Mga Proseso sa Paglutas ng Problema ng Benepisyaryo
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.
Taunang Ulat sa Karaingan at Apela (ABGAR)
Kinakailangan ng mga MHP na iulat sa Department of Health Care Services taun-taon sa ika-1 ng Oktubre ang kabuuang bilang ng mga karaingan, apela, at pinabilis na apela na inihain noong nakaraang taon ng pananalapi, na ikinategorya ayon sa uri at disposisyon.
Kinakailangan ng Espesyal na Termino at Kundisyon #5 na ibigay ng estado sa Centers for Medicare and Medicaid Services ang taunang mga ulat ng karaingan at mga apela bago ang ika-1 ng Nobyembre ng bawat taon.
The ABGAR statewide summary data is now housed on the California Health and Human Services Open Data Portal.