Grievance and Appeal Process

Problem Resolution

Behavioral Health Services are overseen by a committee of system partners, family members, advisory board members, and County staff to ensure high-quality care. We encourage informal resolution of issues whenever possible. There are no penalties or discrimination for filing a complaint, grievance, or requesting a State Fair Hearing. Individuals may authorize a representative to act on their behalf at any time.


Please use the links below to access our Problem Resolution Guide

Member Rights & Problem Resolution Guide 

Member Rights and Problem Resolution Guide Spanish

Grievance

Grievance  is an expression of dissatisfaction about any matter other than an Action. Individuals are encouraged to discuss issues related to their behavioral health services directly with their healthcare provider. Every effort will be made to resolve the issue at an informal level. Individuals may file a grievance regarding unhappiness with the provision of behavioral health services by notifying the Patient’s Rights Advocate, a staff member of Sierra County Behavioral Health, or by completing the Grievance and Appeal Form. The member may obtain a grievance and appeal form in the Loyalton and Downieville waiting rooms or by calling the Sierra County Compliance Officer. The member will receive a written response postmarked within five (5) calendar days from receipt of the grievance, acknowledging receipt of the grievance.
  • A member, a provider and/or authorized representative, may file a grievance either orally or in writing to Member Services.
  • If a member requests a provider or authorized representative to file a grievance on their behalf a written consent will be required.
  • The member will receive a written resolution within 30 calendar days.

Shanna Kuhlemier
QAQI Compliance Officer
530-993-6717

Standard Appeal

An Appeal is a request to review an Action.  An Action occurs when previously authorized services are denied, reduced, suspended, or terminated; when payment is denied for a service; when services are not provided in a timely manner; or the County fails to act within the timeframes for the disposition of grievances, standard appeals, or expedited appeals.
  • A member, or a provider and/or authorized representative, may request an appeal either orally or in writing within 60 calendar days from receiving an Adverse Benefit Determination.
  • If a member request a provider or authorized representative to file an appeal on their behalf, a written consent will be required.
  • An appeal must be filed within 60 days of the date of the Action.
  • The member will receive a written resolution within 30 calendar days.

Expedited Appeal

An Expedited Appeal is filed when the standard appeal process could jeopardize the member’s life, health, or ability to have or maintain maximum function is at risk.
  • The member will receive written notice of the resolved appeal within 72 hours of Sierra County receipt of the request for expedited resolution. Sierra County will make reasonable efforts to provide oral notice to the member of the resolution.
  • If the expedited appeal is denied, a written notice will be sent to the member, and the standard appeal process will begin. 
  • Members will receive a written response postmarked within five (5) calendar days from receipt of the appeal, acknowledging receipt of the appeal.

Grievance and Appeal Form English

Grievance and Appeal Form Spanish

State Fair Hearing

 Medi-Cal members have the right to file for a State Fair Hearing. The member must exhaust the Appeal process prior to filing for a State Fair Hearing. The member may only request a State Fair Hearing after receiving a notice from Sierra County that the Adverse Benefit Determination has been upheld. The concerns within the jurisdiction of the Administrative Law Judge are those related to an Adverse Benefit Determination.

  • The members may request a State Fair Hearing within 120 calendar days from the date of the Adverse Benefit Determination.
  • The member will be notified of a resolution within 90 calendar days of the date of the request for the State Hearing.
  • For expedited resolution, the member will be notified of an expedited resolution within three (3) business days of the date of the request for the State Hearing.
Member Services
Call 530-886-2925 (TTY: 711/1-800-855-7400) 24 hours, 7 days a week, toll-free phone number
or
Patient Rights Advocate
The Patient’s Rights Advocate is available for consumers and families to help resolve issues and respond to grievances/complaints about behavioral health services. Clients will not be subject to any penalty or discrimination for filing a complaint/grievance and may appeal decisions.
Phone: (530) 886-5419
Managed Care/Quality Improvement Coordinator
(530) 886-5440
24 hour telephone number for complaint/grievance procedure information
(888) 886-5401
Mental Health Services Act Issue Resolution Process

Sierra County's Behavioral Health Department's Mental Health Services Act has a system for community members and stakeholders to resolve concern or grievances regarding the activities of the Mental Health Services Act (MHSA).

Mental Health Services Act Issue Resolution Process

Change of provider/request for second opinion form English

  1. Am I eligible for services at Sierra County Behavioral Health?
  2. What do I do if I am in a crisis?
  3. Who can see my chart?