GUIDE TO. Medi-Cal Mental Health Services
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1 GUIDE TO Medi-Cal Mental Health Services
2 If you are having an emergency, please call or visit the nearest hospital emergency room. If you would like additional If you are information having to an help emergency, you decide if this is please an emergency, call please or visit the nearest see the information on hospital emergency room. State of California page 6 in this booklet If you would like additional information to help you decide if this is an emergency, please see the information on State of California page 6 in this booklet. Important Telephone Numbers Emergency Colusa County... (530) Mental Health Plan (888) hours Patient s Rights Advocate... (530) Colusa Regional Center...(530) How to Get a Provider List: You may ask for, and your Mental Health Plan (MHP) should give to you, a directory of people, clinics and hospitals where you can get mental health services in your area. This is called a provider list and contains names, phone numbers and addresses of doctors, therapists, hospitals and other places where you may be able to get help. You may need to contact your MHP first, before you go to seek help. Call your MHP s 24-hour toll-free number above to request a provider directory and to ask if you need to contact the MHP before going to a service
3 provider s office, clinic or hospital for help. In What Other Languages And Formats Are These Materials Available? Este folleto (o informacion) esta disponible en Espanol. Usted puede solicitario llamando al numero de telefono gratuito mencionado anteriormente.
4 If you would like a copy of a large font handbook, a handbook in Spanish or in audio, please let the receptionist know.
5 Introduction to Medi-Cal Mental Health Services Why Did I Get This Booklet And Why Is It Important? You are getting this booklet because you are If you have trouble with this booklet, please call the MHP at (888) or (530) to ask for help or to find out about other ways you can get this important information. For TTY/TTD: 711 eligible for Medi-Cal and need to know about the mental health services that Colusa County offers and how to get these services if you need them. If you are now getting services from Colusa County, this booklet just tells you more about how things work. This booklet tells you about mental health services, but does not change the services you are getting. You may want to keep this booklet so you can read it again. If you are not getting services right now, you may want to keep this booklet in case you, or someone you know, need to know about mental health services in the future. What Is A Mental Health Emergency? An emergency is a serious mental or emotional problem such as: When a person is a danger to himself, herself, or others because of what seems like a mental illness, or When a person cannot get or use the food, shelter, or clothing they need because of what seems like a mental illness. In an emergency, please call or take the person to a hospital emergency room. Welcome to Medi-Cal Mental Health Services i
6 How Do I Use This Booklet? This booklet will help you know what specialty mental health services are, who may receive them, and how you can get help from the Colusa County MHP. This booklet has two sections. The first section tells you how to get help from the Colusa County MHP and how it works The second section is from the State of California and gives you amore general information about specialty mental health services. It tells you how to get other services, how to resolve problems, and what your rights are under the program. This booklet also tells you how to get information about the doctors, clinics and hospitals that the Colusa County MHP uses to provide services and where they are located. What is My County s Mental Health Plan (MHP)? Mental health services are available to people on Medi-Cal, including children, young people, adults and older adults in Colusa County. Sometimes these services are available through your regular doctor. Sometimes they are provided by a specialist, and called specialty
7 mental health services. These specialty services are provided through the Colusa County Mental Health Plan or MHP, which is separate from your regular doctor. The Colusa County MHP operates under rules set by the State of California and the federal government. Each county in California has its own MHP. If you feel you have a mental health problem, you may contact the Colusa County MHP directly at (888) This is a toll-free telephone number that is available 24-hours a day, seven days a week. Verbal and oral interpretation of your rights, benefits and treatments is available in your preferred language. You do not need to see your regular doctor first or get permission or a referral before you call. For TTY/TDD: 711 If you believe you would benefit from specialty mental health services and are eligible for Medi- Cal, the Colusa County MHP will help you find out if you may get mental health treatments and services. If you would like more information about specific services, please see the sections on Services on the State of California page 9 in this booklet. What If I Have A Problem Getting Help? If you have a problem getting help, please call the Colusa County MHP s 24-hour, toll-free
8 Table of Contents phone number at (888) TTY.TDD: 711 You may also call your county s Patient s Right Advocate at (530) If that does not solve your problem, you may call the State of California s Ombudsman for help: (800) CA Only (916) TTY FAX: (916) ombudsman@dmh.ca.gov You may also request a State Fair Hearing. Please see page 26 in the State of California section of this booklet for more information. Colusa County Welcome To The Colusa County Mental Health Plan... 1 Basic Emergency Information Important Telephone Numbers... 2 How Do I Know If Someone Needs Help Colusa Right Away?... County 2 ii Welcome to Medi-Cal Mental Health
9 Medi-Cal Mental Health Services What Specialty Mental Health Services Does Colusa County Provide?...2 Colusa County Mental Health Plan Services/Information How Do I Get These Services?... 3 In What Other Languages And Formats Are These Materials Available?... 3 What Does It Mean To Be Authorized To Receive Mental Health Services And What Is The Amount, Duration And Scope Of Services Provided?... 3 How Do I Get More Information About Doctors, Therapists, Clinics And Hospitals?... 4 How Do I Get A Provider List... 4 Can I See Any Doctor, Therapist, Clinic Or Hospital On The Provider List?... 4 What If I Want To Change Doctors, Therapists Or Clinics?... 4 Can I Use The Provider List To Find Someone To Help Me?... 4 What If I Want To See A Doctor, Therapist, Clinic Or Hospital That Is Not Listed On Colusa County s Provider List?... 4 What If I Need Urgent-Care Mental Health Services On A Weekend Or At Night?... 4 How Do I Get Mental Health Services That My Mental Health Provider Does Not Offer?... 5 What If I Need To See A Doctor For Something Other Than Mental
10 Health Treatment?... 5 What Can I Do If I Am Not Satisfied With My Mental Health Treatment?... 5 How Do I Contact The Patient s Rights Advocate?... 5 Does Colusa County Keep My Mental Health Records Private?... 6 State of California General Statewide Information How Do I Know if Someone Needs Help Right Away?... 1 County Mental Health Plans What Are Mental Health Services?... 2 Where Can I Get Mental Health Services?. 2 How Do I Get Services?...2 State of California
11 Medi-Cal Mental Health Services State of State of California (Continued) California Important Information About Medi-Cal Who Can Get Medi-Cal?... 3 Do I Have To Pay For Medi-Cal? How Do I Get Medi-Cal Services That Are Not Covered by the Mental Health Plan?... 4 What is the Child Health and Disability Prevention (CHDP) Program?... 5 Basic Emergency Information Are You Having an Emergency?... 6 What Kind of Emergency-Related Services Are Provided?... 7 When Does My County MHP s Responsibility for Covering Post-Stabilization Care End?... 8 Services (ADULTS AND OLDER ADULTS) How Do I Know When I Need Help?... 9 What Are Signs I May Need Help?... 9 What Services Are Available? (CHILDREN, ADOLESCENTS, AND YOUNG PEOPLE) How Do I Know When A Child Needs Help?. 12 How Do I Know When An Adolescent or Young Person Needs Help? What Services Are Available?... 13
12 Are There Special Services Available For Children, Adolescents and Young Adults? What Are Therapeutic Behavioral Services (TBS)? Who Can Get TBS? Are There Other Things That Must Happen For Me To Get TBS? How Do I Get TBS? Who Decides If I Need TBS and Where Can I Get Them? What Should Be In My TBS Plan? Medical Necessity Criteria What is Medical Necessity and Why is it so Important? What Are the Medical Necessity Criteria for Coverage of Specialty Mental Health Services Except for Hospital Services? What Are the Medical Necessity Criteria for Covering Specialty Mental Health Services for People under 21 Years of Age? Notice of Adverse Benefit Determination What Is A Notice Of Adverse Benefit Determination? When Will I Get A Notice of Adverse Benefit Determination? Will I Always Get A Notice Of Adverse Benefit Determination When I Don t Get Services I Want?... 21
13 What Will The Notice of Adverse Benefit Determination Tell Me? What Should I Do When I Get A Notice Of Adverse Benefit Determination?... 21
14 Medi-Cal Mental Health Services State of California (Continued) State of Californi Problem Resolution Processes What If I Don t Get the Services I Want From My County MHP? Can I Get Help to File an Appeal, Grievance, or State Fair Hearing? What If I Need Help to Solve a Problem with my MHP but Don t Want to File a Grievance or Appeal? (THE APPEALS PROCESSES - Standard and Expedited) What Is a Standard Appeal? When Can I File an Appeal? How Can I File an Appeal? How Do I Know If My Appeal is Resolved? 24 Is There a Deadline to File an Appeal? When Will My Appeal Be Resolved? What If I Can t Wait 45 Days For My Appeal Decision? What Is an Expedited Appeal? (THE STATE FAIR HEARING PROCESSES - Standard and Expedited) What Is a State Fair Hearing? What Are My State Fair Hearing Rights?.. 26 When Can I File For a State Fair Hearing? 26 How Do I Request a State Fair Hearing?. 26 Is There a Deadline For Filing a State Fair Hearing? Can I Continue Services While I m Waiting For A State Fair Hearing Decision?... 27
15 What If I Can t Wait 90 Days For My State Fair Hearing Decision? (THE GRIEVANCE PROCESS ) What Is a Grievance? When Can I File a Grievance? How Can I File a Grievance? Your Rights What Are My Rights? (ADVANCE DIRECTIVES) What Is an Advance Directive? (CULTURAL COMPETENCY) Why Are Cultural Considerations and Language Access Important? How Services May Be Provided to You How Do I Get Specialty Mental Health Services? How Do I Find a Provider For the Specialty Mental Health Services I Need? Once I Find a Provider, Can the MHP Tell the Provider What Services I Get? Which Providers Does My MHP Use?... 37
16 Welcome to the Colusa County Mental Health Plan We welcome you to Colusa County Mental Health Services, and to the Medi-Cal Mental Health Plan. We provide specialty mental health services for people who live in Colusa County and are eligible for Medi-Cal. Please read this booklet carefully. It contains important information you need to know. As Your Mental Health Services Plan We Will: Get answers to your questions about mental health treatment Tell you what mental health services are covered by Medi-Cal Determine what types of mental health services you need and help you get them Treat you with respect Ensure you receive services in a safe environment
17 Help you get culturally competent care As A Participant, You Also Have Specific Responsibilities: Give honest and complete information about your mental health needs Take an active part in your mental health treatment Keep your appointments as scheduled Call if you cannot keep your appointment Work on treatment goals with your provider 1 Colusa County
18 Colusa County Mental Health Plan The other services that are sometimes needed are included in the list on pages 9 (adults) and 12 (children) in the State of California section of this booklet. How Do I Know If Someone Needs Help Right Away? Even if there is no emergency, a person with mental health problems needs help right away if one or more of these things are true. Hearing or seeing things others believe are not there Extreme and frequent thoughts of, or talking about, death Giving away their things Threatening to kill themselves (suicide) Wanting to hurt themselves or others If one or more of these things is true, call 911 or the Colusa County MHP at (888) (24- hours toll free). TTY/TDD: 711. Mental Health workers are on-call 24-hours a day.
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