受益人问题解决流程
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.
年度受益人申诉和上诉报告 (ABGAR)
MHP 必须于每年 10 月 1 日向卫生保健服务部报告上一财政年度内提交的申诉、上诉和加急上诉的总数，并按类型和处置情况分类。
特殊条款和条件#5 要求州政府在每年 11 月 1 日之前向医疗保险和医疗补助服务中心提供年度申诉和上诉报告。
The ABGAR statewide summary data is now housed on the California Health and Human Services Open Data Portal.