CAAC & CADC Reimbursement Application

Pennsylvania Certification Board Reimbursement Application

Greetings! DBHIDS and BHTEN are committed to helping our Philadelphia behavioral health provider network continue to prepare for the transition from the PCPC to the ASAM framework. As the ASAM framework is being implemented across all levels of care, we plan to support addiction’s services staff obtain accreditation such as the Certified Alcohol and Drug Counselor (CADC), Certified Associate Addictions Counselor (CAAC), Certified Peer Specialist. (CPS), and Certified Recovery Specialist (CRS). In an effort to bolster these certifications in our Philadelphia system, we will be reimbursing a limited number of staff who successfully pass the certification examination for either the CADC, CAAC, CPS, or CRS. Those that wish to be reimbursed must be employed by one of our Philadelphia providers and have completed the reimbursement application process. The reimbursement opportunity will be available over the next 3 years.
DBHIDS and BHTEN have partnered with the Pennsylvania Certification Board (PCB) to screen addiction’s services staff who may be eligible for the CADC, CAAC, CPS, or CRS certification examination. DBHIDS and BHTEN will not play any role in determining whether or not an applicant is eligible to take the exam for the respective certification. Individuals that wish to appeal a decision of eligibility, must follow the instructions listed in the decision letter.
Instructions for the DBHIDS CADC and CAAC Screening Tool:

1. You do not need to complete the form in one sitting, you can save it and return later. You will receive an email link to send you back to your draft.

2. All required fields must be completed.

3. Required attachments must be legible and signed (if necessary).

4. Applicants may only be screened for one of the certification types.

5. If questions arise during the applciation process, please email PCBScholarshipFund@gmail.com

6. This form is only for people who have already taken and passed their CAAC, CADC, CRS, or CPS exam.
FAQ: Below is a form with responses to some frequently asked questions (if you right click and open 'Save As' you can get a larger version of the document).
Information about the Applicant and Provider-
Applicant's Name *

First Name Last Name
Title *
Applicant's Address (Where the hard copy reimbursement check will be sent.) *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Applicant's Phone Number *
Applicant's Email (All correspondence will be sent to this address) *
example@example.com
Name of current provider agency that provides employment to the applicant *
What is the physical address of current provider agency that provides employment to the applicant? *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Main telephone number of the provider *

Applicant's Supervisor Information
Name of the applicant's direct supervisor *
Telephone number of the applicant's direct supervisor *
E-mail address of the applicant's direct supervisor (applicant's direct supervisor will be copied on all correspondence) *

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Information about the Applicant and Provider-

Applicant's Supervisor Information

In order to qualify for the scholarship you must have taken and passed the IC&RC ADC exam.

Acknowledgment Page