Complaint/Grievance Process

WHAT IS THE DIFFERENCE BETWEEN A GRIEVANCE AND AN ACTION?

As a client of the Glenn County Mental Health Plan, you have a right to file a Grievance. A Grievance is an expression of dissatisfaction about any matter, other than an Action.

An Action occurs when Glenn County Mental Health does at least one of the following:

• Denies or limits authorization of a requested service, including the type or level of service;
• Reduces, suspends, or terminates a previously authorized service;
• Denies, in whole or in part, payment for a service;
• Fails to provide services in a timely manner, as determined by Glenn County Mental Health or;
• Fails to act within the timeframes for disposition of standard grievances, the resolution of standard appeals, or the resolution of expedited appeals.

If your dissatisfaction is because of one of the actions above, you will use either the Standard Appeal Process or the Expedited Appeal Process.

GRIEVANCE PROCESS

You have the right to file a grievance either orally or in writing. If you wish, you can have someone call or write for you.

• Glenn County Mental Health will write to you to let you know your grievance has been received, within 1 (one) working day after receiving your grievance.
• Glenn County Mental Health will review your grievance and write to you to let you know the decision within 60 (sixty) calendar days from the date your grievance was filed.
• The Grievance Process may be extended by up to 14 (fourteen) calendar days if you request an extension, or if Glenn County Mental Health decides that there is a need for additional information and that the delay is in your best interest.

STANDARD APPEAL PROCESS

You have the right to file an appeal either orally or in writing to request the review of an action. If you request an appeal orally, you will need to follow up with a signed written appeal. You must file an appeal within 90 (ninety) days of the date of the action you are appealing.

• Glenn County Mental Health will write to you to let you know your appeal has been received, within 1 (one) working day after receiving your appeal.
• You have the right to present evidence in person or in writing.
• You also have the right to look at your case file and any other records that pertain to your appeal before and during the appeal process.
• Glenn County Mental Health will review your appeal and write to you to let you know the decision of the appeal process and the date that the appeal decision was made, within 45 (forty-five) calendar days from the date your appeal was filed.
• The Standard Appeal Process may be extended by up to 14 (fourteen) calendar days if you request an extension, or if Glenn County Mental Health decides that there is a need for additional information and that the delay is in your best interest.
• If the decision of the appeal is not completely in your favor, the notice we will write to you will also include your right to file for a State Fair Hearing and how to do so. It will also include your right to request continued services while the hearing is pending and the process for making such a request.

You have a right to request a State Fair Hearing at any time before, during or after the appeal process has begun.

EXPEDITED APPEAL PROCESS

You have the right to file an expedited appeal either orally or in writing to request the review of an action, ONLY when using the standard resolution process could jeopardize your life, health, or ability to attain, maintain, or regain maximum function.

• Glenn County Mental Health will write to you to let you know your expedited appeal has been received, within 1 (one) working day after receiving your expedited appeal.
• Glenn County Mental Health will review your request for an expedited appeal. If Glenn County Mental Health denies your request for an expedited appeal, it will be transferred to the timeframe specified in the standard appeal process, and Glenn County Mental Health will make reasonable efforts to give you and your representative(s) prompt oral notice of the denial of the expedited appeal process, and follow up within 2 (two) calendar days with a written notice.
• If Glenn County Mental Health determines that your request for an expedited appeal meets the expedited appeal criteria, you will have the right to present evidence in person or in writing.
• You also have the right to look at your case file and any other records that pertain to your expedited appeal before and during the expedited appeal process.
• Glenn County Mental Health will review your expedited appeal and will make reasonable efforts to give you and your representative(s) prompt oral notice of the decision of the expedited appeal process. Glenn County Mental Health will also follow up with a written notice no later than 3 (three) working days after we receive your request for an expedited appeal. This notice will contain the decision of the expedited appeal process and the date that the expedited appeal decision was made.
• The Expedited Appeal Process may be extended by up to 14 (fourteen) calendar days if you request an extension, or if Glenn County Mental Health decides that there is a need for additional information and that the delay is in your best interest. If Glenn County Mental Health extends the timeframe for any extension not requested by you, Glenn County Mental Health will give you written notice of the reason for the delay.
• If the decision of the expedited appeal is not completely in your favor, the notice we will write to you will also include your right to file for a State Fair Hearing and how to do so. It will also include your right to request continued services while the hearing is pending and the process for making such a request.

You have a right to request a State Fair Hearing at any time before, during or after the expedited appeal process has begun.

WHAT IF I NEED HELP COMPLETING THE PROBLEM RESOLUTION PROCESS?

At any time, you may ask for a staff person or someone of your choice to help you. You have a right to authorize another person or your legal representative to act on your behalf. You can also ask the Patients' Rights Advocate or Ombudsman Services for help.

CONFIDENTIALITY

We want to assure you that your grievance, appeal, and/or expedited appeal will be kept confidential and will only be discussed with those directly involved in the matter. You will not be discriminated against or penalized in any way for your grievance, appeal, and/or expedited appeal.

AVAILABILITY OF INTERPRETERS

We have Spanish-speaking interpreters available during normal office hours and we utilize the AT&T Language Line for all other languages. If you are hearing impaired and use TDD, please call 1-800-952-8349.

CLIENT PROBLEM RESOLUTION GUIDE

Glenn County Mental Health
MEDI-CAL
Mental Health Plan

242 N. Villa
Willows, CA 95988
Phone: (530) 934-6582
Fax: (530) 934-6592

604 E. Walker Street
Orland, CA 95963
Phone: (530) 865-6459
Fax: (530) 865-6483

Toll-Free 24-Hour Crisis Services
Call 1-800-500-6582 during office hours,
or 1-800-507-3530 after hours, holidays, and weekends

Office Hours
8:00 a.m. - 5:00 p.m.
Monday - Friday

Patients' Rights Advocate
(530) 934-6582