Grievance and Appeals

Board of Behavioral Sciences (BBS), Partnership, and MTM Grievance and Appeals Process

 

BBS Grievance Process:

The Board of Behavioral Sciences is a California state regulatory agency, responsible for licensing, examination, and enforcement of professional standards for:

•         Licensed Marriage and Family Therapists (LMFT) and Associates (AMFT)

•         Licensed Clinical Social Workers (LCSW) Associates (ASW)

•         Licensed Professional Clinical Counselors (LPCC) and Associates (APCC)

•         Licensed Educational Psychologists (LEP)

 

Reporting to the Board of Behavioral Sciences: As of July 1, 2020

Beginning July 1, 2020, all mental health counselors, whether licensed or unlicensed, will be required to provide a notice to each of their clients stating where they can file a complaint. (AB 630, Chapter 229, Statutes of 2019)

For new clients, therapists (whether licensed or unlicensed) are required to provide this notice prior to initiating psychotherapy services. For existing clients, provide the notice as soon as possible after July 1, 2020. This information will be available in Lassen County Behavioral Health current grievance brochure and provided to all clients before initiating services.

If you are unlicensed or unregistered with the Board but providing services within the scope of practice of Board licensees in an exempt setting (a governmental entity, a school, college, or university, or an institution that is both nonprofit and charitable), you are required to provide your clients with a notice about how to file a complaint with your agency. The fact that your setting is considered exempt is conditional upon you doing this.

The notice must be in at least 12-point font, and must be in substantially the following form:

NOTICE TO CLIENTS The (Name of office or unit) of the (Name of agency) receives and responds to complaints regarding the practice of psychotherapy by any unlicensed or unregistered counselor providing services at (Name of agency). To file a complaint, contact (Telephone number, email address, internet website, or mailing address of agency).

If you are a Board licensee or registrant, you must provide your clients with a notice in at least 12-point font, that substantially states the following:

 

NOTICE TO CLIENTS: The Board of Behavioral Sciences receives and responds to complaints regarding services provided within the scope of practice of (marriage and family therapists, licensed educational psychologists, clinical social workers, or professional clinical counselors). You may contact the board online at www.bbs.ca.gov, or by calling (916) 574-7830.

 

Partnership Grievance Process:

 

Partnership HealthPlan of California (PHC) is a non-profit community-based health care organization that contracts with the State to administer Medi-Cal benefits through local care providers to ensure Medi-Cal recipients have access to high-quality comprehensive cost-effective health care. PHC provides quality health care to over 560,000 lives. Beginning in Solano County in 1994, PHC now provides services to 14 Northern California counties - Del Norte, Humboldt, Lake, Lassen, Marin, Mendocino, Modoc, Napa, Shasta, Siskiyou, Solano, Sonoma, Trinity and Yolo.

 

How to File a Grievance or Appeal

By Phone:

1-800-863-4155

You may file an appeal or grievance by calling us at the number above. Our Member Services department is also available if you have any questions about the grievance process. Bilingual staff is available. PHC uses an interpreter service for members who speak other languages.

By Fax:

You may fax your Grievance or Appeal to: 1-707-863-4351

By Mail:

You may file you Grievance or Appeal by mailing it to the following address:

Partnership HealthPlan of California

4665 Business Center Drive

Fairfield, CA 94534

Attention: Grievance and Appeals Dept.

Online:

You may file your grievance online: http://www.partnershiphp.org

In Person:

You may file your Grievance or appeal in person at the following locations:

Fairfield: 4665 Business Center Drive, Fairfield, CA

Redding: 3688 Avtech Parkway, Redding, CA

 

If you have already filed an Appel

 

State Fair Hearing Information:

 A State Hearing is when a member requests an Administrative Law Judge (ALJ) to review PHC’s decision because they are still unhappy. The ALJ will review laws, PHC Policy, testimony, and evidence, then issue a new decision.

 

How to File a State Fair Hearing:

By Mail:

California State Department of Social Services State Hearing Division

PO Box 944243, Mail Station 09-17-37

Sacramento, CA 94244-2430

By Phone:

1-800-952-5253

Hearing Impaired members may use TTY/TDD by calling 1-800-952-8349

By Fax:

1-916-651-5210 or 1-916-651-2789

In Person:

You can turn in a Hearing request form or your own written request at one of the local County offices

 

 

 

MTM Grievance Process:

 

MTM is a healthcare and transportation management company whose mission is to partner with clients in developing innovative solutions for accessing healthcare, increasing independence, and connecting community resources in the most cost-effective manner. To achieve this, we leverage our core competencies in managing customer service operations and building provider networks.

How to File a Complaint or an Appeal

There are two types of grievances; complaint and an appeal. You have the right to file a complaint or an appeal on any issue that is regarding your Medi-Cal benefit. Your grievance must explain your issue and why you disagree with a decision made by PHC, one of its providers, or if you are not happy with the service you received. Please note that PHC does not handle issues about your Medi-Cal eligibility. For eligibility issues contact your County Eligibility Worker.

Grievance Process

A grievance is an expression of dissatisfaction. Grievances can be filed by telephone, in writing, in person, filed through a contracted provider and through PHC website http:www.partnershiphp.org.

Processing your Grievance

PHC will send you an acknowledgment letter within five (5) calendar days of the date of receiving your grievance. You can contact the PHC grievance staff to discuss your grievance. PHC will send you a written resolution to your grievance within thirty (30) days from receiving your grievance. If you file an appeal, PHC will make every effort to resolve your appeal within thirty (30) calendar days. However, if there is some reason this is not possible, you will be notified by letter that additional time is required. PHC will then send you a written resolution within an addition fourteen (14) calendar days. If you are not satisfied with our resolution, you may request a State Hearing. Please note, you must file a grievance through PHC. You have the right to file a State Hearing if you disagree with the resolution made by PHC. You may file a State Hearing after receiving resolution from PHC.

Expedited Review Request

If you feel that a delay in processing your grievance through the standard timeframe would create a serious threat to your health, including but not limited to severe pain, potential loss of life, limb or major bodily function, you can call PHC’s Member Service Department at 800-863-4155 and request an expedited grievance.

Timeframes for Submission

You can file your complaint anytime following any incident or action in which you were dissatisfied. You must file an appeal within sixty (60) calendar days from the date of the notice of action.

To File a State Hearing

There are four ways to request a State Hearing. By telephone (800) 952-5253 TDD (800)-952-8349, by mail California State Department of Social Services State Hearing Division P.O. Box 944243 Mail Station 9-17-37 Sacramento, CA 94244-2430 by fax (916) 651-5210 or (916) 651-2789 or by filing in person at your local county office. For more information, please refer to your member handbook section 5.

Authorized Representative

Authorized representative forms are required for grievances filed for members over the age of 18.

Your Rights

To learn more about your rights and the grievance process, please call Member Services at (800) 863-4155.

Contact Information: 

Contact Information

Lassen County Behavioral Health
555 Hospital Lane
96130 Susanville , CA
Substance Use Disorder Program
1400 Chestnut Street Suite A
96130 Susanville , CA
Mon - Fri:
8:00 am-5:00 pm
Sat - Sun:
Closed
Crisis Line: Toll free 24-Hour
Fax
(530) 251-8394