受益者問題解決プロセス
In accordance with Title 9, California Code of Regulations, Chapter 11, Subchapter 5, and the Mental Health Plan Contract, Mental Health Plans (MHP) must have problem resolution processes that enable a beneficiary to resolve a problem or concern about any issue related to the MHP’s performance, including the delivery of specialty mental health services.
Each MHPs beneficiary problem resolution process must include a system to receive and resolve beneficiary grievances, appeals, expedited appeals, and State Fair Hearings. The MHPs process must meet State and Federal requirements outlined in MHSUDS Information Notice 18-010E.
If a beneficiary disagrees with the MHP’s appeal or expedited appeal decision, the beneficiary may request a State Fair Hearing, or an Expedited State Fair Hearing.
年次受益者苦情および上訴報告書(ABGAR)
MHPは、毎年10月1日に、前会計年度に提出された苦情、不服申し立て、および迅速な不服申し立ての総数を、種類と処分ごとに分類して、医療サービス省に報告する必要があります。
特別条件#5は、州が毎年11月1日までに、メディケアおよびメディケイドサービスセンターに年次苦情および上訴報告書を提供することを要求しています。
The ABGAR statewide summary data is now housed on the California Health and Human Services Open Data Portal.