements for SAP
Attachment G SAP Credentialing Worksheet
CCA 310 General
CCA 310 Pre-Treatment Groups
CCA 310 Early Recovery Support Groups
CCA Family Intervention)
CCA Student Assistance Program
CCA Tobaccol Enforcement
MCR 11-12
MCR 12-13
DOH/SCA Contract (updated 10/10)
CR01 boilerplate
CR02 Appendix A without special initiatives
CR03 Attachment 1 Drug And Alcohol Activities Definitions version 1-03-05
CR04 Appendix B Payment Provisions with County Match
CR05 Appendix D – SGT&C _Rev. 6-01_
CR06 Appendix E – Audit Appendix _Rev. September 2003_
CR07 Appendix F – Federal Lobbying Certification and Disclosure Forms
CR08 Appendix G – Substance Abuse Prevention and Treatment
CR09 Appendix H – Pro-Children Act of 1994
CR10 Appendix I _SAP_ final 7-14-04
CR11 Appendix J – Commonweatlh Travel & Subsistence Rates _Rev. 1-04_
BDAP Operations Manual (updated 10/10)
Operations Manual 7-1-10- 7/1/10
BDAP Liability Determination Procedures (updated 7/28/10)
Client Liability Materials for Addiction Treatment Services
Client Liability Form 9-3-08
BDAP Prevention Manual (updated 10/10)
BDAP Treatment Manual (updated 10/10)
Treatment Manual 7-1-10 updated
BDAP Fiscal Manual (updated 10/10)
Case Management Policies and Procedures
BERKS COUNTY 02-2011 Final (updated 2/17/11)
If you have any questions about this document, please contact the Council at 610-376-8669.
Case Management Guidelines Appendices (updated 11/17/2010)
Click on each appendix below to download a PDF of the specific case management guidelines for Berks County. If you have any questions about these guidelines, please contact the Council at 610-376-8669.
Appendix A – BDAP Screening Tool
Appendix B – PCPC Summary Sheet
Appendix C – Adolescent Placement Summary Sheet
Appendix D – Non-Treatment Needs Checklist
Appendix E – Inventory of Support Services
Appendix F – ICM Service Plan
Appendix G – ISS Matrix
Appendix H – ICM Discharge Form
Appendix I – Grievance and Appeals Acknowledgement
Appendix J – Grievance Reporting Form
Appendix K – Minimum Education Requirements
Appendix L – Intensive Case Managment Activity Report
Appendix N – Interim Services Resource List 211
Appendix N – Interim Services Resource List 211
Appendix O – Ancillary Services List 211
Appendix P – Outreach Model 7-8-2010
service guide brochure
County Contracted SAP Providers
Integrated Student Assistance Program (SAP) Assessment: Core Content Areas Best Practice Guidelines: BDAPSCAGuidelines and MentalHealthGuidelinesAug05
Berks County SAP Service Provider Guidelines (updated August 2009)
Berks County SAP Service Provider Guidelines details the terms of service between the Council and SAP Service Providers. If you have any questions about this document, please contact the Council at 610-376-8669 or via email.
SAP Contract-Related Documents (updated August 2009)
Click on each appendix below to download SAP contract-related documents for Berks County. If you have any questions, please contact the Council at 610-376-8669 or via email. Forms are PDF files unless indicated otherwise. Free Adobe Acrobat Reader is available to read these documents.
Attachment A SAP Reimbursement Rates
Attachment B Best Practice Guidelines
Attachment C Student Tracking Form
Attachment D SAP PROVIDER INVOICE
Attachment E SAP Invoice Report Summary
Attachment F PBPS Requirements for SAP
Attachment G SAP Credentialing Worksheet
