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Reporting Templates and Contract-Related Documents

Service Element Reporting Requirements

The following table lists the reporting requirements for each Service Element (SE) currently funded in Financial Assistance Agreements with the Oregon Health Authority.

  • To sort or filter by service type, SE, or more, click the column heading.
  • Report Type "N/A" means there is no reporting requirement for the Service Element.
  • For reports with a specific frequency, the Contract Reporting Frequency fact sheet lists specific due dates by subject month, quarter, and year.
  • Report Link provides a link to the forms you must complete for the requirement. If this field is blank, this means there is no standard form that you need to use in order to complete the requirement.

To learn more about specific reporting requirements for any SE, please refer to your financial pages.

  
  
  
  
  
  
  
2021-2023A&D03System Management and CoordinationN/AN/A
2021-2023A&D60Start-UpStart-up expendituresVariesStart-Up Request and Expenditure Report Form
2021-2023A&D62Supported Capacity for Dependent Children whose Parents are in Adult Substance Use Disorder Residential TreatmentAccounting report of financial assistanceQuarterlySupported Capacity Report
2021-2023A&D63Peer-Delivered ServicesSummary of services deliveredQuarterlyPeer Delivered Services Report
2021-2023A&D64Housing AssistanceQuarterly reportQuarterlyHousing Assistance Quarterly Report
2021-2023A&D65Intoxicated Driver Program FundQuarterly reportQuarterlyIDPF Invoice-Report
2021-2023A&D66Community Behavioral and Substance Use Disorder ServicesSummaryAnnualReporting of services Non-Encounterable Via MOTS
2019-2021A&D66Community Behavioral and Substance Use Disorder ServicesSummaryQuarterlyOther Non-MOTS Reportable Services
2021-2023A&D71Residential Treatment Services for YouthAcute Care Payment Authorization RequestPrior to receiving fundingPayment Authorization request (Form OHA 8062)
2021-2023A&D80Problem Gambling Prevention ServicesFinal Report - Trauma-Informed CareBiennialReporting Tools for PGS Prevention Providers - Trauma Informed Care
2021-2023A&D80Problem Gambling Prevention ServicesAnnual reportAnnualReporting Tools for PGS Prevention Providers
2021-2023A&D80Problem Gambling Prevention ServicesQuarterly reportQuarterlyReporting Tools for PGS Prevention Providers
2021-2023A&D81Problem Gambling Residential ServicesReport in GPMSVariesResources for Treatment Providers
2021-2023A&D81Problem Gambling Treatment ServicesFinal Report - Trauma-Informed CareBiennialReporting Tools for PGS Prevention Providers - Trauma Informed Care
2021-2023A&D82Problem Gambling Treatment ServicesReport in GPMSVariesResources for Treatment Providers
2021-2023A&D82Problem Gambling Residential ServicesFinal Report - Trauma-Informed CareBiennialReporting Tools for PGS Prevention Providers - Trauma Informed Care
2021-2023A&D83Problem Gambling Respite TreatmentReport in GPMSVariesResources for Treatment Providers
2021-2023A&D83Problem Gambling Respite TreatmentFinal Report - Trauma-Informed CareBiennialReporting Tools for PGS Prevention Providers - Trauma Informed Care
2021-2023A&D84Problem Gambling Client Finding Outreach ServicesQuarterly reportQuarterlyProblem Gambling Client Finding Outreach Services
2021-2023MHS01System Management and CoordinationN/AN/A
2021-2023MHS04Aid and Assist Client ServicesDelivery of Restoration ServicesQuarterlyAid and Assist Combined Report
2021-2023MHS06Choice Model ServicesDelivery of servicesMonthlyChoice Model Services Monthly Data Report
2021-2023MHS07Commercial Sexual Exploitation of Children (CSEC) Residential Treatment ServicesAccounting report of financial assistanceQuarterlyCSEC Quarterly Report
2021-2023MHS08Community Crisis Services for Adults and Children(OHSU) EASA RedCap Data SystemVariesQuestions or training click here
2021-2023MHS09Jail DiversionDelivery of servicesQuarterlyJail Diversion Services Quarterly Report
2021-2023MHS10Mental Health Promotion and PreventionExpenditure and Service ReportSemi-AnnuallyMental Health Prevention and Promotion Semi-Annual Report
2021-2023MHS10Mental Health Promotion and PreventionPlanAnnualMHPP Plan
2021-2023MHS11Parent Child Interaction Therapy (PCIT)Quarterly reportQuarterlyPCIT Quarterly Report Face Sheet
2021-2023MHS11Parent Child Interaction Therapy (PCIT)Progress reportQuarterlyPCIT Data Collection Workbook
2021-2023MHS11Parent Child Interaction Therapy (PCIT)Quarterly reportQuarterlyPCIT - Early Learning Center Collaboration and Outreach
2021-2023MHS12Rental Assistance ProgramDelivery of servicesQuarterlyRental Assistance Program Quarterly Report
2021-2023MHS12Rental Assistance ProgramN/AVariesHousing Condition List
2021-2023MHS128Psychiatric Residential Treatment ServicesDelivery of servicesUpon admission to programMOTS reporting
2021-2023MHS13School-Based Mental Health ServicesSummary of services deliveredQuarterlySchool-Based Mental Health Services Report
2021-2023MHS14Tribal-Based Mental Health ServicesPlanAnnual and biennialTribal Implementation Plan
2021-2023MHS14Tribal-Based Mental Health ServicesPlanAnnual and biennialSuicide Prevention Plan and Budget Template
2021-2023MHS14Tribal-Based Mental Health ServicesNarrative reportSemi-AnnuallySuicide Prevention Report
2021-2023MHS14Tribal-Based Mental Health ServicesNarrative reportSemi-AnnuallyTribal MH Narrative Report
2021-2023MHS15Youth Adult Hub ProgramsSummary of services deliveredQuarterlyYoung Adult Hub Program Report Template
2021-2023MHS16Peer-Delivered ServicesQuarterly reportQuarterlyPeer Delivered Services
2021-2023MHS16AVeterans Peer Delivered ServicesQuarterly reportQuarterlyVeterans Peer Delivered Services
2021-2023MHS20Non-Residential Services for Youth and Young Adults in TransitionQuarterly reportQuarterlyMOTS reporting
2021-2023MHS24Psychiatric Inpatient Services - AcuteAccounting report of financial assistanceAnnualAcute Care Annual Accounting Report
2021-2023MHS25Community Crisis Services for Adults and ChildrenDelivery of Mobile Crisis ServicesQuarterlyMobile Crisis Unit Response Time Tracker
2021-2023MHS26Non-Residential Services for Youth and Young Adults in TransitionQuarterly reportQuarterlyMHS 26 Non-Residential Community MH Service for Youth and Young Adults in Transistion
2021-2023MHS26AEarly Assessment and Support Alliance (EASA)Accounting report of financial assistanceQuarterlyEASA
2021-2023MHS26AEarly Assessment and Support Alliance (EASA)Progress reportSemi-AnnuallyEASA Semi Annual Report
2021-2023MHS27Residential Services for Youth and Young Adults in TransitionSummary of services deliveredQuarterlyMHS 27 Residential Community Mental Health Treatment Service for Youth and Young Adults in Transition
2021-2023MHS28Residential TreatmentDelivery of servicesVariesMOTS reporting
2021-2023MHS28ASecure Residential Treatment FacilityDelivery of servicesVariesMOTS reporting
2021-2023MHS30Monitoring, Security and Supervision Services for Individuals under the Jurisdiction of the Adult and Juvenile Panels of the Psychiatric Security Review BoardDelivery of servicesVariesMOTS reporting
2021-2023MHS31Enhanced Care and Enhanced Care OutreachECS Data Base Part IUpon admission to programECS Data Base Part I
2021-2023MHS31Enhanced Care and Enhanced Care OutreachEnhanced Care Services Census ReportMonthlyECS Census Report
2021-2023MHS31Enhanced Care and Enhanced Care OutreachECS Data Base Part IIUpon discharge from programECS Data Base Part II
2021-2023MHS34Adult Foster CareDelivery of servicesVariesMOTS reporting
2021-2023MHS35Services for Older or Disabled AdultsFinancial summary and program narrativeQuarterlyMHS 35 Quarterly Financial Reporting Requirement
2021-2023MHS35AServices for Older or Disabled AdultsN/AN/A
2021-2023MHS35BServices for Older or Disabled AdultsN/AN/A
2021-2023MHS36Pre-Admission Screening and Resident Review Services (PASARR)AMH 0438Upon review0438 Mental Illness Screening Form
2021-2023MHS36Pre-Admission Screening and Resident Review Services (PASARR)AMH 0440Upon reviewMHS 36 0440 - Data Sumary
2021-2023MHS36Pre-Admission Screening and Resident Review Services (PASARR)SummaryUpon admission to programMHS 36 PASRR Determination Notice: Evaluation Summary and Report
2021-2023MHS37Start-UpStart-up expendituresUpon request or expenditure of fundsStart-Up Request and Expenditure Report Form
2021-2023MHS38Supported EmploymentDelivery of servicesVariesMOTS reporting
2021-2023MHS39Projects for Assistance in Transition from Homelessness (PATH)Online report on the activities conducted and services provided during the year with the funds awarded through this AgreementQuarterlyPATH Financial Report

Other contract forms and requirements

  
Corona Virus Relief Fund - Culturally Responsive Behavioral Health Services
CRF LRP Final Report Form
CRF LRP Progress Report Form
Mental Health Block Grant Adult Discretionary Funds Quarterly Report
OFSN Quarterly Reporting Form
Peer Delivered Services Facilitating Centers Report Form

 

Manuals and resources

  
ACT Fidelity Scale
Mobile Crisis Response Time FAQ
Mobile Crisis Response Time Webinar
Practice guidelines for Oregon EASA
SE Fidelity Scale

Also visit the Measures and Outcomes Tracking System (MOTS) website for:

Program Contact:
HSD Contracts Team