Grievance and Appeal Process

Clients who are dissatisfied with their services may file a complaint. Complaints are divided into two categories: informal complaints and formal complaints (grievances). Clients will not be subject to any penalty or discrimination for filing a complaint or grievance and may appeal decisions.

INFORMAL COMPLAINT


Clients are encouraged to discuss issues regarding their services directly with their case manager or service provider. Clients who cannot resolve the issue through the case manager should ask to speak to the case manager’s supervisor or program manager. Clients may call the S.O.C. Managed Care Unit or the Patient’s Rights Advocate to file an informal complaint at any time.

FORMAL COMPLAINT (GRIEVANCE)


Clients can call or write a letter to the Managed Care Unit or the Patient’s Rights Advocate to file a formal complaint at any time. The Patient’s Rights Advocacy staff is available to assist in completing the form upon request. Clients may authorize a person to act on their behalf during the formal complaint process or in the State Fair Hearings process. Clients may obtain an official complaint form at any System of Care office, Network Private Provider office, or by calling the S.O.C. Managed Care Unit. Clients will receive a written response to a formal complaint within 30 days. The decision can be appealed.

MEDI-CAL STATE “FAIR HEARINGS”


Medi-Cal beneficiaries who disagree with the denial, reduction or termination of their Medi-Cal Mental Health services have the right to file for a State Hearing at any time. Instructions on filing for a State Hearing are available on the Notice of Action forms or by calling the S.O.C. Managed Care Unit or the Patient’s Rights Advocate. For assistance for all or any of the above procedures, contact any of the following:

Patients’ Rights Advocate


(530) 886-5419

Managed Care/Quality Improvement Coordinator
(530) 886-5440

24-hour telephone number for complaint/grievance procedure information:


1-888-886-5401

Grievance Process Brochure
Grievance Form
Change of provider/request for second opinion form