Grievance and Appeal Procedure

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Grievance Procedure

We encourage you to discuss concerns about mental health services with your therapist or program staff.  You may talk to the Quality Management Coordinator at 559.673.3508 or 888.275.9779; or call the California Department of Health Care Ombudsman at 800.896.4042; or TTY800.896.2512 or email MHOmbudsman@dhcs.ca.gov.

Grievance forms and pre-addressed envelopes are available in the reception area of all clinics and provider office or is available by Click here for English Version or Click here for Spanish Version

You may designate someone to act on your behalf at any time.

Appeal Procedure

If you wish to appeal an "Action" by the Mental Health Plan (MHP), you may call the Quality Management Coordinator at 559.673.3508 or 888.275.9779 toll free.  An "Action" is when the MHP:

  • Denies or limits authorization of a requested service.
  • Reduces, suspends, or terminates a previously authorized service.
  • Denies, in whole or in part, payment for a service.
  • Fails to act within the timeframes for disposition of standard grievances, the resolution of standard appeals, or
  • The resolution of expedited appeals.
  • Fails to provide services in a timely manner, as determined by MHP.

An Expedited Appeal may be used when a decision must be made quickly to protect the beneficiary's life, health, or ability to function at a maximum level.

Beneficiaries have a right to request a State Fair Hearing after the Appeal process has been completed.  You may contact the State Ombudsman to assist in filing for a State Fair Hearing.  All State Fair Hearing decisions are final.  An appeal form is available Click here for English Version or Click here for Spanish Version

YOUR MENTAL HEALTH SERVICES WILL NOT BE AFFECTED IN ANY WAY, NOR WILL YOU BE SUBJECT TO ANY PENALTY, BY FILING A GRIEVANCE OR AN APPEAL.