Complaint/Grievance Process

Grievance, Appeal and State Fair Hearing Processes

There are different ways in which you can let the Mental Health Plan know about your concerns or problems. You can file:

A Grievance, An Appeal, and a request for a State Fair Hearing

Here are the steps to follow for each type:

• Grievance Process. A grievance is an oral or written expression of your dissatisfaction about any matter other than an Action (as action is defined).

Grievance forms, as well as envelopes already addressed to the Access Unit, are available at all Mental Health Plan sites in locations where you may obtain them without asking a staff member. If you have a question about completing the grievance form, you may contact either your fee-for-service provider or the clinic supervisor at the clinic where you receive mental health services. You may also fill out a grievance form and send it directly to the Access Unit without speaking to anyone about your concern. You can telephone the Access Unit at (888) 743-1478 and give you grievance verbally.

Your grievance is reviewed and a decision is made by the Access Unit within 60 calendar days of the receipt of your grievance. An extension of up to 14 days may be extended if the beneficiary requests it or the MHP determines that there is a need for additional information that the delay is in the beneficiaries' interest.

• Appeal Process. An appeal is an oral or written request for review of an action (as action is defined).

Appeal forms, as well as envelopes already addressed to the Access Unit, are available at all Mental Health Plan sites in locations where you may obtain them without asking a staff member. Your appeal will be reviewed and a decision made by the Access Unit within 45 calendar days of its receipt. An extension of up to 14 days may be extended if the beneficiary requests it or the MHP determines that there is a need for additional information that the delay is in the beneficiaries' interest. An expedited review process for appeals will take place if the MHP determines, or the beneficiary and /or provider requests that taking the time for a standard resolution could seriously jeopardize the beneficiary's life, health or ability to function. The expedited process will notify the parties no later than 3 working days after the MHP has received the appeal.

• Request for a State Fair Hearing. If you are a MediCal beneficiary, you may request a State Fair Hearing if you have received an Action (as action is defined).

If you are currently receiving mental health services and have received a Notice of Action letter which denies, reduces or terminates those services, and if you request a State Fair Hearing within 10 days of receipt of the Notice of Action, it may be possible to maintain the same level of services pending the outcome of the State Fair Hearing. Beneficiaries will be required to exhaust the MHP's problem resolution process prior to filing for a state fair hearing.

A beneficiary may file an appeal or state fair hearing whether or not a Notice of Action (NOA) has been issued.

To request a State Fair Hearing, please call toll-free or write to:

Public Inquiry and Response
744 "P" Street, M. S. 19-37
Sacramento, CA 95814
Telephone: (800) 952-5253
TDD: (800) 952-8349
Effective July 1, 2005:
Beneficiaries will be required to exhaust the MHP's problem resolution process prior to filing for a state fair hearing. A beneficiary may file an appeal or state fair hearing whether or not a Notice of Action (NOA) has been issued.