ຂະບວນການແກ້ໄຂບັນຫາຂອງຜູ້ໄດ້ຮັບຜົນປະໂຫຍດ
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.
ລາຍງານການຮ້ອງທຸກ ແລະ ການອຸທອນປະຈຳປີຂອງຜູ້ໄດ້ຮັບຜົນປະໂຫຍດ (ABGAR)
MHPs ຈໍາເປັນຕ້ອງໄດ້ລາຍງານໃຫ້ພະແນກບໍລິການການດູແລສຸຂະພາບປະຈໍາປີໃນວັນທີ 1 ເດືອນຕຸລາເຖິງຈໍານວນຄໍາຮ້ອງທຸກ, ການອຸທອນ, ແລະຄໍາຮ້ອງທຸກທີ່ເລັ່ງລັດທີ່ຍື່ນໃນປີທີ່ຜ່ານມາ, ແບ່ງຕາມປະເພດແລະການຈັດຕໍາແຫນ່ງ.
ເງື່ອນໄຂ ແລະເງື່ອນໄຂພິເສດ #5 ຮຽກຮ້ອງໃຫ້ລັດຈະສະໜອງໃຫ້ສູນບໍລິການ Medicare ແລະ Medicaid ລາຍງານການຮ້ອງທຸກ ແລະ ການອຸທອນປະຈຳປີພາຍໃນວັນທີ 1 ພະຈິກຂອງແຕ່ລະປີ.
The ABGAR statewide summary data is now housed on the California Health and Human Services Open Data Portal.